European Clinics in Obstetrics and Gynaecology

, Volume 2, Issue 4, pp 181–189

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

Clinical Review
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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.

Keywords

Genital herpes Herpes simplex virus Virus culture Polymerase chain reaction Type-specific serology Antiviral therapy 

References

  1. 1.
    Strand A, Barton S, Alomar A et al (2002) Current treatments and perceptions of genital herpes: a European-wide view. J Eur Acad Dermatol Venereol 16:564–572PubMedCrossRefGoogle Scholar
  2. 2.
    Guthrie R (1999) American Herpes Foundation Monitor 1:1Google Scholar
  3. 3.
    Malkin J-E (2004) Epidemiology of genital herpes simplex infection in developed countries. Herpes 11(Suppl 1):2A–23APubMedGoogle Scholar
  4. 4.
    Beauman JG (2005) Genital herpes: a review. Am Fam Physician 72:1527–1534PubMedGoogle Scholar
  5. 5.
    Xu F, Sternberg MR, Kottiri BJ et al (2006) Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 296:964–973PubMedCrossRefGoogle Scholar
  6. 6.
    Looker KJ, Garnett GP (2005) A systematic review of the epidemiology and interaction of herpes simplex virus types 1 and 2. Sex Transm Infect 81:103–107PubMedCrossRefGoogle Scholar
  7. 7.
    Lafferty WE, Downey L, Celum C, Wald A (2000) Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis 181:1454–1457PubMedCrossRefGoogle Scholar
  8. 8.
    Löwhagen GB, Tunbäck P, Andersson K et al (2000) First episodes of genital herpes in a Swedish STD population: a study of epidemiology and transmission by the use of herpes simplex virus (HSV) typing and specific serology. Sex Transm Infect 76:179–182PubMedCrossRefGoogle Scholar
  9. 9.
    Cowan FM, Johnson AM, Ashley R et al (1994) Antibody to herpes simplex virus type 2 as serological marker of sexual lifestyle in populations. BMJ 309:1325–1329PubMedGoogle Scholar
  10. 10.
    Gottlieb SL, Douglas JM Jr, Schmid DS et al (2002) Seroprevalence and correlates of herpes simplex virus type 2 infection in five sexually transmitted-disease clinics. J Infect Dis 186:1381–1389PubMedCrossRefGoogle Scholar
  11. 11.
    Cusini M, Cusan M, Parolin C et al (2000) Seroprevalence of herpes simplex virus type 2 infection among attendees of a sexually transmitted disease clinic in Italy. Sex Transm Dis 27:292–295PubMedCrossRefGoogle Scholar
  12. 12.
    Austin H, Macaluso M, Nahmias A et al (1999) Correlates of herpes simplex virus seroprevalence among women attending a sexually transmitted disease clinic. Sex Transm Dis 26:329–334PubMedCrossRefGoogle Scholar
  13. 13.
    Gibson JJ, Hornung CA, Alexander GR et al (1990) A cross-sectional study of herpes simplex virus types 1 and 2 in college students: occurrence and determinants of infection. J Infect Dis 162:306–312PubMedGoogle Scholar
  14. 14.
    Russell DB, Tabrizi SN, Russell JM et al (2001) Seroprevalence of herpes simplex virus types 1 and 2 in HIV-infected and uninfected homosexual men in a primary care setting. J Clin Virol 22:305–313PubMedCrossRefGoogle Scholar
  15. 15.
    Conde-Glez CJ, Juarez-Figueroa L, Uribe-Salas F et al (1999) Analysis of herpes simplex virus 1 and 2 infection in women with high risk sexual behaviour in Mexico. Int J Epidemiol 28:571–576PubMedCrossRefGoogle Scholar
  16. 16.
    Corey L, Adams HG, Brown ZA, Holmes KK (1983) Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med 98:958–972PubMedGoogle Scholar
