How To Diagnose Herpes Simplex

If You Have Active Symptoms Of Herpes

If active symptoms are present and the sores are not healed one should request a specific virus culture or assay for the herpes virus. A Viral culture looks for the presence of the virus in the lesion. This method is very specific and does not frequently give a positive result when something else is the culprit.

The viral culture often misses herpes even when it is present Often a patient who has received a negative culture result will be asked to come back again when a new genital lesion appears so the culture can be tried a second or third time.

How Do Dermatologists Treat Herpes Simplex

There is no cure for herpes simplex. The good news is that sores often clear without treatment. Many people choose to treat herpes simplex because treatment can relieve symptoms and shorten an outbreak.

Most people are treated with an antiviral medicine. An antiviral cream or ointment can relieve the burning, itching, or tingling. An antiviral medicine that is oral or intravenous can shorten an outbreak of herpes.

Prescription antiviral medicines approved for the treatment of both types of herpes simplex include:

Taken daily, these medicines can lessen the severity and frequency of outbreaks. They also can help prevent infected people from spreading the virus.

Importance Of Laboratory Diagnosis Or Testing For Genital Herpes

Genital herpetic infection is mainly diagnosed on clinical grounds, especially when the clinical picture is classical, with the presence of typical papular lesions progressing to vesicle and ulcerative lesions which finally crust, associated with local adenitis and in recurrent cases preceded by prodromal . However, clinical diagnosis of genital herpes may be limited in accuracy. The clinical differentiation of genital HSV infection from other infectious and non-infectious etiologies of genital ulceration is often difficult and laboratory confirmation of the infection should always be sought . Besides classic vesicular lesions, HSV genital infection may be associated with other clinically atypical presentations. These include either unusual sites or atypical morphological forms of genital disease . Meningitis may be observed during phases of primary infection and reactivation and can also confuse the diagnosis of genital HSV infection . Accordingly, exclusive reliance on clinical diagnosis could lead both to false positive and false negative diagnosis of the condition. Thus, a clinical diagnosis of genital herpes should be confirmed with laboratory tests .

Figure 1

The laboratory diagnosis of genital herpes is recommended in various situations:

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What Are The Symptoms Of Herpes Simplex

Many people with the infection never experience any herpes symptoms. If you do notice symptoms, youll experience them differently depending on whether youre having your first herpes outbreak or a repeat outbreak. Recurring symptoms are usually milder than the first outbreak. Symptoms dont last as long with later outbreaks. Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.

People who do have herpes symptoms may experience:

• Cold sores around their lips, mouth or tongue. They may look crusty or like fluid-filled blisters.
• Tingling, itching or burning.
• Pain while urinating.

When Is It Ordered

HSV PCR testing or herpes culture may be ordered when you have signs and symptoms of a herpes infection, such as a blister or blisters on or around your eye, mouth, genitals or rectum.

Herpes PCR testing may be ordered when you have signs and symptoms of encephalitis that a healthcare practitioner suspects may be caused by a virus. Examples of these signs and symptoms include:

Prenatal and newborn testing

• A pregnant woman who has been diagnosed with herpes may be monitored regularly prior to delivery to detect a reactivation of her infection.
• A baby born to a mother who has active lesions during delivery may be tested before symptoms appear to assess whether the baby was exposed to HSV during delivery.
• A mother and newborn may be tested for HSV soon after delivery when a baby shows signs of HSV infection, such as meningitis or skin lesions that could be caused by the herpes virus.

HSV antibody testing may be done when your healthcare practitioner wants to determine if you have been exposed to HSV in the past.

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Is A Blood Test For Genital Herpes Included When I Ask To Be Tested For Everything Why Does Cdc Recommend Testing For Other Stds But Not Herpes

Herpes blood tests may or may not be included. Your doctor chooses STD tests based on your sexual behaviors , as well as how common the infection is in the area that you live in. This is why you should have an open and honest discussion with your doctor about your sex practices and history. When you go in for STD testing, it is important to ask your doctor which infections you are and are not being tested for, and why.

STD tests are usually done for infections that have serious outcomes if they are not treated. For example, finding and treating curable STDs like chlamydia can stop them from causing serious complications like infertility in women. Genital herpes does not usually result in serious outcomes in healthy, non-pregnant adults. More often, the stigma and shame from a genital herpes infection can be more troubling to someone who is infected than the disease itself. If you are worried about genital herpes, you should talk with your doctor about whether you should be tested.

Is Herpes Simplex Related To Herpes Zoster

Herpes simplex and the varicella-zoster virus are related, but they arent the same. VZV causes chickenpox and shingles.

Like HSV-1 and HSV-2, shingles can cause a painful, blistering rash. The shingles rash usually shows up on the back, side, abdomen , neck and face. It is often only on half of your body, following the pattern of your nerves. See your healthcare provider if you have a new rash and suspect you may have shingles.

