From: Diagnosis of genital herpes simplex virus infection in the clinical laboratory
Method | Principle | Sample | Sensitivity | Specificity | Advantages | Disadvantages |
---|---|---|---|---|---|---|
Viral antigen detection | Immunopreoxidase staining | Swab | Middle (80%) | High (90%) | Reagent cost | Fresh vesicles |
Smears from lesions | ||||||
Rapid (<4 hours possible) | Suboptimal sensitivity | |||||
Smear or vesicular fluid of exudate from base of vesicle | ||||||
Does no require the integrity of the specimen | ||||||
Typing possible | ||||||
Capture ELISA | Swab | High (Genital ulcer: >95%) | High (62-100%) | Fresh vesicles | ||
Vesicular fluid or exudate from base of vesicle | No viral typing | |||||
Rapid test device | Swab | Unknown | Unknown | Point-of-care testing | Not yet evaluated | |
Vesicular fluid or exudate from base of vesicle | ||||||
Virus culture | HSV isolation susceptible cells | Swab | Low to high depending of the clinical context | High (≈100%) | Allows virus isolation | Less sensitive than PCR |
Skin lesions | ||||||
Sample storage and transport conditions influence sensitivity | ||||||
Classically, “gold standard” method | ||||||
Vesicular fluid or exudate from base of vesicle | Vesicular content :>90% | |||||
(➜ Rapid transport, cooled, protected from light in virus transport medium) | ||||||
Currently, “preferred” test (CDC 2010) | ||||||
Ulcer : 95% | ||||||
Swab : 70%-80% | ||||||
Labor-intensive | ||||||
Mucosal sample without lesions Biopsies | Mucosa without lesion: 30% | Simplicity of sampling | ||||
Expensive | ||||||
Virus typing | Specialized laboratories | |||||
Resistance | Results in 2/7 days | |||||
Phenotype testing* | Arrangement with laboratory necessary | |||||
Conjunctival/corneal smear | ||||||
Neonates | ||||||
Molecular biology | HSV DNA detection and/or quantitation by NAAT, including in-house classical PCR, real-time PCR and commercial assays | Swab | Highest | High. | High sensitivity. | Only in specialized laboratories |
Skin lesions | (98%) | (≈100%) | ||||
Vesicular fluid or exudate from base of vesicle | Containment of potential cross-contamination important | Currently, “preferred” test (CDC 2010) | Not standardized | |||
Allows virus detection and typing in the same test | Not validated for all samples | |||||
Mucosal sample without lesions | ||||||
Risk of contamination (PCR) | ||||||
May be relatively expensive (real-time PCR) | ||||||
Rapid | ||||||
Aqueous/vitreous humor | May be automated. | |||||
Labor efficient | Routine resistance genotyping not available | |||||
Cortico-spinal fluid | ||||||
Result within 24–48 h, possibly in <3 hours | ||||||
Blood | ||||||
Resistance genotyping | ||||||
Method of choice for CSF | ||||||
Real-time PCR: | ||||||
Rapid amplification | ||||||
Quantitative analysis | ||||||
Reduced risk of contamination | ||||||
Method of choice for skin lesions | ||||||
Cytological examination | Tzanck smears | Skin/mucosal lesions | Low | Low | Inexpensive | Fresh lesions |
Papanicolaou or Romanovsky stain | low sensitivity and no distinction between HSV-1 and HSV-2, nor between HSV and varicella zoster virus infection | |||||
Biopsies | ||||||
Conjunctival/corneal smears | ||||||
Detection of infected cells by direct immunoflorescence | Smears, Tissue section Smear from base of vesicle | Middle | High | Inexpensive | Fresh vesicles | |
(Genital ulcer: 70-90% | (>95%) | Rapid (<4 hours possible) | Suboptimal sensitivity | |||
Asymptomatic : < 40-50%) | ||||||
Typing possible | Time-consuming | |||||
Labor-intensive | ||||||
Not standardized |