Diagnosis of genital herpes: the role and place of HSV testing in clinical practice

Abstract

Genital herpes is caused by herpes simplex virus (HSV)-1 and HSV-2. It is an underdiagnosed and undertreated sexually transmitted infection characterised by latency followed by reactivation. The seroprevalence of both types of HSV varies throughout Europe, and HSV-1 is an increasing cause of genital herpes. Transmission is through skin-to-skin contact, and neonatal herpes resulting from transmission during delivery is a particularly serious problem. Diagnosis of genital herpes is not straightforward, and a clinical diagnosis alone is usually insufficient. Correct diagnosis is essential for appropriate management and reduction of transmission. Laboratory diagnosis can be by direct detection of the virus or indirect measurement of antibodies. Direct testing has traditionally been through culture of the virus, but detection of viral nucleic acids by real-time polymerase chain reaction is now considered the gold standard method. Type-specific serological testing based on glycoprotein G also has a role in asymptomatic patients or those with non-specific symptoms and in identifying serodiscordant couples, pregnant women at risk and patients co-infected with HIV and HSV-2. Having made an accurate diagnosis, effective management of genital herpes is by treatment with an oral antiviral agent and patient counselling.