A note from Cleveland Clinic

Herpes simplex is a virus. Once you have herpes, its a lifelong condition. A herpes infection can lead to outbreaks , but youll also have times when you have no symptoms. The main sign of herpes is sores that appear on the infected skin. Some people choose not to treat herpes, especially if symptoms are mild. Others take antiviral medications to reduce the severity and frequency of outbreaks.

Last reviewed by a Cleveland Clinic medical professional on 05/17/2022.

References

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Tests That Are Not Recommended

Some clinics will use diagnostic tools other than the recommended tests. Among these, two are generally NOT recommended:

Neither of these are specific tests for herpes.

A Pap smear is not a specific test for herpes and so the virus can go overlooked or be misdiagnosed, especially if no active symptoms are present at the time of the smear. When testing for herpes it is important that your Doctor perform a test specifically for the herpes virus.

Are There Other Types Of Herpes Viruses Besides Hsv

Yes. There are over 25 viruses in the herpes family and at least 8 types that infect humans. These include herpes simplex virus types 1 and 2 discussed in this article as well as varicella zoster virus , associated with chickenpox and shingles, Epstein Barr virus , which can cause infectious mononucleosis, cytomegalovirus , human herpes virus 6 and human herpes virus 7 , both associated with roseola in young children, and human herpes virus 8 , which has been found in tumors in people with Kaposi’s sarcoma . KS primarily affects people with weakened immune systems, such as those with HIV/AIDS and organ transplant recipients.

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Is There Anything Else I Should Know

Herpes can make people more susceptible to HIV infection. The skin lesions give other sexually transmitted diseases , including HIV, openings for entering the body. Likewise, it can make HIV-infected individuals more infectious. Infection with HSV can also increase HIV viral load. HSV-2 infection is a significant opportunistic infection in HIV-infected individuals due to immune system deficiencies up to 90% of HIV-infected individuals are co-infected with HSV-2.

Submission And Collection Notes

Follow the instructions found in the Virus-Culture Kit Instruction Sheet.

HSV resistance testing is also available at NML (National Microbiology Laboratory, Winnipeg when clinically indicated. Specimens submitted for this test is initially cultured at PHO Laboratory prior to submission to NML for HSV 1 or HSV 2 resistant testing: NML guidelines-Viral Exanthemata and STDs-Viral STI, Polyoma and Herpesvirus unit.

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Is There Anything Else I Need To Know About An Hsv Test

The best way to prevent genital herpes or another STD is to not have sex. If you are sexually active, you can reduce your risk of infection by

• Being in a long-term relationship with one partner who has tested negative for STDs
• Using condoms correctly every time you have sex

If you’ve been diagnosed with genital herpes, condom use can reduce your risk of spreading the infection to others.

What You Need To Know

• Fifty percent to 80 percent of U.S. adults have oral herpes.
• Oral herpes can be spread through intimate contact with someone who is infected.
• Oral herpes can be difficult to diagnose. Often confused with many other infections, it can only be confirmed with a virus culture called PCR, blood test or biopsy. PCR is the preferred test for diagnosing herpes infections.
• The best treatment for oral herpes is antiviral oral medication. Symptomatic treatment may include antiviral ointment, over-the-counter topical anesthetics or over-the-counter anti-inflammatory agents.

Whether you call it a cold sore or a fever blister, oral herpes is a common infection of the mouth area that is caused by herpes simplex virus type 1 . Fifty percent to 80 percent of U.S. adults have oral herpes. According to the National Institutes of Health, about 90 percent of adults have been exposed to the virus by age 50.

Once infected, a person will have herpes simplex virus for the rest of his or her life. When inactive, the virus lies dormant in a group of nerve cells. While some people never develop any symptoms from the virus, others will have periodic outbreaks of infections.

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Other Infections And Complications

). Transmission usually occurs at birth, when the baby comes into contact with infected secretions in the birth canal. Rarely, HSV is transmitted to the fetus during pregnancy. Transmission during birth is more likely when

• The mother has recently acquired the herpes infection

• The mother has visible herpes sores in the vaginal area, although babies may become infected from mothers who have no apparent sores

When acquired at birth, the infection appears between the 1st and 4th week of life. Newborns with HSV infection become very ill. They may have widespread disease, brain infection, or skin infection. Without treatment, about 85% of those with widespread disease and about half of those with a brain infection die. Even with treatment, many have brain damage.

Prevention Of Hsv Infections

People with HSV infection should avoid activities and other things known to trigger recurrences. For example, people with oral HSV infection triggered by sunlight should avoid exposure to sunlight as much as possible or use sunscreen when sunlight cannot be avoided.

Because HSV infection is contagious, people with infection of the lips should avoid kissing as soon as they feel the first tingling until the sore has completely healed. They should not share a drinking glass and, if possible, should not touch their lips. They should also avoid oral sex.

at all times. Even when there are no visible blisters and no symptoms, the virus may be present on the genitals and can be spread to sex partners.

