Type-specific Serology Research Articles

Herpes in Pregnancy

AbstractHerpes simplex virus infection (predominantly HSV2) in pregnancy can be a cause of maternal morbidity. The more serious cause of concern is perinatal transmission of infection resulting in neonatal morbidity and mortality. Genital HSV infection can be primary, non-primary first episode or recurrent infection. Clinical and laboratory diagnosis in pregnant women is similar to non-pregnant women. Direct viral testing (PCR) from lesion's and type specific serology are required to classify type of infection. Vertical transmission occurs during labor and delivery. The risk is higher in primary and non-primary first episode near the time of delivery. Antiviral treatment with Acyclovir or Valacyclovir is recommended for acute episode to reduce lesion duration and viral shedding. Acyclovir as suppressive therapy from 36 weeks onwards reduces clinical recurrences and need for caesarean delivery. Caesarean section reduces but does not eliminate the risk of vertical transmission and is recommended for a woman has an acute infection episode at the time of labor or within 6 weeks before delivery. Clinical management of preterm premature rupture of membranes in a woman with HSV infection should be individualized. All neonates born to these mothers should be carefully handled and monitored for development of neonatal herpes.

P229 Hsv management in pregnancy at a joint antenatal-genitourinary clinic in a large maternity hospital in dublin, ireland – a model of care

IntroductionThe ultimate goal of HSV management in pregnancy is to prevent perinatal transmission and, where possible, to facilitate vaginal delivery.MethodsData was collected from antenatal charts of 107 women who reported a history of HSV or who had a documented outbreak during that pregnancy. Descriptive column statistics were used in excel for data analysis.ResultsFrom May 2013 to Feb 2017, 107 Women were seen in the clinic for management of HSV in 108 pregnancies. Median gestation at referral (82/108) was 23/40 (range 2–39/40). Mean age 33yr (range 18–45). 91 (85%) European. 9(8%) HIV+. 82 (76%) reported prior history. 96 (89%) had type-specific serology sent of which 89 (92%) HSV IgG +ve. 28 (31%) HSV 1 & 2 positive, 47 (52%) Type I positive only, 12 (13%) Type 2 positive only, 2 were weak + and not typed. 69 (63%) had STI testing, 100% negative. 4 of the 107 (80%) had primary HSV in that pregnancy. 67 received HSV prophylaxis; 66 valaciclovir; 1 aciclovir. Mean gestation starting prophylaxis was 36/40 (range 20 – 39). Data on mode of delivery on 82 of 107 (76%) pregnancies; 59 (71%) vaginal, 24 (29%) lower segment caesarean sections, none for HSV. Median gestation at delivery of 84 pregnancies 39/40 (range 29 – 41). To date no cases of perinatal HSV transmission have been reported.DiscussionThere is good compliance with Irish guidelines on HSV management in pregnancy. HSV2 remains an issue. This combined clinic facilitates good compliance with standard guidelines for HSV management in pregnancy. This model of care should be available across all antenatal settings.

Re-detection vs. new acquisition of high-risk human papillomavirus in mid-adult women.

To understand high-risk (hr) human papillomavirus (HPV) epidemiology in mid-adulthood, we assessed whether associations between incident detection of hrHPV DNA and recent sexual behavior differed according to whether or not there was serologic evidence of prior infection. From 2011 to 2012, we enrolled 409 women aged 30-50 years into a 6-month longitudinal study. We collected health and sexual behavior histories, enrollment sera for HPV antibody testing, and monthly self-collected vaginal swabs for HPV DNA genotyping. Generalized estimating equations logistic regression identified risk factors for type-specific incident hrHPV DNA, stratified by type-specific hrHPV serostatus at enrollment. Population attributable risks of hrHPV due to prior and recent exposure were estimated. When type-specific hrHPV serology was negative, recent sexual risk behavior was positively associated with incident hrHPV DNA (odds ratio in women reporting ≥3 recent sexual risk behaviors [e.g., new or multiple partners] vs. no recent sexual activity = 9.8, 95% CI: 2.4-40.6). No associations with recent sexual behavior were observed with positive type-specific hrHPV serology. Thirty percent of incident hrHPV DNA detection was attributable to prior infection (with positive serology) and 40% was attributable to recent sexual risk behavior (with negative serology). The proportion of incident hrHPV DNA detection attributable to recent sexual risk behavior decreased with increasing age. Among women with serologic evidence of prior infection, re-detection of the same hrHPV type is likely due to reactivation or intermittent detection of persistent infection. Without serologic evidence of prior infection, new detection is likely due to new acquisition or to intermittent detection of persisting infection.

