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Herpes Simplex Virus, Type 1/2 DNA, Real-Time PCR

Herpes Simplex Virus, Type 1/2 DNA, Real-Time PCR

Test Summary

Herpes Simplex Virus, Type 1/2 DNA, Real-Time PCR

  

Clinical Use

  • Diagnose genital infection with herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2); detect coinfection

  • Assess prognosis and define appropriate counseling

Clinical Background

Infection with either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) is extremely common in the United States, with a seroprevalence of 58% for HSV-1 and 17% for HSV-2.1 HSV-1 most often causes oral herpes and HSV-2 most often causes genital herpes, although HSV-1 is responsible for an increasing proportion of primary genital infections.

Primary genital HSV infection may be associated with small, painful lesions affecting the genitals and surrounding areas as well as generalized symptoms such as fever, muscle aches, and malaise. However, symptoms are often mild or absent, and only about 25% of primary infections in women are diagnosed by a clinician or recognized as genital herpes by the patient.2 Recurrent outbreaks are often mild or attributed to other conditions. Thus, most women with genital herpes are unaware of their infection.

Distinguishing the type of HSV causing genital infection is important to establish the prognosis and transmission risk. Because HSV-2 leads to more frequent genital recurrence than does HSV-1, it poses a higher risk of transmission to sex partners (Table). Genital HSV-1 and HSV-2 can both cause neonatal herpes, especially among women who acquire genital herpes near the time of delivery; this risk can be reduced by avoiding exposure of the baby to lesions during delivery.3 Genital HSV-2 infection is also associated with an increased risk of acquiring and transmitting HIV infection.

Table. Disease Recurrence and Risks Associated with Herpes Simplex Virus Infection2
  Rate of Recurrence after
Symptomatic Genital Herpesa
Risks Associated with
Genital Herpes
HSV-1 First year of infection: 1/year
After 1 year: rare

Transmission to sexual partner
Maternal transmission to newborn

HSV-2 First year of infection: 4/year
After 1 year: slowly decreasing
Transmission to sexual partner
Maternal transmission to newborn

Increased risk of acquiring and

transmitting HIV infection

HSV, herpes simplex virus; HIV, human immunodeficiency virus.
a Recurrent infections are characterized by type-specific HSV detection in the presence of the same antibody type.

Because diagnosis of genital herpes is insensitive and nonspecific when based on medical history and physical examination, the Centers for Disease Control and Prevention (CDC) recommends laboratory confirmation of infection.3 When genital or mucocutaneous lesions are present, viral culture and polymerase chain reaction (PCR) testing are recommended, but PCR has been shown to be 1.5 to 4 times more sensitive than viral culture in detecting HSV infection.2 When lesions are absent, type-specific serological tests are used. However, antibody detection requires seroconversion (average 2 to 3 weeks after infection) and cannot determine the site of infection.4

Quest Diagnostics offers a PCR-based test that provides type-specific direct detection of HSV from vaginal swabs (SureSwab®; test code 90570) or ThinPrep® endocervical liquid Pap specimens (test code 90569).

Individuals Suitable for Testing

  • Women with clinically suspected genital herpes infection

For men, use test code 34257.

Method

  • Real-time polymerase chain reaction (PCR)

- Automated nucleic acid extraction
- PCR amplification of type-specific HSV DNA
- Real-time measurement of fluorescent signal

  • Analytical sensitivity

- 100 HSV-1 DNA copies/mL
- 150 HSV-2 DNA copies/mL

Interpretive Information

A “not detected” result suggests the absence of HSV DNA. However, because viral shedding is intermittent, this result does not exclude the possibility of HSV infection. In addition, improper sample collection and handling could lead to a result of “not detected.”

A “detected” result supports the diagnosis of HSV infection. Detection of genital HSV-2 infection should be followed up with HIV testing.3

During pregnancy, genital herpetic lesions present at the onset of delivery should lead to consideration of cesarean delivery to prevent neonatal infection.3 Newborns exposed to HSV during birth should be followed closely with consideration of antiviral therapy.3

References

  1. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006;296:964-973.

  2. ACOG Committee on Practice Bulletins–Gynecology. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists, number 57, November 2004. Gynecologic herpes simplex virus infections. Obstet Gynecol. 2004;104:1111-1118.

  3. Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1-110.

  4. Strick LB, Wald A. Diagnostics for herpes simplex virus. Is PCR the new gold standard? Mol Diag Ther. 2006;10:17-28.
     

These tests were developed and their performance characteristics have been determined by Quest Diagnostics Nichols Institute. Performance characteristics refer to the analytical performance of the test.

Polymerase chain reaction (PCR) is performed pursuant to a license agreement with Roche Molecular Systems, Inc.

Content reviewed 07/2013
 

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