From the Guidelines
A positive HSV-1 test result indicates that the patient has been infected with the virus at some point in their life, but it does not necessarily mean they have an active outbreak or current infection. The interpretation of the test result depends on the type of test performed, with antibody tests detecting HSV-1 antibodies that remain indefinitely after infection, and viral culture or PCR tests indicating a current, active infection 1. If the patient has a positive antibody test but no symptoms, they likely have a latent infection that may or may not cause future outbreaks. Many people with HSV-1 never experience symptoms despite testing positive, and the virus can reactivate periodically throughout life. It's essential to note that HSV-1 can cause both oral and genital herpes, and a positive test result does not necessarily mean the patient has genital herpes. The patient's medical history, symptoms, and physical examination should be taken into account when interpreting the test result. Antiviral medications like acyclovir, valacyclovir, or famciclovir may be beneficial in managing symptoms and reducing the frequency of outbreaks, but they do not eradicate the virus from the body 1. Some key points to consider when interpreting HSV-1 test results include:
- The type of test performed (antibody, viral culture, or PCR)
- The patient's medical history and symptoms
- The possibility of latent infection
- The potential for future outbreaks
- The importance of antiviral medication in managing symptoms and reducing outbreak frequency. The most recent and highest quality study on this topic, published in 2022, provides guidance on the diagnosis and management of genital herpes, including the use of type-specific serologic assays and nucleic acid amplification tests (NAATs) 1.
From the Research
Herpes Simplex Virus 1 (HSV-1) Infection
A positive Herpes Simplex Virus 1 (HSV-1) test result indicates that the patient has been infected with HSV-1 at some point in their lives. This infection can cause a range of symptoms, including:
- Cold sores or fever blisters on the lips, mouth, or around the oral area 2, 3
- Mucocutaneous vesicular eruptions, particularly in children 3
- Herpetic gingivostomatitis, which affects the tongue, lips, gingival, buccal mucosa, and the hard and soft palate 3
- Recurrent infections, which can occur at variable intervals and typically give rise to vesiculo-ulcerative lesions at mucocutaneous junctions, particularly the lips (herpes labialis) 3, 4
Current or Past Infection
It is essential to note that a positive HSV-1 test result does not necessarily indicate a current infection. The virus can remain latent in the body, and the patient may not exhibit any symptoms 2. The test result only confirms that the patient has been infected with HSV-1 at some point in their lives.
Diagnosis and Treatment
The diagnosis of HSV-1 infection can usually be based on the clinical history and presenting features 3. However, confirmatory laboratory diagnosis is required when patients are or may be immunocompromised. Treatment options are available, including antiviral medications like acyclovir, which can help manage symptoms and reduce the risk of transmission 2, 5.
Test Performance
The performance characteristics of HSV-1 and HSV-2 IgG testing have been evaluated in several studies. The results show that some commercial assays have low sensitivity and specificity for detecting HSV-1 IgG, while others have high sensitivity and specificity for detecting HSV-2 IgG 6. Therefore, it is crucial to choose a reliable testing method to ensure accurate diagnosis and treatment.