Genital herpes and encephalitis; a case history

A 19-year-old, previously healthy unmarried girl presented with sudden onset loss of consciousness preceded by genital ulcers, fever and headache. Examination revealed mild neck stiffness, 4/15 of GCS, and upper motor neuron signs in all four limbs. In addition, there were multiple, superficial and tender genital ulcers. Electro Encephalogram (EEG) showed evidence of encephalitis and subsequent serological tests revealed presence of HSV antibodies. Her condition improved remarkably following intravenous Aciclovir therapy. Presence of typical herpetic ulcers, positive type specific serology test for HSV, evidence of encephalitis in the EEG and good response to Aciclovir, favoured the possible diagnosis of Herpes Simplex Encephalitis (HSE). Sri Lanka Journal of Sexual Health and HIV Medicine Vol.1 2015: 29-32

False-negative type-specific glycoprotein G antibody responses in STI clinic patients with recurrent HSV-1 or HSV-2 DNA positive genital herpes, The Netherlands

ObjectivesHerpes simplex virus (HSV) type-discriminating antibody tests (glycoprotein G (gG) directed) are used to identify naïve persons and differentiate acute infections from recurrences. We studied test characteristics of three commercially...

Diagnosis of genital herpes simplex virus infection in the clinical laboratory.

Since the type of herpes simplex virus (HSV) infection affects prognosis and subsequent counseling, type-specific testing to distinguish HSV-1 from HSV-2 is always recommended. Although PCR has been the diagnostic standard method for HSV infections of the central nervous system, until now viral culture has been the test of choice for HSV genital infection. However, HSV PCR, with its consistently and substantially higher rate of HSV detection, could replace viral culture as the gold standard for the diagnosis of genital herpes in people with active mucocutaneous lesions, regardless of anatomic location or viral type. Alternatively, antigen detection—an immunofluorescence test or enzyme immunoassay from samples from symptomatic patients--could be employed, but HSV type determination is of importance. Type-specific serology based on glycoprotein G should be used for detecting asymptomatic individuals but widespread screening for HSV antibodies is not recommended. In conclusion, rapid and accurate laboratory diagnosis of HSV is now become a necessity, given the difficulty in making the clinical diagnosis of HSV, the growing worldwide prevalence of genital herpes and the availability of effective antiviral therapy.

P5.068 Role of Type Specific Herpes Simplex Virus Serology in Diagnosis of Primary and Recurrent Genital Herpes- a Study in the Indian Population

Background Type specific serologic tests for herpes simplex virus (HSV)-1&2 are used for sero-epidemiological studies. Its early application has also been shown to be of benefit in testing for primary & recurrent infections in diagnosis and patient management. The present study was conducted to evaluate the role of type specific HSV-1&2 antibody detection as a diagnostic modality in patients with clinically suspected genital herpes. Methods Sera obtained from 44 patients with clinically suspected genital herpes attending the STD clinic of our institution over last 7 months were tested for type specific HSV-1&2 IgG antibody by glycoprotein G based ELISA (HerpeSelect 1&2, Focus Diagnostics, USA). Direct Fluorescent Antibody testing (DFA) (BIO-RAD laboratories, USA) was used for identification and typing of HSV-1& 2 in genital ulcer specimens in all cases. Results There were 21 cases of primary & 23 cases of recurrent genital ulceration. DFA was positive in 68% samples (43% only HSV-2, 9% only HSV-1, 16% both HSV-1&2). On comparison with DFA, the sensitivity, specificity, positive and negative predictive value of HSV-2 IgG ELISA in primary herpetic ulcer was 8%, 75%, 33%, 33%, while it was 79%, 89%, 92%, 73% in recurrent genital ulceration. The sensitivity, specificity, positive predictive and negative predictive values of HSV-1 IgG ELISA in primary herpetic ulcer was 50%, 67%, 37.5%, 77%, while it was 80%, 39%, 27%, and 87.5% in recurrent genital ulceration. Conclusion Our results highlight the importance of HSV-2 IgG detection in strengthening the diagnosis of recurrent HSV-2 disease, while absence of HSV-2 IgG antibody helps in excluding genital herpes as a likely cause of recurrent genital ulceration. The identification of HSV-1 IgG antibody may not be useful for diagnosis in patients of genital ulcer disease highlighting the need for typing HSV-1 strains from the genital lesion.

