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.