  17. 17.
    Wald A, Zeh J, Selke S et al (2000) Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med 342:844–850PubMedCrossRefGoogle Scholar
  18. 18.
    Corey L (1994) The current trend in genital herpes: progress in prevention. Sex Transm Dis 21:538–544Google Scholar
  19. 19.
    Benedetti J, Corey L, Ashley R (1994) Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med 121:847–854PubMedGoogle Scholar
  20. 20.
    Habif TP (1996) Clinical dermatology, 4th edn. Mosby, St Louis, pp 306–310Google Scholar
  21. 21.
    Corey L (1988) First-episode, recurrent, and asymptomatic herpes simplex infections. J Am Acad Dermatol 18:169–172PubMedGoogle Scholar
  22. 22.
    Langenberg AG, Corey L, Ashley RL et al (1999) A prospective study of new infections with herpes simplex virus type 1 and type 2. N Engl J Med 341:1432–1438PubMedCrossRefGoogle Scholar
  23. 23.
    Koutsky LA, Stevens CE, Holmes KK et al (1992) Underdiagnosis of genital herpes by current clinical and viral-isolation procedures. N Engl J Med 326:1533–1539PubMedCrossRefGoogle Scholar
  24. 24.
    Ashley RL, Wald A (1999) Genital herpes: review of the epidemic and potential use of type-specific serology. Clin Microbiol Rev 12:1–8PubMedGoogle Scholar
  25. 25.
    Markos AR (2004) Successful management of vulvar adhesions with potent topical corticosteroids: a case report. J Reprod Med 49:398–400PubMedGoogle Scholar
  26. 26.
    Lautenschlager S, Eichmann A (2001) The heterogeneous clinical spectrum of genital herpes? Dermatology 202:211–219PubMedCrossRefGoogle Scholar
  27. 27.
    Uuskula A, Raukas E (2004) Atypical genital herpes: report of five cases. Scand J Infect Dis 36:37–39PubMedCrossRefGoogle Scholar
  28. 28.
    Mertz GJ, Schmidt O, Jourden JL et al (1985) Frequency of acquisition of first-episode genital infection with herpes simplex virus from symptomatic and asymptomatic source contacts. Sex Transm Dis 12:33–39PubMedGoogle Scholar
  29. 29.
    Koelle DM, Wald A (2000) Herpes simplex virus: the importance of asymptomatic shedding. J Antimicrob Chemother 45(Suppl T3):1–8PubMedCrossRefGoogle Scholar
  30. 30.
    Corey L, Simmons A (eds) (1997) The medical importance of genital herpes simplex virus infection. International Herpes Management ForumGoogle Scholar
  31. 31.
    Wald A, Zeh J, Selke S et al (1995) Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med 333:770–775PubMedCrossRefGoogle Scholar
  32. 32.
    Wald A, Corey L, Cone R et al (1997) Frequent genital herpes simplex virus 2 shedding in immunocompetent women: effect of acyclovir treatment. J Clin Invest 99:1092–1097PubMedCrossRefGoogle Scholar
  33. 33.
    Mertz GJ, Benedetti J, Ashley R et al (1992) Risk factors for the sexual transmission of genital herpes. Ann Intern Med 116:197–202PubMedGoogle Scholar
  34. 34.
    Nahmias AJ, Lee FK, Beckman-Nahmias S (1990) Sero-epidemiological and -sociological patterns of herpes simplex virus infection in the world. Scand J Infect Dis 69(Suppl):19–36Google Scholar
  35. 35.
    Schacker T, Hu HL, Koelle DM et al (1998) Famciclovir for the suppression of symptomatic and asymptomatic herpes simplex virus reactivation in HIV-infected persons: a double-blind, placebo-controlled trial. Ann Intern Med 128:21–28PubMedGoogle Scholar
  36. 36.
    Hutto C, Arvin A, Jacobs R et al (2003) Intrauterine herpes simplex virus infections. J Pediatr 110:97–101Google Scholar