Prevention, recognition and management of neonatal HSV infections

Neonatal HSV is most commonly transmitted at the time of delivery with the risk being dramatically higher if the mother has first-episode genital HSV and does not have an elective Cesarean section. Maternal HSV type-specific serology can be used to differentiate first-episode from recurrent infection in this setting, allowing for use of empiric acyclovir for the highest risk infants. There is a need for new strategies as current methods of prevention of transmission of HSV to neonates have limited effectiveness, as they do not account for the fact that the majority of transmission occurs from asymptomatic women. After transmission has occurred, early recognition of neonatal HSV improves the prognosis. Diagnosis needs to be considered in all infants who develop vesicles, unexplained seizures, or possible sepsis in the first 5 weeks of life.

Using Centralized Laboratory Data to Monitor Trends in Herpes Simplex Virus Type 1 and 2 Infection in British Columbia and the Changing Etiology of Genital Herpes

Understanding the regional epidemiology of genital Herpes Simplex Virus (HSV) infections is important for clinical and public health practice, due to the increasing availability of type-specific serologic testing in Canada and the contribution of genital HSV-2 infection to ongoing HIV transmission. We used centralized laboratory data to describe trends in viral identifications of genital HSV in BC and assess the utility of these data for ongoing population surveillance. Records of viral identifications (1997-2005) were extracted from the Provincial Public Health Microbiology & Reference Laboratory database. Classification as genital or other site was based on documented specimen site. We conducted a descriptive analysis of trends over time, and calculated odds of HSV-1 infection among individuals with genital herpes. Of 48,183 viral identifications, 56.8% were genital, 10.0% were peri-oral and 9.1% cutaneous; site was unknown for 22.9%. Among genital identifications, HSV-1 infection was more likely in females, younger age groups, and later time periods. The proportion of genital herpes due to HSV-1 increased over time from 31.4% to 42.8% in BC. Our analysis of population-level laboratory data demonstrates that the proportion of genital herpes due to HSV-1 is increasing over time in BC, particularly among women and younger age groups; this has implications for clinical practice including the interpretation of type-specific serology. Provincial viral identification data are useful for monitoring the distribution of genital HSV-1 and HSV-2 infections over time. Improving clinical documentation of specimen site would improve the utility of these data.

Legal Briefs

A 3,545-g, 35–3/7 weeks', large for gestational age (LGA) male is delivered to an insulin-dependent diabetic mother who became pregnant with the help of a fertility specialist. After conception, a general obstetrician managed her pregnancy. The antenatal course was uneventful except for a history of herpes simplex virus (HSV) infection. A cesarean section was planned at 38 weeks' gestation because of a relatively large fetus and a small pelvic outlet. The mother developed premature rupture of membranes (PROM) at 35 weeks' gestation, and 48 hours later, labor began. The obstetrician was out of town, and the mother was triaged to a midwife for the delivery. The mother's last HSV outbreak was 2 weeks before delivery, with lesions healing 4 days before delivery. The mother claimed in her deposition that she told the midwife about her history of herpes. The medical records from the fertility specialist and the obstetrician documented the history of HSV. The medical records reflecting the herpes were computerized and available to the midwife and the nurses who managed labor and delivery. The infant was delivered by a spontaneous vaginal vertex delivery. The Apgar scores were 8 at 1 minute and 9 at 5 minutes. The infant was asymptomatic and observed for 6 hours before rooming-in with his mother. Multiple bedside glucose evaluations were read as normal. A complete blood count (CBC) yielded unremarkable results. A blood culture was reported as negative on the final reading. Vital signs were stable. The infant was sleepy at the breast, but the mother fed him formula. The discharge examination was performed at 41 hours, and the only notable finding besides the LGA and late preterm gestation was that an ophthalmic examination could not be performed because the eyes were closed. The grandmother stated in her deposition that the baby's eyes were …