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Who Gets Herpes Simplex

Primary attacks of Type 1 HSV infections occur mainly in infants and young children. In crowded, underdeveloped areas of the world, nearly all children have been infected by the age of 5. In less crowded places, the incidence is lower for example, less than half of university entrants in Britain have been infected. Type 2 HSV infections occur mainly after puberty and are often transmitted sexually.

HSV is transmitted by direct or indirect contact with someone with active herpes simplex, which is infectious for 712 days. Asymptomatic shedding of the virus in saliva or genital secretions can also lead to transmission of HSV, but this is infrequent, as the amount shed from inactive lesions is 100 to 1000 times less than when it is active. The incubation period is 212 days.

Minor injury helps inoculate HSV into the skin. For example:

• A thumb sucker may transmit the virus from their mouth to their thumb.
• A health-care worker may develop herpetic whitlow
• A rugby player may get a cluster of blisters on one cheek .

How Can You Prevent Cold Sores

There are some things you can do to keep from getting the herpes simplex virus.

• Avoid coming into contact with infected body fluids, such as kissing an infected person.
• Avoid sharing eating utensils, drinking cups, or other items that a person with a cold sore may have used.

After you have been infected with the virus, there is no sure way to prevent more cold sores. But there are some things you can do to reduce your number of outbreaks and prevent spreading the virus.

• Avoid the things that trigger your cold sores, such as stress and colds or the flu.
• Always use lip balm and sunscreen on your face. Too much sunlight can cause cold sores to flare.
• Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore may have used.
• When you have a cold sore, make sure to wash your hands often, and try not to touch your sore. This can help keep you from spreading the virus to your eyes or genital area or to other people.
• Talk to your doctor if you get cold sores often. You may be able to take prescription pills to prevent cold sore outbreaks.

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What Questions Should I Ask My Doctor

You may want to ask your healthcare provider:

• What is the best treatment for me?
• What happens if I dont treat a cold sore?
• What are the side effects of antiviral medications?
• How can I reduce the risk of future outbreaks?
• Whats the best way to prevent getting another STI?
• How can I protect my partner from getting genital herpes?
• Should I lookout for signs of complications?

If You Have No Symptoms Of Herpes

Herpes Blood Tests are generally used in cases where no visible symptoms are present. A blood test works by detecting the presence of herpes antibodies There is a possibility that the virus will not show up in a blood test, and a positive result is not always indicative that a person has genital herpes.

Firstly, after the first exposure to herpes, a person may take several weeks to develop the antibodies that the test looks for Usually, it takes two weeks to three months after exposure to herpes for antibodies to appear in the blood.

Some blood tests detect antibodies sooner than others. However, once antibodies are found they remain in the body for life.

Secondly, blood tests cannot tell the difference between the two types of herpes, HSV-1 and HSV-2. For this reason, anyone seeking an accurate diagnosis of genital herpes must be sure to get a âtype-specificâ serologic herpes test, which can accurately distinguish HSV-2 from HSV-1 antibodies. Most commercially available kit assays currently cannot make this distinction despite their claims.

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Warnings For People With Certain Health Conditions

For people with kidney problems: Your kidneys clear this drug from your body. If you have kidney problems or a history of kidney disease, you may not be able to clear it from your body. This may increase the levels of the drug in your body and cause more side effects. This drug can also make your kidney function worse. To help prevent these problems, your doctor may prescribe a lower dosage of this drug for you.

For people with advanced HIV or a history of transplant: If you have advanced HIV or a history of bone marrow or kidney transplant, you may be at a higher risk of certain blood disorders. These conditions are called thrombocytopenic purpura and hemolytic uremic syndrome . They can result in severely low red blood cells and platelets in your body. TTP or HUS can cause death.

Therapeutic Monitoring: Drug Resistance Testing

Long-term prophylaxis and treatment with antiviral drugs targeting the viral DNA polymerase can result in the development of resistance . The prevalence of acyclovir-resistant HSV is about 1% in immunocompetent individuals and increases in immuncompromised patients, 5% in HIV-seropositive individuals and 30% in hematopoietic stem cell recipients . Antiviral drugs such as acyclovir or valacyclovir inhibit the viral DNA pol in triphosphorylated form, the first phosphorylation step ensured by the viral thymidine kinase and the subsequent steps by host cell kinases. Therefore mutations in both DNA pol and TK may confer resistance to antiviral drugs . Because a functional TK may be dispensable but not the DNA pol for HSV replication, there is a higher probability of inducing a viable acyclovir-resistant virus by a mutation in the UL23 gene coding for TK than by a mutation in the UL30 gene coding for DNA pol. Accordingly, 95% of clinical isolates exhibiting acyclovir resistance harbor mutations in UL23 gene .

Table 9 Molecular changes associated with anti-herpetic drugs resistance in thymidine kinase and DNA polymerase genes of Herpes simplex virus type 1 and type 2 according to amino acid mutations, stop codon and nucleotide insertion or deletion reported in the literature

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