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Table 1 Direct methods for HSV diagnosis

From: Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention

Method

Tissue sampled

Sensitivity

Specificity

Advantages

Disadvantages

Virus isolation by cell culture1

Skin/mucosal lesions (stage):

   

Specialized laboratories

 

   - vesicular content

>90%

 

Gold standard

Virus transport medium

 

   - ulcers

95%

~100%

Simplicity of sampling

Transport rapid, cooled, protected from light

 

   - scabs

70%

 

Virus typing

Results in 2/7 days

 

   - mucosa without lesions

30%

 

Resistance phenotype determination

Not suitable for CFS

  

Unknown

  

Arrangement with laboratory necessary

 

Biopsies

    
 

Conjunctival smear/corneal

    
 

Neonates

    

Cytologic diagnosis

(Tzanck's smear)35

Skin/mucosal lesions

73–100%

100%

Easy, quick, reproducible and inexpensive

Optimal lesions are fresh, intact bisters of 1/3 days' duration

 

Biopsies

    
 

Conjunctival smear/corneal

    

IF (detection of infected cells)30

Smears, tissue sections, smears from base of vesicle

41–70%

>95%

Rapid (<4 h possible)

Typing possible

Fresh vesicles

     

Specialised laboratories

     

Technically demanding

     

Not standardized

Virus antigen detection

by EIA o ELISA30

Smears from lesions, vesicular content with base of vesicle

41–80%

80%

Simplicity of sampling

Suitable only for fresh vesicles

    

Does not require the integrity of the specimen

 
    

Rapid (<4 h possible)

 
    

Typing possible

 
    

PCR:

 
    

Most sensitive method

 

Virus DNA detection by PCR30 or Real-time PCR31

CSF

9798%

~100%

Result within 24–48 h

Only in specialised laboratories

 

Aqueous or vitreous humour

  

Virus typing and resistance genotyping

Not standardised

    

Method of choice for CSF

Not validated for all samples

     

Risk of contamination (PCR)

    

Real-time PCR:

High costs (real-time PCR)

 

Skin lesions, vesicular content or mucosa without lesions

  

Rapid amplification

 
    

Quantitative analysis

 
    

Reduced risk of contamination

 
    

Method of choice for skin lesions

 
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Virology Journal

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