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Gary A. Richwald, MD,, MPH, Former Director, Los Angeles County STD Clinic, 250 Fifth Ave, Venice, CA 90291, 310-396-2200, drgary1@comcast.net
Of the 45,000,000 Americans infected with herpes simplex virus (HSV)-2, only about 10–15 percent are aware they have genital herpes, with the vast majority being asymptomatic or having atypical clinical outbreaks. This latter group is the principal source of new genital herpes infections through asymptomaic viral shedding episodes. Also, as many as 1,000,000 pregnant women with unrecognized genital HSV infections pose a risk of vertical transmission to neonates. The development and use of diagnostic tests for genital herpes have lagged far behind diagnostics for other STDs. The oldest tests – herpes cultures of classic genital lesions – lack sensitivity, and cultures are only useful early in the course of a classic outbreak, not during inter-lesional periods. False negative cultures make up the majority of test results, especially in cases of recurrent genital herpes. Five years ago, the FDA approved new HSV type-specific serologies (antibody tests), and these have become widely available commercially following endorsement by the CDC in 2002. The new serological (blood) tests called HerpeSelect-2 and HerpeSelect-1 ELISA can accurately identify those who are infected with HSV-2 and HSV-1 respectively and distinguish between the two viruses. Applications include use in patients whose cultures are negative or who present for care after their lesions are healed, the sex partners of patients with genital herpes, those with atypical presentations, pregnant women, HIV-infected patients, candidates for STD screening, and couples under consideration for daily suppressive therapy to prevent transmission. Possible roles for HSV type-specific antibody testing in prevention efforts will be discussed.
Learning Objectives:
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Some grant and speaker support from GSK