Herpes simplex virus

Complications of an often underdiagnosed infection

Affecting almost half the worldwide population, herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) may pose a serious threat to immunocompromised patients and pregnant women.1

Transmission of HSV most often occurs without symptoms.1 HSV-1 is spread through oral-to-oral contact and primarily causes cold sores, while HSV-2 is transmitted almost entirely through sexual contact, causing genital herpes2 (symptoms may include fever, itching, burning, and trouble urinating). However, as the majority of these infections are asymptomatic or unrecognized—up to 90% of patients with genital herpes may be undiagnosed—patient management remains a challenge.3

This is especially true for vulnerable patient groups. Transplant recipients and patients with a compromised immune system, for example, are more susceptible to severe manifestations of HSV infection and may be slower to respond to therapy.4 Additionally, pregnant women risk transmitting the virus to the fetus or child which can cause significant disease and even death in infants.5

Adult patients with untreated infections may experience numerous complications, from increased risk of contracting other sexually transmitted infections (STIs) —including HIV —to bladder problems, meningitis, and rectal inflammation.6 The active infection can also have a significant negative impact upon a person’s mental wellness and personal relationships.

Correct monitoring and access to treatment can help lower the risk of spreading the HSV infection, underscoring the need for reliable diagnostic testing.

Close up of femal herpes simplex virus patient in hospital bed
The importance of the right diagnostic approach in HSV testing

Laboratories play an important role in identifying and informing patient management decisions that may reduce recurrence and limit transmission of the virus.

Several testing options are available for diagnosing an HSV infection, including a combination of serological and virologic techniques. However, molecular testing using polymerase chain reaction (PCR) technology is regarded as the most sensitive methodology to directly detect HSV-1 and HSV-2.

Since the type of infection affects prognosis and subsequent counseling, type-specific testing to distinguish HSV-1 from HSV-2 is recommended.

Given HSV’s potential for being overlooked during clinical diagnoses, its growing worldwide prevalence, and the access to effective antiviral therapy, rapid and accurate laboratory diagnosis is a necessity.

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  1. Globally, an estimated two-thirds of the population under 50 are infected with herpes simplex virus type 1. Accessed 10 October 2020.
  2. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Accessed 10 October 2020.
  3. Ashley RL, Wald A. Genital herpes: review of the epidemic and potential use of type-specific serology. Clin Microbiol Rev. 1999;12(1):1-8.
  4. Wilck MB, Zuckerman RA; AST Infectious Diseases Community of Practice. Herpes simplex virus in solid organ transplantation. Am J Transplant. 2013 Mar;13 Suppl 4:121-7.
  5. James SH, Sheffield JS, Kimberlin DW. Mother-to-Child Transmission of Herpes Simplex Virus. J Pediatric Infect Dis Soc. 2014;3 Suppl 1(Suppl 1):S19-S23.
  6. Genital herpes. Accessed 10 October 2020.
  7. Patel R, Kennedy OJ, Clarke E, et al. European guidelines for the management of genital herpes. Int J STD AIDS. 2017;28(14):1366-1379.