  37. 37.
    Brown Z, Sleke S, Zeh J et al (1997) The acquisition of herpes simplex virus during pregnancy. N Engl J Med 337:509–515PubMedCrossRefGoogle Scholar
  38. 38.
    Brown ZA, Wald A, Morrow RA et al (2003) Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 289:203–209PubMedCrossRefGoogle Scholar
  39. 39.
    Kohl S (1997) Neonatal herpes simplex virus infection. Clin Perinatol 24:129–150PubMedGoogle Scholar
  40. 40.
    Griffiths PD, Volpi A (eds) (1997) Progress with diagnostic tests and vaccines for alpha-herpes viruses. International Herpes Management ForumGoogle Scholar
  41. 41.
    Celum CL (2004) The interaction between herpes simplex virus and human immunodeficiency virus. Herpes 11(Suppl 1):36A–45APubMedGoogle Scholar
  42. 42.
    Filen F, Strand A, Allard A et al (2004) Duplex real-time polymerase chain reaction assay for detection and quantification of herpes simplex virus type 1 and herpes simplex virus type 2 in genital and cutaneous lesions. Sex Transm Dis 31:331–336PubMedCrossRefGoogle Scholar
  43. 43.
    Löwhagen GB, Tunbäck P, Bergström T (2002) Proportion of herpes simplex virus (HSV) type 1 and type 2 among genital and extragenital HSV isolates. Acta Derm Venereol 82:118–120PubMedCrossRefGoogle Scholar
  44. 44.
    Strick LB, Wald A (2006) Diagnostics for herpes simplex virus: is PCR the new gold standard? Mol Diagn Ther 10:17–28PubMedGoogle Scholar
  45. 45.
    Mackay IM, Arden KE, Nitsche A (2002) Real-time PCR in virology. Nucleic Acids Res 30:1292–1305PubMedCrossRefGoogle Scholar
  46. 46.
    Nicoll S, Brass A, Cubie HA (2001) Detection of herpes viruses in clinical samples using real-time PCR. J Virol Methods 96:25–31PubMedCrossRefGoogle Scholar
  47. 47.
    Read SJ, Kurtz JB (1999) Laboratory diagnosis of common viral infections of the central nervous system by using a single multiplex PCR screening assay. J Clin Microbiol 37:1352–1355PubMedGoogle Scholar
  48. 48.
    Burrows J, Nitsche A, Bayly B et al (2002) Detection and subtyping of herpes simplex virus in clinical samples by lightCycler PCR, enzyme immunoassay and cell culture. BMC Microbiol 2:12PubMedCrossRefGoogle Scholar
  49. 49.
    Ramaswamy M, McDonald C, Smith M et al (2004) Diagnosis of genital herpes by real time PCR in routine clinical practice. Sex Transm Infect 80:406–410PubMedCrossRefGoogle Scholar
  50. 50.
    Scoular A, Gillespie G, Carman WF (2002) Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic. Sex Transm Infect 78:21–25PubMedCrossRefGoogle Scholar
  51. 51.
    Strick L, Wald A (2004) Type-specific testing for herpes simplex virus. Expert Rev Mol Diagn 4:443–453PubMedCrossRefGoogle Scholar
  52. 52.
    Page J, Taylor J, Tideman RL et al (2003) Is HSV serology useful for the management of first episode genital herpes? Sex Transm Infect 79:276–279PubMedCrossRefGoogle Scholar
  53. 53.
    Morrow R, Friedrich D (2006) Performance of a novel test for IgM and IgG antibodies in subjects with culture-documented genital herpes simplex virus-1 or -2 infection. Clin Microbiol Infect 12:463–469PubMedCrossRefGoogle Scholar
  54. 54.
    Australian Herpes Management Forum (2004) The use of type-specific serology for the diagnosis of genital herpes. AHMF, Westmead NSWGoogle Scholar
  55. 55.
    Bryson Y, Dillon M, Bernstein DI et al (1993) Risk of acquisition of genital herpes simplex virus type 2 in sex partners of persons with genital herpes: a prospective couple study. J Infect Dis 167:942–946PubMedGoogle Scholar
