Western blot hsv test near me12/8/2023 ![]() The majority of available, accurate type-specific HSV serologic assays are based on the HSV-specific glycoprotein G2 (gG2) (HSV-2) and glycoprotein G1 (gG1) (HSV-1). Type-Specific Serologic Testsīoth type-specific and type-common antibodies to HSV develop during the first weeks after infection and persist indefinitely. Although a direct immunofluorescence assay using fluorescein-labeled monoclonal antibodies is also available for detecting HSV antigen from genital specimens, this assay lacks sensitivity and is not recommended ( 449). Similarly, random or blind genital swabs in the absence of lesions should not be used to diagnose genital HSV infection because sensitivity is low, and a negative result does not exclude the presence of HSV infection.Ĭytologic detection of cellular changes associated with HSV infection is an insensitive and nonspecific method of diagnosing genital lesions (i.e., Tzanck preparation) and therefore should not be relied on. Failure to detect HSV by NAAT or culture, especially in the presence of older lesions or the absence of active lesions, does not indicate an absence of HSV infection because viral shedding is intermittent. Viral culture isolates and PCR amplicons should be typed to determine whether HSV-1 or HSV-2 is causing the infection. The sensitivity of viral culture is low, especially for recurrent lesions, and decreases rapidly as lesions begin to heal ( 443, 448). In certain settings, viral culture is the only available virologic test. HSV PCR of the blood should not be performed to diagnose genital herpes infection, except in cases in which concern exists for disseminated infection (e.g., hepatitis). PCR is also the test of choice for diagnosing HSV infections affecting the central nervous system (CNS) and systemic infections (e.g., meningitis, encephalitis, and neonatal herpes). Although multiple FDA-cleared assays exist for HSV detection, these tests vary in sensitivity from 90.9% to 100% however, they are considered highly specific ( 445– 447). HSV NAAT assays are the most sensitive tests because they detect HSV from genital ulcers or other mucocutaneous lesions these tests are increasingly available ( 442– 444). HSV-2 genital herpes infection increases the risk for acquiring HIV twofold to threefold therefore, all persons with genital herpes should be tested for HIV ( 441). Both type-specific virologic and type-specific serologic tests for HSV should be available in clinical settings that provide care to persons with or at risk for STIs. Type-specific serologic tests can be used to aid in the diagnosis of HSV infection in the absence of genital lesions. Therefore, prognosis and counseling depend on which HSV type is present. Recurrences and subclinical shedding are much more frequent for HSV-2 genital herpes infection than for HSV-1 genital herpes ( 439, 440). If genital lesions are present, clinical diagnosis of genital herpes should be confirmed by type-specific virologic testing from the lesion by NAAT or culture ( 186). Diagnostic ConsiderationsĬlinical diagnosis of genital herpes can be difficult because the self-limited, recurrent, painful, and vesicular or ulcerative lesions classically associated with HSV are absent in many infected persons at the time of clinical evaluation. Management of genital HSV should address the chronic nature of the infection rather than focusing solely on treating acute episodes of genital lesions. Consequently, most genital herpes infections are transmitted by persons unaware that they have the infection or who are asymptomatic when transmission occurs. The majority of persons infected with HSV-2 have not had the condition diagnosed, many of whom have mild or unrecognized infections but shed virus intermittently in the anogenital area. ![]() However, an increasing proportion of anogenital herpetic infections have been attributed to HSV-1, which is especially prominent among young women and MSM ( 186, 437, 438). Most cases of recurrent genital herpes are caused by HSV-2, and 11.9% of persons aged 14–49 years are estimated to be infected in the United States ( 436). Two types of HSV can cause genital herpes: HSV-1 and HSV-2. Genital herpes is a chronic, lifelong viral infection.
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