Herpes simplex antibody testing
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.
HSV Antibody Testing Recommendations
- Testing for HSV type-specific antibodies can be used to diagnose HSV infection in asymptomatic persons.
- HSV-2 antibodies are indicative of genital herpes. HSV-1 antibodies do not differentiate between genital and oropharyngeal infection.
- Arguments in favour of serological screening include:
- HSV-2 infection rates are as high as or higher than those of other sexually transmitted infections for which screening is in place.
- Persons with asymptomatic or undiagnosed infection may transmit HSV to sexual partners or neonates.
- Behavioural changes, condom use and suppressive antiviral therapy reduce the risk of HSV transmission.
- Vaccines may soon become available to protect HSV seronegative persons from infection and disease.
- HSV-2 seropositive persons who engage in high-risk sexual behaviour can be counselled about the increased risk of HIV acquisition
- Arguments against screening include:
- The specificity and sensitivity of current antibody assays are less than 100%.
- False-positive results generate unnecessary psychological morbidity.
- False-positive and false-negative results lead to inappropriate counselling.
- Counselling of HSV-2 seronegative HSV-1 seropositive persons is problematic, given the large proportion of GH due to HSV-1.
- Assays should be used that detect antibodies against the antigenically unique glycoproteins gG1 and gG2.
- Western blot (WB) is the diagnostic gold-standard. It is >97% sensitive and >98% specific, but is labour-intensive and not commercially available.
- Several commercial assays have become available. Among commercial assays, the HerpeSelect-1 and HerpeSelect-2 enzyme-linked immunosorbent assay (ELISA) immunoglobulin G (IgG). HerpeSelect 1 and 2 Immunoblot IgG have been approved by the American Food and Drug Administration.
- In sexually active adults, sensitivity and specificity of ELISA relative to WB are 91% and 92% for HSV-1 and 96% and 97% for HSV-2. Immunoblot sensitivity and specificity are 99% and 95% for HSV-1 and 97% and 98% for HSV-2.
- HSV seroprevalence rates in the local population and the presence or absence of risk factors for genital herpes influence the positive predictive value of HSV type-specific antibody assays. Local epidemiological data and patient demographic characteristics should guide testing and result interpretation.
- In patients with a low likelihood of genital herpes, a positive HSV-2 result should be confirmed in a repeat sample or by using a different assay.
- Type-specific antibody can take months to develop and false-negative results may occur early after infection. In first episode disease the diagnostic use of type-specific antibody testing will require follow-up samples after 3 months to demonstrate seroconversion.