From the Guidelines
For a patient with no symptoms and a history of a sexual partner with Herpes Simplex Virus (HSV) infection, serologic testing for HSV-2, specifically HSV IgG, is the most appropriate screening test. This recommendation is based on the patient's increased epidemiologic risk due to sexual activity with a partner with genital HSV-2 infection, as noted in the 2022 study published in Clinical Infectious Diseases 1.
Key Considerations
- The USPSTF recommends against screening for HSV-2 infection among asymptomatic adolescents and adults with low pretest probability of infection, but this patient's history of exposure to an infected partner increases their risk, making screening reasonable 1.
- Serologic testing, such as HSV IgG, can identify undiagnosed symptomatic infection and provide valuable information about infection status and potential risk for future recurrences or transmission to partners, even in asymptomatic individuals.
- Other screening methods, such as HSV PCR, are only useful during active lesions and would not be appropriate for this asymptomatic patient.
Screening Approach
- The goal of screening in this context is to identify undiagnosed infection and provide counseling about the chronic nature of HSV infection and preventive measures if the test is positive.
- Given the current limitations of commercially available serologic tests, a positive result would indicate past infection and the need for further counseling and potential management strategies.
- It is essential to consider the patient's epidemiologic risk factors, such as sexual activity with a partner with genital HSV-2 infection, when deciding on the appropriate screening approach 1.
From the Research
Screening Test for Herpes Simplex Virus (HSV) Infection
- For a patient with no symptoms and a history of a sexual partner with Herpes Simplex Virus (HSV) infection, the appropriate screening test is type-specific serologic testing based on glycoprotein G 2.
- This test is recommended to establish the diagnosis of HSV infection when no active lesion is present 2.
- Type-specific serologic testing can help distinguish between HSV-1 and HSV-2 infections, which is important for prognosis and counseling 2, 3.
- The test can be useful in confirming the diagnosis in patients with a partner with genital herpes and in individuals with genital complaints suggestive of herpes 3.
- However, routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons, is not recommended due to the potential for false-positive results and psychosocial harms 4, 5.
Key Considerations
- The US Preventive Services Task Force (USPSTF) recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons 5.
- The accuracy of screening tests, benefits of screening, and harms of screening should be considered when deciding on a screening test for HSV infection 4.
- Type-specific serologic testing should be recommended for the management of couples where one has genital herpes and the other apparently does not, and in individuals with genital complaints suggestive of herpes 3.