USPSTF, AAFP Issue Final Recommendations

Don't Routinely Screen Adults, Teens for Genital Herpes

December 21, 2016 03:09 pm News Staff
[The word Herpes in shattered form]

On Dec. 20, the U.S. Preventive Services Task Force (USPSTF) published a final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence summary(www.uspreventiveservicestaskforce.org) on screening for genital herpes simplex virus (HSV) infection using serology. 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)

"Despite genital herpes being common, testing is not generally helpful for people without symptoms, in part because early identification does not improve a person's health, as there is no cure for herpes," said USPSTF member Ann Kurth, Ph.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "In addition, because current screening methods are often inaccurate, harms of screening include high false-positive rates and potential anxiety and disruption of personal relationships related to diagnosis."

Story highlights
  • The U.S. Preventive Services Task Force published a final recommendation statement on screening for genital herpes simplex virus (HSV) infection using serology.
  • 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.
  • This final recommendation is consistent with the task force's 2016 draft and 2005 final recommendation statements.

This final recommendation is consistent with the task force's 2016 draft and 2005 final recommendation statements.

The AAFP released its own final recommendation statement that paralleled the USPSTF's recommendation.

According to the USPSTF news release, no major public health organizations currently recommend universal screening for genital herpes in asymptomatic patients, including pregnant women. Instead, the USPSTF recommends screening certain populations for various other sexually transmitted infections (STIs) -- including chlamydia and gonorrhea,(www.uspreventiveservicestaskforce.org) syphilis (in both nonpregnant adolescents and adults(www.uspreventiveservicestaskforce.org) and pregnant women),(www.uspreventiveservicestaskforce.org) and HIV(www.uspreventiveservicestaskforce.org) -- and also recommends intensive behavioral counseling(www.uspreventiveservicestaskforce.org) for sexually active adolescents and adults at high risk to reduce the risk of acquiring STIs.

Response to Public Comment

The draft version of this recommendation statement was posted for public comment on the USPSTF website from Aug. 2 to Aug. 29.

The task force said it received several comments that supported its analysis and conclusions. Some commenters pointed out that this recommendation is consistent with current clinical practice and advice from other organizations, including the AAFP, the CDC and the American College of Obstetricians and Gynecologists.

A few commenters expressed concern, however, that patients with asymptomatic genital herpes infection can unknowingly transmit the infection to sexual partners.

"While the USPSTF understands this concern, given the current lack of accurate, widely available serologic screening tests and the expected high rate of false-positive results that would occur with widespread screening in asymptomatic persons, the USPSTF continues to recommend against routine serologic screening in asymptomatic adolescents and adults," the final recommendation statement said.

Additionally, the task force clarified its language about HSV-1 infection, noting that although HSV-1 infection can be identified by serologic tests, the tests cannot determine if the site of infection is oral or genital.

Update Based on New Evidence

USPSTF members based their final recommendation on a substantial body of new evidence on the accuracy of serologic screening tests for HSV-2 infection -- the most common cause of genital herpes in the United States -- but only limited new evidence on the benefits and harms of screening.

The task force examined evidence on the accuracy, benefits and harms of serologic screening for HSV-2 infection in asymptomatic adolescents and adults, including those who are pregnant, as well as on the effectiveness and potential harms of preventive medications and behavioral counseling in these populations to reduce future symptomatic episodes and transmission to susceptible sexual partners and infants.

The USPSTF found that using 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 final 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.

Related AAFP News Coverage
USPSTF: Evidence Doesn't Support Routine Screening for Genital Herpes
Harms Outweigh Benefits of Screening Asymptomatic Patients

(8/17/2016)

More From AAFP
American Family Physician: Genital Herpes: A Review
(6/1/2016)

American Family Physician: AFP by Topic: Sexually Transmitted Diseases