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HSV Screening Still Not Recommended, According to New USPSTF Report

NEW YORK (360Dx) – The US Preventive Services Task Force today issued a recommendation against the routine serologic screening of genital herpes simplex virus infection in asymptomatic adolescents and adults, saying the potential harms resulting from screening outweigh the potential benefits.

In a report published in The Journal of the American Medical Association, the USPSTF said it updated a similar recommendation made in 2005 after reviewing evidence based on the accuracy, benefits, and harms of serologic screening of infection from the HSV-2 subtype in asymptomatic persons, and the effectiveness and harms of preventive treatments and behavioral counseling interventions to reduce future symptomatic episodes and transmission to others.

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," while the potential harms from screening are "at least moderate."

The US Centers for Disease Control and Prevention estimates that nearly 1 in 6 people between 14 and 49 years old have genital herpes, which is caused by two HSV subtypes, HSV-1 and HSV-2. More than 45 million people in the US between those ages have the virus. Unlike other infections for which screening is recommended, HSV may have a long asymptomatic period, during which screening, early identification, and treatment may alter its course, the USPSTF said. It added that antiviral medications can provide symptomatic relief from outbreaks, but they do not cure the infection.

HSV transmission can also occur between an infected pregnant woman and her infant during vaginal delivery, but interventions can help reduce transmission.

The USPSTF said that most cases of genital herpes in the US are the result of infection with HSV-2. Evidence suggest that the most widely used serologic screening test for HSV-2 approved by the US Food and Drug Administration, the HerpeSelect test from DiaSorin's Focus Diagnostics, has low specificity and a high false-positive rate. That, along with a lack of confirmatory testing, renders the test unsuitable for population-based screening.

Meanwhile, serologic tests for HSV-1 are unable to determine if the infection site is oral or genital, making them inadequate for screening for asymptomatic genital herpes from HSV-1 infection.

In an accompanying editorial, Edward Hook from the University of Alabama at Birmingham School of Medicine, wrote that the USPSTF's recommendation should not be misinterpreted to mean that current tests for HSV should be dismissed at hand as useless. While their performance may be "suboptimal," they can provide information that may influence treatment decisions. They also provide information for sex partners of people with the virus who may be uncertain of their own status.

Hook called HSV infection in the US an epidemic and said that the recommendation should serve as a "call to action" for the National Institutes of Health and other federal agencies, as well as industry, to address it by developing better diagnostic tests.