The US Preventive Services Task Force recommends not screening asymptomatic adults for genital herpes infection, because the harms of screening outweigh the benefits.
Genital herpes is a sexually transmitted infection (STI) that is caused by 2 types of the Herpes Simplex Virus (HSV), in most cases by HSV-2. It affects 1 in every 6 people in the USA in the age group of 14-49 years. Genital herpes does not have a long asymptomatic period before symptoms appear, and it has no cure after infection, only treatment of the outbreaks is available. HSV-2 is detected by serologic screening techniques, however, these methods have a low specificity and a high false positive rate. Furthermore, HSV-1 screening is not specific for the site of infection (genital or oral).
The US Preventive Services Task Force (USPSTF) published their recommendation statement in the Journal of the American Medical Association on the routine HSV screening of asymptomatic adults. In their statement, they noted that screening tests for HSV are not sensitive and specific enough, almost half of the positive results are false positive. Furthermore, there is no real benefit of early detection, as no cure is currently available and the active infection only poses a risk to pregnant women and their neonates during delivery. Also, research has shown that neonatal infection is most likely to occur at the initial infection of the mother, and when an outbreak is present at time of delivery. However, a positive test result may result in social and emotional harm and unnecessary treatment. Therefore, the USPSTF does not recommend routine HSV screening of asymptomatic adults. This recommendation is in accordance with recommendations of the American Academy of Family Physicians, The American Congress of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC). Both CDC and ACOG suggest a caesarean delivery in case of an active HSV infection, and the CDC suggests screening for HSV in the case of recurrent atypical symptoms and HIV infection or high risk for HIV. The CDC also suggests a suppressive therapy in infected pregnant women after 36 weeks of gestation.
The USPSTF does not recommend screening of asymptomatic adults for genital herpes, but they note that further research is needed to develop tests with higher sensitivity and specificity and to use behavioral intervention to reduce the risk of infection, especially in pregnant women.
Written By: Dr. Fanni R. Eros
