Infectious Disease Book

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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
  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, preferred)
      1. Test Sensitivity: 95% (similar Test Specificity)
      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. HSV PCR is preferred over culture
      2. Differentiates HSV I from HSV II
      3. Expect viral growth within 5 days (range 3-10 days)
      4. 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 - Type specific HSV serology
    1. Tests
      1. HSV Western Blot
      2. Glycoprotein G-specific HSV serology
      3. Older HSV IgG and IgM are out-dated and are not recommended
    2. Incidence of positives
      1. HSV I: 90% of adults are positive
      2. HSV II: 30% of adults positive
    3. Indications
      1. Confirm HSV where history is questionable
      2. Partners of Genital Herpes patients
      3. High risk patients (multiple sexual partners, HIV positive, HIV Risk Factors)
      4. Recurrent lesions, but negative HSV PCR or culture
        1. More useful if positive serology for HSV II
        2. Positive serology for HSV I does not identify infection site (oral or genital)
    4. Disadvantages
      1. USPTF and CDC do not recommend routine use (esp. since HSV I causes >50% of Genital Herpes)
      2. Antibodies form with weeks of primary infection
      3. Does not differentiate acute infection from prior infection
    5. 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

Herpes simplex antibody (C0919754)

Concepts Laboratory Procedure (T059)
Dutch herpes simplex antistof
French Anticorps de l'herpès simplex
German Herpes-simplex-Virus-Antikoerper
Italian Anticorpo anti-herpes simplex
Portuguese Anticorpos de herpes simples
Spanish Anticuerpos anti Herpes simple
Japanese 単純ヘルペス抗体, タンジュンヘルペスコウタイ
Czech Protilátky proti viru herpes simplex
Hungarian Herpes simplex antitest
English Herpes simplex antibody
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Herpes simplex serology (C1262158)

Concepts Laboratory Procedure (T059)
Italian Reazione sierologica per Herpes simplex
Japanese 単純ヘルペス血清学的検査, タンジュンヘルペスケッセイガクテキケンサ
Czech Průkaz protilátek proti viru herpes simplex
Hungarian Herpes simplex szerológia
English Herpes simplex serology
Portuguese Teste serológico do herpes
Spanish Serología de herpes simple
Dutch herpes simplex serologie
French Test sérologique de l'herpès
German Herpes simplex-Serologie
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Herpes simplex virus culture (C1294252)

Concepts Laboratory Procedure (T059)
SnomedCT 122213002
English Herpes simplex virus culture (procedure), Herpes simplex virus culture
Spanish cultivo de HSV, cultivo de VHS, cultivo de virus del herpes simple (procedimiento), cultivo de virus del herpes simple
Sources
Derived from the NIH UMLS (Unified Medical Language System)


serum Herpes simplex detection by polymerase chain reaction test (C2098863)

Concepts Laboratory Procedure (T059)
English serum PCR for herpes simplex, serum Herpes simplex detection by polymerase chain reaction test, serum Herpes simplex detection by polymerase chain reaction test (lab test)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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