No impact of oral tenofovir disoproxil fumarate on herpes simplex virus shedding in HIV-infected adults

to determine the impact of oral tenofovir as part of combination antiretroviral therapy on asymptomatic herpes simplex virus (HSV) shedding. observational study of a cohort of HSV, HIV-1 co-infected adults. HSV infection was diagnosed using type-specific serology (HerpeSelect ELISA, Focus Technologies). Asymptomatic HSV, HIV-1 co-infected individuals achieving HIV viral load below 50 copies/ml on antiretroviral therapy self-collected oral, genital and anal swabs daily for 28 days. Refrigerated specimens were dropped off weekly for HSV-1 and HSV-2 testing by polymerase chain reaction (PCR). Shedding rate was calculated as the proportion of days on which HSV PCR was positive. : Forty co-infected patients were enrolled, of whom 30 were HSV-2 seropositive. Tenofovir was part of the antiretroviral regimen in 22 of 40 (55%) participants overall and 17 of 30 (57%) of HSV-2 infected participants. The median (interquartile range) HSV-2 shedding rate among HSV-2 seropositive participants was low, at 7.1% (0, 14.3) of specimen collection days, and did not differ between tenofovir users and nonusers (P = 0.36). There was no difference in the number of HSV-2 shedders in the tenofovir and nontenofovir groups (59 vs. 46%; P = 0.49). Rates of shedding for HSV-1 alone (P = 0.59), and for either HSV-1 or HSV-2 (P = 0.38), were also similar between tenofovir users and nonusers. although topical tenofovir 1% gel was associated with a significant decrease in HSV-2 acquisition among high-risk women in the recent CAPRISA 004 trial, in these preliminary data we did not observe an impact of oral tenofovir on HSV-2 or HSV-1 shedding rates among HIV, HSV co-infected asymptomatic adults.

Genital Herpes / Genitalni herpes

Abstract Genital herpes is a chronic, nearly always active herpes simplex virus (HSV) infection of sacral ganglia, that may appear bilaterally and in more ganglia than previously thought. It represents one of the most prevalent sexually transmitted infections, and the most frequent cause of genital ulcer disease in the general populations of developed countries. It is caused by HSV type-2 (HSV-2) in 60-80% of cases, with HSV-1 infections causing the remainder. Genital herpes caused by HSV-1 is on the rise. Since genital HSV-1 infections have higher risk for transmission from mother to infant during delivery than HSV-2, they account for 30% of all cases of neonatal herpes. Serological studies have found prevalence of HSV-2 in the general population of developed contries to be up to 25%. Thirty years ago, herpes was defined as “Today’s Scarlet Letter”in the absence of reliable serological tests and highly effective medications, for diagnosis and treatment of genital herpes. In 2000, apart from virus isolation in cell culture (70% sensitivity), that has long been regarded as the diagnostic gold standard, type specific serological tests and higly effective antiviral agents have evolved. However, the following questions were raised: should serological testing be routinely recommended in asymptomatic patients; can antiviral therapy reduce asymptomatic shedding of the virus; can antiviral therapy reduce sexual transmission of infection; can antiviral therapy reduce acquisitation of viral copathogens, such as human immunodeficiency virus (HIV)? Now, ten years later, we know the answers. Type specific HSV DNA detection by real-time PCR assays (100% sensitivity) are tests of choice for every person with recurrent genital ulcers lasting more than 4 days, and must be available in those laboratories currently performing a significant number of PCR tests for different purposes. Type specific IgG serology assays are indicated in all asymptomatic persons who are at increased risk for HSV infection. In sexually active patients experiencing ≥ 6 recurrences per year, daily supressive dose of acyclovir, valacyclovir or famciclovir should be discontinued after a maximum of a year of continuous antiviral therapy in order to reassess recurrence frequency. If necessary, the therapy should be restarted after at least two recurrences. With such expansive diagnostic possibilities and more aggressive therapeutic approaches, we can define genital herpes not as a “Scarlet Letter”, but as a “widespread untoward consequence of human sexuality”.

Evaluation of a Novel Serology Algorithm to Detect Herpes Simplex Virus 1 or 2 Antibodies

Herpes simplex virus (HSV)-type specific serology (TSS) testing has been commercially available for nearly a decade. Guidelines on appropriate use of such testing exist, including Canadian-based recommendations. Despite this, most Canadian laboratories do not offer HSV-type specific serology and many provide only nontype-specific HSV serology tests. At the Alberta Provincial Laboratory, HSV TSS is performed using the following algorithm (termed the Alberta algorithm). Eligible specimens are first tested with a nontype-specific kit (Behring Enzygnost IgG). If positive, sera are then tested using the Focus HerpeSelect-2 assay to establish HSV-2 infection. If the HerpeSelect-2 result is negative, the result is reported as anti-HSV-1 positive. In this study we sought a validation of the Alberta algorithm by testing 344 serum samples with the Behring Enzygnost IgG assay, the type specific Focus HerpeSelect 1 and 2 assays, and by Western blot (WB). Taking the WB as a gold standard, the Behring Enzygnost IgG assay showed a sensitivity of 94% and a specificity of 100%, whereas the Alberta algorithm had a sensitivity of 92% and a specificity of 97% for the detection of HSV-2 antibodies, and a sensitivity of 94% and a specificity of 100% for the detection of HSV-1 antibodies in HSV-2 negative sera. Focus HerpeSelect 1 and HerpeSelect 2 sensitivities against WB were 88% and 91%, whereas specificities were 95% and 97% for HSV-1 and HSV-2, respectively. The Alberta algorithm was at least equivalent to HerpeSelect 1 and 2 in detecting anti-HSV antibodies. Although sensitivity and specificity were higher, the differences were not statistically significant.

