Table 8 Indications of type specific serology

Asymptomatic patients

Not routinely recommended

Confirmation of clinical diagnosis

HSV-2 antibodies are supportive of a diagnosis of genital herpes.

History of recurrent or atypical genital disease with direct virus detection negative

HSV-1 antibodies do not differentiate between genital and oropharyngeal infection.

Counseling of HSV-2 IgG-negative, HSV-1 IgG-positive patients should take into account that HSV-1 is an uncommon cause of recurrent genital disease.

First-episode genital herpes

Differentiation between primary and established infection guides counseling and management.

At the onset of symptoms, the absence of HSV IgG against the virus type detected in the genital lesion is consistent with a primary infection.

Seroconversion should be demonstrated at follow-up.

Partner with genital herpes

Knowledge of infection status can guide patient education and counseling if the partnership is discordant.

Pregnant women

Not routinely recommended.

HSV-1 and/or HSV-2 seronegative women should be counseled about strategies to prevent a new infection with either virus type during pregnancy.

HIV infected patients

Not routinely recommended.

Although HSV-2 seropositivity increases the risk of HIV transmission and frequent HSV recurrences augment HIV replication, there is limited evidence to inform the management of HSV-2 co-infection in HIV-infected patients without symptoms of genital herpes.

Limited data suggest an increased risk of perinatal HIV transmission among HSV-2 seropositive HIV-infected women. As the evidence is not consistent, testing of HIV-positive pregnant women is not routinely recommended.