Genital Herpes Infection: Serologic Screening --Asymptomatic adolescents and adults, including those who are pregnant


General

Grade: D

Specific Recommendations

The USPSTF recommends against routine serologic screening for genital herpes simplex virus (HSV) infection in asymptomatic adolescents and adults, including those who are pregnant.

Frequency of Service

No information available.

Risk Factor Information

No information available.


Clinical

Patient Population Under Consideration

This recommendation statement applies to asymptomatic adolescents and adults, including those who are pregnant, without a history of genital HSV infection.

Screening Tests

The USPSTF does not recommend serologic screening for genital HSV infection in asymptomatic persons.

Treatment

The CDC provides guidance for the diagnosis and management of genital HSV infection.2

Additional Approaches to Prevention

The USPSTF recommends intensive behavioral counseling interventions to reduce the likelihood of acquiring an STI for all sexually active adolescents and for adults at increased risk.3

Useful Resources

The USPSTF has issued recommendations on screening for other STIs, including chlamydia and gonorrhea,4 hepatitis B virus,5 human immunodeficiency virus (HIV),6 and syphilis.7


Rationale

Importance

Genital herpes is a prevalent sexually transmitted infection (STI) in the United States; the Centers for Disease Control and Prevention (CDC) estimates that almost 1 in 6 persons aged 14 to 49 years have genital herpes.1 Genital herpes infection is caused by 2 subtypes of HSV, HSV-1 and HSV-2. Unlike other infections for which screening is recommended, HSV infection may not have a long asymptomatic period during which screening, early identification, and treatment may alter its course. Antiviral medications may provide symptomatic relief from outbreaks; however, these medications do not cure HSV infection. Although vertical transmission of HSV can occur between an infected pregnant woman and her infant during vaginal delivery, interventions can help reduce transmission. Neonatal herpes infection, while uncommon, can result in substantial morbidity and mortality.

Detection

In the past, most cases of genital herpes in the United States have been caused by infection with HSV-2. Adequate evidence suggests that the most widely used, currently available serologic screening test for HSV-2 approved by the US Food and Drug Administration is not suitable for population-based screening, based on its low specificity, the lack of widely available confirmatory testing, and its high false-positive rate. Rates of genital herpes due to HSV-1 infection in the United States may be increasing. While HSV-1 infection can be identified by serologic tests, the tests cannot determine if the site of infection is oral or genital; thus, these serologic tests are not useful for screening for asymptomatic genital herpes resulting from HSV-1 infection.

Benefits of Early Detection and Intervention

Based on limited evidence from a small number of trials on the potential benefit of screening and interventions in asymptomatic populations and an understanding of the natural history and epidemiology of genital HSV infection, the USPSTF concluded that the evidence is adequate to bound the potential benefits of screening in asymptomatic adolescents and adults, including those who are pregnant, as no greater than small.

Harms of Early Detection and Intervention

Based on evidence on potential harms from a small number of trials, the high false-positive rate of the screening tests, and the potential anxiety and disruption of personal relationships related to diagnosis, the USPSTF found that the evidence is adequate to bound the potential harms of screening in asymptomatic adolescents and adults, including those who are pregnant, as at least moderate.

USPSTF Assessment

The USPSTF concludes with moderate certainty that the harms outweigh the benefits for population-based screening for genital HSV infection in asymptomatic adolescents and adults, including those who are pregnant.


Others

Other Considerdations Research Needs and Gaps There are many areas in need of research to better understand the detection and management of asymptomatic genital HSV infection, including: Improved epidemiologic data on the true prevalence and natural history of asymptomatic genital HSV infection in the United States Development of screening and diagnostic tests with higher specificity that detect both asymptomatic genital HSV-1 and HSV-2 infections Behavioral interventions to reduce the transmission of genital HSV infection, including interventions to reduce the risk of transmission to uninfected pregnant women Further interventions to prevent and treat neonatal herpes infection Potential effectiveness of antiretroviral medications, including topical gels, as preexposure or postexposure prophylaxis More data on the potential harms of screening in asymptomatic persons, including psychological distress and the disruption of personal relationships Increased understanding of the potential role of HSV infection in increasing the risk of HIV infection and the management of coinfection with HSV and HIV Research to develop a cure for genital HSV infection and a vaccine to prevent genital HSV infection should continue.   Recommendations of Others The American Academy of Family Physicians,26 ACOG,27 and the CDC2 do not recommend routine serologic screening for genital HSV infection in asymptomatic adolescents or adults. Diagnostic testing, however, in persons with recurrent atypical genital symptoms may be helpful. The CDC recommends consideration of serologic testing for HSV-2 in persons presenting for STI evaluation and for persons living with HIV infection.2 The CDC also recommends consideration of screening for HSV infection in men who have sex with men and who are at high risk for HIV infection.2 The American Academy of Family Physicians,26 ACOG,28 and the CDC2 do not recommend routine serologic screening for genital HSV infection in pregnant adolescents and women. The CDC2 and ACOG28 recommend asking pregnant women about history of genital HSV infection and consideration of cesarean delivery for women with prodromal symptoms or active genital lesions during labor to reduce the risk of neonatal HSV infection. The CDC recommends that women with recurrent genital herpes during pregnancy be offered suppressive therapy at 36 weeks of gestation.2


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