The Purpose of HHV-2 Screening

The purpose of screening for Genital Herpes is to identify infected patients and help them recognize symptoms, reduce transmission to others, and protect themselves from acquiring HIV and other STDs. Screening the people also helps to identify uninfected patients and helps them protect themselves from acquiring genital herpes and other STDs. The following screening recommendations are based on currently available evidence and expert opinion. Patient education and client-centered risk-reduction counseling should always be provided in conjunction with HSV serologic screening.

Screening in Patients at Risk for STD/HIV

Individuals with multiple partners and high-risk sexual behavior are at increased risk of acquiring and transmitting HSV-2. If a provider identifies a patient as being at risk for STD/HIV and is motivated to reduce his or her sexual risk behavior, the provider should offer HSV-2 serology testing as an adjunct to counseling to facilitate risk reduction. Recommendations for how frequently patients who test negative for HSV-2 should be screened have not yet been established.

Screening in HIV-infected Patients

Asymptomatic HSV-2 infections in HIV-infected individuals may be associated with increased transmission of HIV and may accelerate the course of HIV disease. Thus, providers should offer screening to HIV-infected patients who do not have a history of genital herpes. If previously unidentified symptoms are uncovered with screening, HSV suppressive therapy may be offered for symptom management. Although the subject of ongoing clinical trials, there is currently no direct evidence that HSV antiviral suppression will decrease HIV transmission. In addition to the risk-reduction counseling that should be offered to all HIV-infected patients, HSV specific education and counseling also should be provided. HIV-infected patients who are HSV-2 negative have a high risk of HSV-2 acquisition. Recommendations regarding frequency of repeat testing for those who test negative have not yet been developed; however, testing should be considered with acquisition of STDs or high-risk behaviors.

Screening of Patients in Relationships or Considering Relationships With HSV-2-Infected Individuals

Individuals in HSV-serodiscordant relationships are at high risk of HSV transmission. To inform patients' sexual decision-making, providers should offer to screen patients whose partners or potential partners have a history of genital herpes or known HSV- 2 infection. Serologic testing would be useful if results indicating discordance motivate couples to take measures to prevent transmission. Recommendations regarding frequency of repeat testing for those who test negative have not yet been established. However, testing should be considered if genital symptoms develop, prior to entry into a new partnership, and for seronegative women when pregnant. HSV-2- infected patients should be educated about the risk of transmission in future partnerships, pregnancy risks, and risk of HIV acquisition.

Screening in Pregnancy

Neonatal herpes, although rare, is one of the most serious complications of herpes infection. Unfortunately, there is no evidence that screening women to identify at-risk pregnancies (serologically negative pregnant women with HSV-infected partners) will lead to a reduction in neonatal herpes. Therefore, universal screening should not be offered to pregnant women. Among women with existing HSV infection, maternal antibodies passed to the neonate are usually protective against infection at birth. Because there are no known safe and effective interventions to prevent neonatal transmission when lesions are absent at delivery, screening to identify pregnant women with asymptomatic herpes infections is not recommended. All pregnant women should be asked about their own and their partners' history of genital (and oral) herpes and examined for evidence of active herpes lesions at delivery. Providers should offer screening to asymptomatic pregnant women whose partners have genital herpes, as well as HIV-infected pregnant women. Serodiscordant couples (serologically negative pregnant women with HSV-infected partners) should be educated regarding the risk of acquiring and transmitting herpes and transmission to their newborn. Specific advice should be to avoid sex or to use condoms consistently in the third trimester. Women who have a history of herpes or seroconvert before delivery have a very low risk of transmitting herpes to their newborn. These women should be educated about their low risk of neonatal herpes and that cesarean section does not reduce risk except when they have symptoms around the time of delivery. Antiviral suppression has been shown to decrease the rate of cesarean sections.

Screening in the General Population

Universal HSV-2 screening of sexually active patients is not recommended because there is limited evidence that either risk-reduction counseling or antiviral medication will significantly decrease HSV transmission in the general population.

Education and Counseling Herpes education and prevention counseling is necessary for all patients being tested or screened for HSV-2. In pre-test counseling, the provider can determine patient preparedness for the diagnosis, as well as motivation to reduce risk behavior. Post-test counseling can provide support and reassurance to patients testing positive, as well as educate them about the natural history of the disease and its transmissibility. Those identified as uninfected should be informed about how to prevent future acquisition of herpes and other STDs.