USPSTF recommends against routine serologic screening for genital herpes simplex virus

The USPSTF recommends against routine serologic screening for genital herpes simplex virus infection.
The USPSTF recommends against routine serologic screening for genital herpes simplex virus infection.

The US Preventive Services Task Force (USPSTF) has released an updated recommendation against routine serologic screening for genital herpes simplex virus (HSV) infection in asymptomatic adolescents and adults, including women who are pregnant.

The USPSTF gave a D grade to its recommendation, which updates the 2005 USPSTF recommendation on screening for genital herpes.

The task force reviewed the evidence of the accuracy, benefits, and harms of serologic screening for HSV-2 infection in asymptomatic persons. They also reviewed the evidence of the effectiveness and harms of preventive medications and behavioral counseling interventions to lower symptomatic episodes and transmission to others.

Based on the natural history of HSV infection and the available evidence on the accuracy of serologic screening tests, the task force found that the potential benefits of HSV screening in asymptomatic adults and adolescents is small, and concluded that the harms outweigh the benefits of screening for HSV screening in this population.

The USPSTF notes that serologic screening in asymptomatic individuals will most likely result in a large number of false-positive results. Testing to confirm these results is not widely available and is only performed in a single research laboratory.

In addition, many areas of research are needed to better understand the detection and management of asymptomatic HSV, including improved epidemiologic data on the prevalence of the virus, the development of screening and diagnostic tests with higher specificity to detect genital HSV-1 and HSV-2 infections, and an increased understanding of the role of HSV in the increasing risk of HIV infection.

In an accompanying editorial, Edward W Hook III, MD, from the School of Medicine, Department of Microbiology at the University of Alabama at Birmingham, noted that the recommendation should not be misinterpreted to assume that the current tests for HSV do not have a role in current herpes management. The current tests are useful for diagnostic testing, evaluating individuals with a history of recurring anogenital lesions, and providing information that could influence treatment decisions.

“While it is disappointing that so little progress in test performance has occurred in the more than a decade since the 2005 USPTF recommendation against general population screening for this important and widespread STI, the current USPSTF recommendation should serve to renew efforts to develop better tests for HSV, to improve management strategy, and to address the pervasive and harmful stigma associated with genital herpes,” he stated.

Recommendation Summary


Population: Asymptomatic adolescents and adults, including those who are pregnant
Recommendation: The USPSTF recommends routine serologic screening for genital herpes simplex virus (HSV) infection in asymptomatic adolescents and adults, including those who are pregnant.
Grade: D
Screening tests: The USPSTF does not recommend serologic screening for genital HSV infection in asymptomatic persons.
Treatment: The CDC provides guidance for the diagnosis and management of genital HSV infection.
Additional approaches to prevention: The USPSTF recommends intensive behavioral counseling interventions to reduce the likelihood of acquiring a sexually transmitted infection for all sexually active adolescents and for adults at increased risk.

Reference

  1. US Preventive Services Task Force. Serologic screening for genital herpes infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(23):2525-2530. doi:10.1001/jama.2016.16776
  2. Hook EW. A recommendation against serologic screening for genital herpes infection—what now? JAMA. 2016;316(23):2493-2494. doi:10.1001/jama.2016.17139
  3. US Preventive Services Task Force. Final Recommendation Statement: Genital Herpes Infection: Serologic Screening. Accessed December 21, 2016.
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