Herpes Simplex Virus Testing

Aka: Herpes Simplex Virus Testing, HSV Test, Genital Herpes Diagnosis, HSV Diagnosis, Genital Herpes Screening, HSV PCR, Herpes Simplex Virus Culture, Herpes Simplex Antibody, Herpes simplex serology, Tzanck Smear

1. Indications
   1. Herpes Simplex Virus
   2. Oral Hepes
   3. Genital Herpes
   4. Genital Herpes in Pregnancy
   5. Neonatal Herpes Simplex Virus
   6. Herpes Keratitis
   7. Herpetic Whitlow
   8. Herpetic Sycosis
   9. Herpes Gladiatorum
   10. Erythema Multiforme
   11. HSV Encephalitis
2. Labs: Definitive HSV Diagnosis
   1. Sample collection
      1. Unroof Vesicles with scalpel or needle tip and apply viral culture swab
   2. HSV Polymerase chain reaction (HSV PCR)
      1. Test Sensitivity: 95%
      2. Provides more rapid results than viral culture or Direct Fluorescence
      3. Used in HSV Encephalitis diagnosis for rapid results
   3. HSV Viral Culture of vesicular fluid
      1. Differentiates HSV I from HSV II
      2. Expect viral growth within 5 days (range 3-10 days)
      3. Test Sensitivity: 50-75% (90% in primary episode)
         1. Vesicles are most concentrated with infection within first 48 hours
         2. Early ulcerative stage may yield a positive result
         3. Not useful in lesions beyond 5 days old
   4. Older tests replaced by HSV PCR
      1. Tzanck Smear of Ulcer scraping
      2. HSV Direct Fluorescent Antibody
         1. Test Sensitivity: 80-90% of viral culture positive
      3. Rapid Giemsa (Dif-Quik) stain
         1. Multinucleated giant cells
         2. Test Sensitivity: 40-77%
3. Labs: Presumptive HSV Diagnosis
   1. HSV serology (Glycoprotein G-specific HSV serology)
      1. Incidence of positives
         1. HSV: 90% of adults are positive
         2. HSV II: 30% of adults positive
      2. Indications
         1. Confirm HSV where history is questionable
         2. Recurrent lesions, but negative culture
      3. Disadvantages
         1. Antibodies form with weeks of primary infection
         2. Does not differentiate acute infection from prior infection
      4. Interpretation
         1. Primary Herpes Simplex Infection may result in a four fold increase in acute over convalescent Antibody titiers
4. Resources
   1. CDC Genital Herpes Screening
      1. http://www.cdc.gov/std/herpes/screening.htm