The CDC estimates that about one in six U.S. residents ages 14-49 has genital herpes.1 In new draft guidance, the U.S. Preventive Services Task Force (USPSTF) recommends against using current blood tests to screen for genital herpes in people with no signs or symptoms of infection, including adolescents and adults, as well as pregnant women.2
“While genital herpes is relatively common, testing is not generally helpful for people who have not experienced symptoms, in part because the tests are often inaccurate,” says Task Force member Maureen Phipps, MD, MPH, department chair and Chace-Joukowsky professor of obstetrics and gynecology and assistant dean for teaching and research on women’s health at the Warren Alpert Medical School of Brown University in Providence, RI. “Further, because there’s no cure, there isn’t much doctors and nurses can do for people who don’t have symptoms.”
Most U.S. cases of genital herpes are caused by infection with herpes simplex virus-2 (HSV-2). According to the USPSTF evidence review, there is adequate evidence that the most widely used HSV-2 serologic screening test approved by the FDA is not suitable for population-based screening, due to its low specificity, lack of widely available confirmatory testing, and high false-positive rate.2
Task Force member Ann Kurth, PhD, RN, MSN, MPH, says, “People should be aware of the signs and symptoms of genital herpes and should talk to their doctor or nurse if they are concerned. This is especially true for women who are pregnant because there are things clinicians can do to help women who have genital herpes protect their babies during delivery.” Kurth is dean of the Yale School of Nursing and an adjunct professor at the New York University College of Nursing and the College of Global Public Health, as well as an affiliate faculty member at the University of Washington’s department of global health and School of Nursing.
The Task Force found that the benefits of screening are low, because screening, early identification, and treatment are unlikely to alter the course of the disease. However, the potential harms of screening for herpes are substantial, due in part to the high rate of false-positive results associated with blood tests.2
The draft recommendation is consistent with the Task Force’s 2005 final recommendation. There are no major public health organizations that recommend universal screening for genital herpes in patients who have no signs or symptoms, including pregnant women.
According to the 2015 STD Treatment Guidelines, all pregnant women should be asked whether they have a history of genital herpes. The guidance advises that at the onset of labor, women should be questioned carefully about genital herpes symptoms, including prodromal symptoms, and all women should be examined carefully for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. While cesarean delivery does not completely eliminate the risk of HSV transmission to the neonate, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean delivery to reduce the risk of neonatal HSV infection, the guidance advises.3
REFERENCES
- CDC. Genital herpes. Fact sheet. Accessed at http://bit.ly/NvXWhh.
- U.S. Preventive Services Task Force. Draft Recommendation Statement: Genital Herpes Infection: Serologic Screening. Accessed at http://bit.ly/2aMHJlm.
- CDC. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep 2015; 64(No. RR-3): 1-137.
