infectious diseases
Genital Herpes
Diagnosis of Genital Herpes
History and physical examination Culture and polymerase chain reaction (PCR) Serologic testing Diagnosis of genital herpes is often clinical based on characteristic lesions; clusters of vesicles or ulcers on an erythematous base are unusual in genital ulcers other than those due to HSV. However, these lesions are absent in many patients. Tests for HSV should be done to confirm the diagnosis if it is not clear. Testing is usually done using a sample of fluid from the base of a vesicle or of a newly ulcerated lesion, if present. Absence of HSV in culture, especially in patients without active lesions, does not rule out HSV infection because viral shedding is intermittent. Also, culture has limited sensitivity; PCR is more sensitive and is favored over culture. Direct immunofluorescence withfluorescein-labeled monoclonal antibodies is sometimes available; it is specific but not sensitive. Serologic tests can accurately detect HSV-1 and HSV-2 antibodies, which develop during the first several weeks after infection and then persist. Thus, if genital herpes is thought to be recently acquired, tests may have to be repeated to allow time for seroconversion. HSV serologic testing should be considered for the following; To evaluate patients who have no suspicious genital lesions but who require or request evaluation (eg, because of past genital lesions or high-risk behaviors) To help determine risk of developing lesions To identify pregnant women who do not have genital lesions but are at risk of transmitting herpes to the neonate during delivery To determine whether a person is susceptible to infection from a sex partner with genital herpes 