  56. 56.
    McClelland RS, Wand CC, Overbaugh J et al (2002) Association between cervical shedding of herpes simplex virus and HIV-1. AIDS 16:2425–2430PubMedCrossRefGoogle Scholar
  57. 57.
    Kulhanjian JA, Soroush V, Au DS et al (1992) Identification of women at unsuspected risk of primary infection with herpes simplex virus type 2 during pregnancy. N Engl J Med 326:916–920PubMedCrossRefGoogle Scholar
  58. 58.
    Zimet GD, Rosenthal SL, Fortenberry JD et al (2004) Factors predicting the acceptance of herpes simplex virus type 2 antibody testing among adolescents and young adults. Sex Transm Dis 31:665–669PubMedCrossRefGoogle Scholar
  59. 59.
    Krantz I, Löwhagen G-B, Ahlberg BM, Nilstun T (2004) Ethics of screening for asymptomatic herpes virus type 2 infection. BMJ 329:618–621PubMedCrossRefGoogle Scholar
  60. 60.
    International Herpes Management Forum (2000) Algorithms for managing genital herpes in primary careGoogle Scholar
  61. 61.
    Bodsworth NJ, Crooks RJ, Borelli S et al (1997) Valaciclovir versus aciclovir in patient initiated treatment of recurrent genital herpes: a randomised, double blind clinical trial. Genitourin Med 73:110–116PubMedGoogle Scholar
  62. 62.
    Chosidow O, Drouault Y, Leconte-Veyriac F et al (2001) Famciclovir vs. aciclovir in immunocompetent patients with recurrent genital herpes infections: a parallel-groups, randomized, double-blind clinical trial. Br J Dermatol 144:818–824PubMedCrossRefGoogle Scholar
  63. 63.
    Whitley RJ (2006) New approaches to the therapy of HSV infections. Herpes 13:53–55PubMedGoogle Scholar
  64. 64.
    Mertz GJ, Loveless M, Levin M et al (1997) Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Arch Intern Med 157:343–349PubMedCrossRefGoogle Scholar
  65. 65.
    Patel R, Bodsworth NJ, Woolley P et al (1997) Valaciclovir for the suppression of recurrent genital HSV infection: a placebo controlled study of once daily therapy. Genitourin Med 73:105–109PubMedGoogle Scholar
  66. 66.
    Patel R, Tyring S, Strand A et al (1999) Impact of suppressive antiviral therapy on the health related quality of life of patients with recurrent genital herpes infection. Sex Transm Infect 75:398–402PubMedCrossRefGoogle Scholar
  67. 67.
    Romanowksi B, Marina RB, Roberts JN (2003) Patients’ preference of valacyclovir once-daily suppressive therapy versus twice-daily episodic therapy for recurrent genital herpes: a randomized study. Sex Transm Dis 30:226–231CrossRefGoogle Scholar
  68. 68.
    Corey L, Wald A, Patel R et al (2004) Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 350:11–20PubMedCrossRefGoogle Scholar
  69. 69.
    Catotti DN, Clarke P, Catoe KE (1993) Herpes revisited: still a cause for concern. Sex Transm Dis 20:77–80PubMedCrossRefGoogle Scholar
  70. 70.
    Melville J, Sniffen S, Crosby R et al (2003) Psychosocial impact of a serological diagnosis of herpes simplex virus type 2: a qualitative assessment. Sex Transm Infect 79:280–285PubMedCrossRefGoogle Scholar
  71. 71.
    Patel R (2004) Supporting the patient with genital HSV infection. Herpes 11:87–92PubMedGoogle Scholar

Copyright information

© European Board and College of Obstetrics and Gynaecology 2007

Authors and Affiliations

  1. 1.Department of Medical Sciences, Dermatology and VenereologyUniversity HospitalUppsalaSweden

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