Herpes Antibody Testing

[mknudtson]

I frequently have patients who come in because of a possible exposure to herpes. The patient reports he/she has no symptoms or prior history of herpes. Are you offering or recommending the herpes serology antibody testing for type 1 and type 2 in these scenarios? Our lab uses the HerpeSelect test kits which are supposed to be 96-97% sensitive and 98% specific.

Mary Knudtson, DNSc, NP, FAAN

[eejjrr]

Nearly 25% of the adolescent and adult (1 in 4 women and 1 in 5 men) population will be serologically positive for HSV-2. Even higher percentages are found in HSV-1, which is more and more commonly being found "below the belt", so to speak due to the decreased tabu associated with oral sex in the West. It is never appropriate to test in this situation, for a non-life threatening disease.

[SusanTiso]

Sometimes the decision about whether to test or not is determined by the patient's health insurance coverage. Some insurers do not cover this cost. Although the test has good sensitivity and specificity, what it does not answer is when the patient contracted the virus, and I have found that patients want to point the finger to a recent contact and assign blame. In a study of patients who were seropositive, only 47% had a history of outbreaks ever (reported in UpToDate, 2010). So there is limited value in trying to answer that question about time of transmission with serology.

One comment in response to the reply above from eejjrr- I respectfully disagree about it never being appropriate to test for herpes. If one partner has herpes, that person has an obligation to disclose to sexual partners and use protection. If the outbreaks were atypical, then testing may be the only way to prove it is herpes vs folliculitis or something else. Additionally, in discordant couples, using antivirals reduces the transmission to the uninfected partner. This information would also be pertinent in the case of pregnancy; if there was an outbreak at the time of delivery, the infant would be delivered by C-section.

[eejjrr]

Just to clarify, I never said that it's never appropriate to test. what I said was that, in my opinion, it was never appropriate in that situation. Reason being is, again in my opinion, nearly 25% of the adolescent and adult (1 in 4 women and 1 in 5 men) population will be serologically positive for HSV-2. Even higher percentages are found in HSV-1. If this patient were to come back as positive there is a one in four chance that she was ALREADY positive, prior to her POSSIBLE exposure. Testing in this situation is never appropriate. This is just one, all be it, simple example of why we spend so much on health care in this country. Extremely easy access to expensive testing. Further, I agree with most of your other reasons to test, however in MOST situations, a good practitioner doesn't need an antibody test to diagnose herpes. Certainly, you would deliver via C-Section in the presence of an outbreak, but herpes viruses shed WITHOUT the presence of lesions. So that begs the question, do you serotype for herpes all pregnant women and deliver all that are sero-positive? Of course not.