Seroprevalence and Risk Factors for Herpes Simplex Virus Infection in a Population of HIV-Infected Patients in Canada

To determine the seroprevalence of herpes simplex virus infection in a population of HIV-infected individuals in Canada. HIV-infected patients attending 5 infectious disease clinics for follow-up care were approached to participate in the study. After informed consent was obtained, subjects completed a questionnaire documenting HIV-risk behavior, duration of infection, history of oral and/or genital herpes, and treatment for HIV and/or genital herpes. Blood for HSV type-specific serology was drawn and tested by enzyme-linked immunosorbent assay (Focus Diagnostics HerpeSelect HSV-1, HSV-2 enzyme-linked immunosorbent assay IgG). Equivocal samples were repeated and any discrepant results were resolved with Western blot. Six hundred twenty-nine HIV-infected individuals participated. The mean age was 43.9 years, 74.7% were Canadian born and 72.3% were men. The majority of foreign-born subjects were black (endemic) and women. The seroprevalence of HSV-1 and HSV-2 was 78.1% and 54.6%, respectively. Women were 2.7 times more likely to be HSV-2 seropositive, non-Canadian-born participants were 2.0 times more likely to be HSV-2 seropositive, and nonwhite subjects were 3.2 times more likely to be seropositive. Men who had sex with other men had the lowest seroprevalence of HSV-2. Only 30.3% of HSV-2 positive subjects reported a history of genital herpes. A significant proportion of HIV-infected subjects attending 5 infectious disease clinics in Canada are coinfected with HSV. Routine type-specific HSV-2 testing should be introduced to direct education regarding symptoms, signs, and transmission reduction of genital herpes and perhaps ultimately HIV-1. Knowledge of HSV serostatus would also provide an opportunity to consider antiviral therapy.

Guidelines for the Management of Herpes Simplex Virus in Pregnancy

ObjectiveTo provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. OutcomesMore effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. EvidenceMedline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. ValuesRecommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. Recommendations1.Women’s history of genital herpes should be evaluated early in pregnancy. (III-A)2.Women with known recurrent genital herpes simplex virus (HSV) should be counselled about the risks of transmission of HSV to their neonates at delivery. (III-A)3.At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV. (II-2A)4.Women with known recurrent genital HSV infection should be offered acyclovir or valacyclovir suppression at 36weeks’ gestation to decrease the risk of clinical lesions and viral shedding at the time of delivery and therefore decrease the need for Caesarean section. (I-A)5.Women with primary genital herpes in the third trimester of pregnancy have a high risk of transmitting HSV to their neonates and should be counselled accordingly and should be offered a Caesarean section to decrease this risk. (II-3B)6.A pregnant woman who does not have a history of HSV but who has had a partner with genital HSV should have type-specific serology testing to determine her risk of acquiring genital HSV in pregnancy before pregnancy or as early in pregnancy as possible. Testing should be repeated at 32 to 34weeks’ gestation. (III-B) ValidationThese guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC. SponsorThe Society of Obstetricians and Gynaecologists of Canada

Quelle place pour la sérologie herpétique dans l’herpès genital ?

The epidemiology of genital herpes is changing. The seroprevalence of HSV-2 infections is increasing, while HSV-1 is an increasingly common cause of herpetic ulcerations. The reference examination provides direct diagnosis after viral isolation in a cell culture or genome amplification. Herpes serology is indicated principally if direct examination is negative and in the absence of lesions. Non-type-specific serology detects antibodies common to HSV-1 and HSV-2. Its specificity and sensitivity are excellent, and it is approved as a reimbursable laboratory procedure. It cannot specify the viral type involved. Type-specific serology can distinguish between anti-HSV-1 and anti-HSV-2 antibodies. Currently available kits have a sensitivity and specificity, depending on the population studied, of 90 to 100%. It is not approved as a reimbursable laboratory procedure. HSV-1-specific serology cannot diagnose old HSV-1 genital infections, but seropositivity for HSV-2 generally suffices to diagnose HSV-2 genital herpes. The indication for type-specific serology must be discussed according to clinical context. The value of non-type-specific serology is limited.

