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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
  Conjunctival smear/corneal     
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
  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  
     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