Under what clinical circumstances would you recommend serum herpes simplex virus (HSV) typing/testing? What information would you provide to a serum-positive but asymptomatic patient?
—Adena Bargad, PHD, CNP, ARNP, Gainesville, Fla.
The CDC’s 2006 sexually transmitted disease (STD) guidelines recommend serologic assays for (1) recurrent genital symptoms with negative HSV cultures; (2) a clinical diagnosis of genital herpes without laboratory confirmation; (3) a person whose partner has genital herpes; and (4) possibly as part of a comprehensive evaluation for STDs among persons with multiple sexual partners or HIV infection and among men having sex with men at increased risk for HIV acquisition. Screening for HSV-1 or HSV-2 in the general population is not recommended. Counseling of infected persons is important. Asymptomatic, seropositive patients should be advised that asymptomatic viral shedding does occur and that their sex partners should be informed. Condoms offer some protection but are not entirely effective against HSV because of behavioral and anatomic issues. Suppressive antiviral therapy has been shown to reduce asymptomatic shedding and decrease outbreaks.
—Jo Ann Deasy, PA-C, MPH (117-14)