Sexually transmissible infection and HIV management among men who have sex with men with and without HIV: survey of medical practitioners who are members of the Australasian Society for HIV Medicine

Rates of HIV in New South Wales (NSW) have been stable, but have increased significantly in other Australian states. The reasons for this are unknown and may be associated with differences in the management of sexually transmissible infections (STI) and HIV in different states in Australia. Our aim was to determine if the use of suppressive treatment for genital herpes, the treatment of HIV or STI screening practices were different between states in Australia. This study was a cross-sectional survey of medical practitioners who are S100 prescribers and members of the Australian Society for HIV Medicine. In general, there were no differences between the clinical practices of practitioners in NSW and other states except that in NSW fewer practitioners tested HIV-positive men who have sex with men (MSM) for syphilis annually (NSW 78% v. others 87%, P = 0.04) or treated MSM with advanced HIV disease (CD4 < 150 x 10(6) cells L(-1)) with acicylovir in the absence of herpes simplex virus (HSV) (NSW 4% v. others 13%, P = 0.03), and more practitioners in NSW tested HIV-negative MSM for HSV type-specific serology (NSW 21% v. others 11%, P = 0.02). It is unlikely that the minor differences in HSV and HIV treatment or STI screening practices among practitioners in NSW and other Australian states explains the differences in HIV notifications between these two areas.

Interactions and management issues in HSV and HIV coinfection

Significant synergistic interactions have been observed between HIV and herpes simplex virus (HSV). HIV-induced immune compromise can cause frequent and persistent HSV disease, while poorly controlled HSV replication may influence HIV pathogenicity and transmission. HSV-2 seroprevalence is high in HIV-infected cohorts worldwide, with rates of over 80% for HSV-1 and ranging from 33% to more than 80% for HSV-2. As seen in HIV-negative individuals, HSV-2 coinfection is associated with female gender, older age and black ethnicity. HSV infection is commonly under-diagnosed in HIV-infected individuals, although the use of PCR for HSV detection in mucocutaneous swabs and HSV type-specific serology can improve the diagnostic yield. In HIV-1-infected patients with frequent clinical episodes of HSV reactivation, suppressive antiviral therapy may prove beneficial in controlling HSV disease while also reducing HSV-mediated promotion of HIV replication. Antiretroviral therapy leads to a gradual recovery of HSV-specific T-cell responses and a reduction in HSV-related morbidity, indicating that successful management of coinfection should target both HIV and HSV replication. The aim of this review is to address the more speculative issues surrounding the management of HSV/HIV coinfection and to summarize the data that inform them.

Herpes Simplex Virus Type‐Specific Serology: Where Does it Fit in the Diagnostic Armamentarium?

Herpes Simplex Virus Type‐Specific Serology: Where Does it Fit in the Diagnostic Armamentarium?

The Diagnosis of Genital Herpes – Beyond Culture: An Evidence‐Based Guide for the Utilization of Polymerase Chain Reaction and Herpes Simplex Virus Type‐Specific Serology

Accurate identification of persons with genital herpes is necessary for optimal patient management and prevention of transmission. Because of inherent inaccuracies, clinical diagnosis of genital herpes should be confirmed by laboratory testing for the causative agents herpes simplex virus type 1 (HSV-1) and HSV type 2 (HSV-2). Further identification of the HSV type is valuable for counselling on the natural history of infection and risk of transmission. Laboratory methods include antigen detection, culture, polymerase chain reaction (PCR) and conventional and type-specific serology (TSS). PCR has, by far, the greater sensitivity and should be the test of choice for symptomatic cases. HSV-2 TSS is indicated for patients with genital lesions in whom antigen detection, culture or PCR fail to detect HSV, and for patients who are asymptomatic but have a history suggestive of genital herpes. HSV-2 TSS is further indicated for patients infected with HIV. HSV-2 TSS along with HSV-1 TSS may be considered, as appropriate, in evaluating infection and/or immune status in couples discordant for genital herpes, women who develop their first clinical episode of genital herpes during pregnancy, asymptomatic pregnant women whose partners have a history of genital herpes or HIV infection, and women contemplating pregnancy or considering sexual partnership with those with a history of genital herpes. The above should be performed in conjunction with counselling of infected persons and their sex partners.