USPSTF: Evidence Doesn't Support Routine Screening for Genital Herpes

Harms Outweigh Benefits of Screening Asymptomatic Patients

August 17, 2016 02:29 pm Chris Crawford

In the United States, one in six people ages 14-49 has genital herpes simplex virus (HSV) infection. This considerable level of prevalence is particularly troubling given that the condition cannot be cured.

[The word Herpes in shattered form]

In light of these facts, the U.S. Preventive Services Task Force (USPSTF) revisited the evidence regarding screening for genital herpes infection using a blood test, and on Aug. 2 released a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on the topic.

After reviewing the evidence, the task force recommended against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant women -- a "D" recommendation.(www.uspreventiveservicestaskforce.org)

"While genital herpes is relatively common, testing is not generally helpful for people who have not experienced symptoms, in part because the tests are often inaccurate," said USPSTF member Maureen Phipps, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "Further, because there's no cure, there isn't much doctors and nurses can do for people who don't have symptoms."

Story highlights
  • The U.S. Preventive Services Task Force (USPSTF) has released a draft recommendation statement against routine serologic screening for genital herpes simplex virus infection in asymptomatic patients.
  • This draft recommendation is consistent with and updates the USPSTF's 2005 recommendation and combines adults, adolescents and pregnant women into one recommendation statement.
  • The USPSTF is accepting public comments on the draft recommendation statement and draft evidence review until Aug. 29.

This draft recommendation is consistent with and updates the USPSTF's 2005 recommendation and combines adults, adolescents and pregnant women into one recommendation statement.

Update Based on New Evidence

The task force's draft recommendation is based on substantial new evidence on the accuracy of serologic screening tests for HSV-2 infection -- the most common cause of genital herpes in the United States -- and limited new evidence on the benefits and harms of screening. (The task force noted that although the prevalence of genital herpes caused by HSV-1 infection may be increasing, no serologic screening test exists for genital herpes caused by HSV-1.)

The USPSTF commissioned a systematic evidence review to examine the evidence on the accuracy, benefits and harms of serologic screening for HSV-2 infection in asymptomatic adolescents and adults, including those who are pregnant. This evidence review also considered the effectiveness and potential harms of preventive medications and behavioral counseling interventions in asymptomatic populations to reduce future symptomatic episodes and transmission to susceptible sexual partners and infants.

The task force found serologic screening with currently available tests in asymptomatic patients could result in a 50 percent rate of false-positives.

"Given the test characteristics of the most widely used serologic screening test for HSV-2 and a population infection prevalence of 15 percent, screening 10,000 people would result in approximately 1,485 true-positive and 1,445 false-positive results," the draft recommendation statement said.

The potential harms of receiving a false-positive result include social and emotional distress, said the task force, as well as potential harms tied to unnecessary treatment with antiviral medications.

Notes From the AAFP

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News this draft recommendation stems from the simple fact there just aren't accurate screening tests for HSV.

"The current serologic test for HSV-2 has a high false-positive rate and there is no confirmatory test," she said. "A screening program requires an accurate screening test."

Frost also said that although symptomatic genital herpes produces lesions that are typically quite painful, there still are patients with milder symptoms who don't realize they have an infection.

"But even if these individuals could be detected with an accurate screening test -- again, there is no 'cure' for genital herpes," she said. "Patients with HSV are treated with antivirals to reduce the severity and frequency of symptomatic outbreaks."

Frost added that pregnant women with a known history of herpes are placed on antiviral prophylaxis at 35 weeks' gestation. "And pregnant women who have active herpes (genital lesions and/or symptoms) near the time of delivery are offered cesarean delivery," she said.

Research Needs, Gaps

The USPSTF said there still are many areas in which research is needed to better understand the detection and management of asymptomatic genital HSV infection, such as

  • improving epidemiologic data on the true prevalence and natural history of asymptomatic genital HSV infection in the United States;
  • creating screening and diagnostic tests with higher specificity and that detect both asymptomatic HSV-1 and HSV-2 genital infections;
  • developing behavioral interventions to reduce the transmission of genital HSV infection, including interventions to reduce the risk of transmission to uninfected pregnant women;
  • assessing potential effectiveness of antiretroviral medications as pre- or postexposure prophylaxis;
  • acquiring more data on the potential harms of screening in asymptomatic patients, including psychological distress and the disruption of relationships; and
  • increasing clinicians' understanding of the potential role of HSV infection in increasing the risk of HIV infection and the management of coinfection with HSV and HIV.

In addition, the task force called for more research to develop a cure for genital HSV infection, as well as a vaccine to prevent the infection.

The USPSTF continues to recommend screening for other sexually transmitted infections (STIs), including chlamydia, gonorrhea, syphilis and HIV, and recommends behavioral counseling to reduce the risk of acquiring STIs for sexually active adolescents and adults at high risk.

Next Steps

The USPSTF is accepting public comments on this draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until Aug. 29.

The AAFP, which in 2005 released parallel recommendations against routine serological screening for HSV in asymptomatic adolescents and adults and also in pregnant women, will now review the USPSTF's current draft materials and release its own final recommendation after the task force finalizes its recommendation statement.

Related AAFP News Coverage
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AAFP Urges FPs to Integrate Preconception Care Into Patient Visits
Position Paper Offers Recommendations for Counseling, Screening

(1/19/2016)

Uptick in Congenital Syphilis Causes Concern
Seize Opportunities to Identify, Treat Disease

(11/23/2015)

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American Family Physician: Genital Herpes: A Review
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