What tests should be ordered for a possible Herpes Simplex Virus (HSV) skin lesion on the mons pubis?

From the Guidelines

For a suspected HSV skin lesion on the mons pubis, the most appropriate test to order is a nucleic acid amplification test (NAAT) or polymerase chain reaction (PCR) diagnostic assay, which has a sensitivity and specificity of >90% 1. When diagnosing genital herpes, it is essential to use assays that differentiate between HSV-1 and HSV-2 infection to provide patients with information regarding the expected natural history of genital herpes.

• Key points to consider when ordering tests for suspected HSV skin lesions include:
  • NAAT/PCR assays are preferred over viral culture due to their higher sensitivity and specificity 1.
  • Viral culture can be used if NAAT/PCR is not available, but it is less sensitive and may require further investigation with serology if results are negative 1.
  • Type-specific serologic assays can be used to diagnose HSV-1 and HSV-2 infection, but they have limitations, including lack of sensitivity for HSV-1 and specificity for HSV-2 1.
  • The gold standard for HSV serologic testing is Western blot/immunoblot assays, which target antibodies to several HSV antigens 1.
• When collecting a sample for testing, it is crucial to swab an active lesion, preferably one that is vesicular rather than crusted, to increase the likelihood of obtaining accurate results.
• If the lesion appears atypical or diagnosis remains uncertain after testing, a skin biopsy may be considered to confirm the diagnosis and guide appropriate treatment.
• The diagnosis of HSV infection is crucial in guiding appropriate treatment, typically with antiviral medications, and preventing complications and transmission to others.

From the Research

Diagnostic Tests for HSV Skin Lesion on Mons Pubis

To diagnose a possible HSV skin lesion on the mons pubis, the following tests can be ordered:

• Viral culture: This test involves taking a sample from the lesion and attempting to grow the virus in a laboratory setting 2
• Polymerase chain reaction (PCR): This test involves taking a sample from the lesion and using PCR to detect the presence of HSV DNA 3, 2
• Serological tests: These tests involve measuring the levels of antibodies against HSV in the blood, but are not as specific as viral culture or PCR for diagnosing a current infection

Considerations for Testing

When ordering tests for a possible HSV skin lesion on the mons pubis, consider the following:

• Turnaround time: PCR testing has been shown to have a faster turnaround time than viral culture, with 68.4% of tests being reported in less than 24 hours 2
• Cost: The cost of PCR testing and viral culture may vary, but PCR testing has been shown to be a cost-effective option for diagnosing genital herpes 2
• Sensitivity and specificity: Viral culture and PCR are both sensitive and specific tests for diagnosing HSV infections, but PCR is more sensitive than viral culture 3, 2

Treatment Options

If the test results confirm an HSV infection, treatment options include:

• Antiviral medications such as acyclovir, valacyclovir, and famciclovir 4, 5
• Suppressive therapy to reduce the frequency and severity of outbreaks 3, 5