What's the best test for HSV-2 after exposure?

John Heintzman, Bruin Rugge, Dolores Zegar Judkins

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

Our literature search failed to find any randomized controlled trials comparing diagnostic tests for HSV-2 infection among asymptomatic populations. Data from cross-sectional studies, however, are available. Glycoprotein G ELISA has better specificity: Using the Western blot technique as the gold standard, a total of 158 serum samples from patients with either HSV-1 or HSV-2 infection-without mention of symptomatology-were used to compare the performance of several commercially available ELISA assays. The glycoprotein G and non-glycoprotein G ELISA tests were both found to have sensitivities >90%, but the non-glycoprotein G ELISA tests had specificities under 90%. In 47% to 82% of the samples tested with non-glycoprotein G ELISA, there was cross-reactivity between HSV-1 and HSV-2 antibodies. The College of American Pathologists found that 46% to 84% of laboratories using non-glycoprotein G ELISA tests incorrectly identified an HSV-1 sample as being HSV-2. All laboratories reporting use of glycoprotein G ELISA tests correctly identified the sample as containing only HSV-1 antibodies. Neither study included controls, delineated symptom status, or measured patient-oriented outcomes. Genital culture has poor sensitivity: A prospective cohort study compared the viral shedding by Western blot among 52 asymptomatic seropositive patients with 90 seropositive and symptomatic patients. Daily genital swabs were done for 3 months for each patient. The asymptomatic individuals had HSV-2 positive cultures on 3% of culture days. Genital culture appears to have a very poor sensitivity (5%) for diagnosis of HSV-2 infection among asymptomatic individuals. We found no studies that measured patient-oriented harms or benefits arising from testing asymptomatic individuals for HSV-2 infection. Recommendations from others: The USPSTF recommends against routine serological screening for HSV in asymptomatic adolescents and adults (D recommendation, fair or good evidence that the service is ineffective or that the harms outweigh the benefits). The California Sexually Transmitted Diseases Controllers Association recommends that serologic testing is likely to benefit HIV-infected patients, those whose sexual partners have genital herpes, and those at high risk of STDs motivated to reduce their sexual risk behavior.

Original languageEnglish (US)
Pages (from-to)221-222
Number of pages2
JournalJournal of Family Practice
Volume56
Issue number3
StatePublished - Mar 1 2007

ASJC Scopus subject areas

  • Family Practice

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