Choosing Wisely:

Don’t use herpes simplex virus (HSV) polymerase chain reaction testing for genital HSV infection screening in adults and adolescents. Real-time HSV polymerase chain reaction testing should only be used to confirm herpes diagnosis in patients with suspected herpes.

Rationale and Comments: HSV shedding is intermittent. Therefore, testing swabs from asymptomatic patients is not recommended for routine diagnosis since it is unlikely to yield confirmation of carrier status. However, laboratory confirmation in all patients with suspected herpes is recommended. HSV DNA detection by real-time polymerase chain reaction is considered the gold standard for diagnosis. Swabs for testing are taken from the base of the lesion (vesicles should be unroofed with a needle or scalpel blade). HSV typing into HSV-1 and HSV-2 is recommended in all patients with first-episode genital herpes to guide counseling and management.
Sponsoring Organizations:
  • American Society for Clinical Laboratory Science
  • Sources:
  • Centers for Disease Control and Prevention
  • Disciplines:
  • Preventive Medicine
  • Infectious disease
  • References: • Patel R, et al. 2017 European guidelines for the management of genital herpes. Int J STD AIDS. 2017;28:1366-1379.
    • Workowski KA. Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61:S759-S762.
    • Ong JJ, et al. Clinical characteristics of herpes simplex virus urethritis compared with chlamydial urethritis among men. Sex Transm Dis. 2017;44(2):121-125.
    • Centers for Disease Control and Prevention. Genital herpes – CDC fact sheet (detailed). August 2017. https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

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