Genital Herpes Infection: Beyond a Clinical Diagnosis

Adriana Villa, MD, Brian Berman, MD, PhD

In This Article


Diagnosing genital herpes infection may be challenging. Increasing the rate of diagnosis may not only alleviate the patient's symptoms, but may also have an impact in decreasing the transmission of genital herpes infection through appropriate counseling. Despite the low sensitivity of the clinical history and physical examination, both provide us with an overall scenario in which the given laboratory diagnostic methods will be interpreted. Therefore, a complete clinical evaluation should prevail as part of the diagnostic process and the individualized approach to patients, based on their risk factors for genital herpes infection. Direct specific laboratory tests should always be attempted in the symptomatic patient. If direct specific laboratory tests are negative, appropriate use of type specific serology becomes pertinent. In an article on genital herpes infection, Ashley[27] suggests the clinician should always formulate these questions when using these tests:

  • Is the laboratory using a truly type-specific HSV antibody test?

  • Has the test been validated for sensitivity against a rigorous standard (preferably culture), or against previously validated tests such as UW WB?

  • How does the test perform in populations similar to the clinician's practice?

  • What is the time of seroconversion for this test? The clinician must be familiar with the given test to be able to order it appropriately, interpret its result and determine when it is advisable to reconfirm a positive or a negative result in low-risk and high-risk populations respectively.

In the individual patient, specific serology tests may provide the basis for diagnosis, appropriate treatment and counseling, and constitute a necessary complement to the clinical diagnosis of genital herpes infection, when specific direct methods of diagnosis are negative.