From the Guidelines
There is no recommended routine screening method for herpes simplex virus (HSV) infection in individuals at high risk of sexually transmitted diseases. Unlike other STDs such as chlamydia or gonorrhea, the CDC and other major health organizations do not recommend routine HSV screening, even in high-risk populations. Testing is instead recommended when a person has symptoms suggestive of herpes, such as genital sores or lesions. When testing is clinically indicated, the preferred diagnostic method is nucleic acid amplification testing (NAAT) or PCR of lesion material, which can detect and type the virus 1.
Key Considerations for Screening
- Type-specific serologic tests can be considered in certain situations, such as for patients with recurrent genital symptoms without a confirmed diagnosis, partners of people with genital herpes, or those seeking a complete STD evaluation.
- However, these blood tests have limitations including false positives, inability to determine infection site, and potential psychological harm from a positive result without symptoms.
- The lack of routine screening recommendations stems from several factors: no evidence that screening asymptomatic individuals reduces transmission, absence of a cure, and potential psychological distress from diagnosis without clear clinical benefit.
Diagnostic Methods
- Nucleic acid amplification testing (NAAT) or PCR of lesion material is the preferred diagnostic method when testing is clinically indicated.
- HSV culture is less sensitive than NAAT/PCR and should only be used if NAAT/PCR is not available.
- Type-specific serologic assays can be used to diagnose HSV-1 and HSV-2 infection, but have limitations including false positives and false negatives 1.
Clinical Implications
- The diagnosis and management of genital herpes should be based on clinical judgment and patient-specific factors.
- Patients with symptoms suggestive of herpes should be tested and treated accordingly.
- Patients with recurrent genital symptoms without a confirmed diagnosis should be considered for type-specific serologic testing.
- Partners of people with genital herpes should be considered for type-specific serologic testing and counseling on prevention and transmission reduction strategies 1.
From the Research
Screening Measures for Herpes Infection
The recommended screening methods for herpes simplex virus (HSV) infection in individuals at high risk of sexually transmitted diseases (STDs) include:
- Type-specific serologic tests based on glycoprotein G to establish the diagnosis of HSV infection when no active lesion is present 2
- Polymerase chain reaction (PCR) for symptomatic cases, as it has a higher rate of HSV detection compared to viral culture 2, 3
- Herpes simplex virus type-specific serological tests for asymptomatic patients who are at high risk for STDs and human immunodeficiency virus (HIV) infection, HIV-infected patients, and patients with sex partners with genital herpes 4
- Type-specific serology (TSS) for patients with genital lesions in whom antigen detection, culture, or PCR fail to detect HSV, and for patients who are asymptomatic but have a history suggestive of genital herpes 3
Target Populations for Screening
Screening for HSV-2 infection is likely to be beneficial among the following groups:
- Those at high risk for STDs and HIV infection who are motivated to reduce their sexual risk behavior 4
- HIV-infected patients 4
- Patients with sex partners with genital herpes 4
- Asymptomatic pregnant women whose partners have a history of genital herpes or HIV infection 3
- Women contemplating pregnancy or considering sexual partnership with those with a history of genital herpes 3
Laboratory Methods
Laboratory methods for diagnosing genital herpes include: