ORIGINAL ARTICLE

An evidence based approach to testing for antibody to herpes simplex virus type 2

A J Copas¹, F M Cowan¹, A L Cunningham² and A Mindel²

¹ Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK
² University of Sydney and Westmead Hospital, Sydney, Australia

Correspondence to:
Correspondence to:
Dr Andrew Copas, Department of Sexually Transmitted Diseases, Royal Free and University College London Medical School, Mortimer Market Centre, Off Capper Street, London WC1E 6AU, UK;
acopas{at}gum.ucl.ac.uk

Objectives: To establish whether a simple risk scoring system, based on limited information, can reflect the variation in HSV-2 prevalence in a population, and whether a common system can be used across settings. To establish whether knowledge of a patient’s score can aid the interpretation of the result from one of the commercial type specific assays.

Methods: Four previous cross sectional studies are considered, with HSV-2 antibody results by western blot or type specific ELISA tests. The clinical settings were a blood donor centre (1359 participants) and STD clinic (808 participants), London, United Kingdom, an antenatal clinic, Sydney, Australia (2317 participants), and a family medical centre, Seattle, United States (478 participants). We determined the factors associated with HSV-2 prevalence, the similarity of associations across settings, and the variation in HSV-2 prevalence by risk score.

Results: A simple scoring captured much variation in HSV-2 prevalence in each population—for example, for London blood donors, scoring based on sex, age, and number of lifetime partners, prevalence varied from 0.7% (95% CI 0.1 to 2.0) to 47.3% (37.9 to 56.6) across five risk groups. For number of lifetime partners, and sex, the association with HSV-2 varied significantly across studies.

Conclusions: A scoring system can aid test interpretation—for example, in London blood donors the post-test probability of infection following a positive result varies from around 25% to 98% across risk groups for a typical type specific assay. Further work could address whether this theoretical benefit can be realised in practice. A common risk scoring probably could not be used across settings.

Keywords: herpes simplex virus type 2; diagnostic test; sensitivity; specificity

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Brief Encounters

Mohsen Shahmanesh
Sex Transm Inf 2002 78: 392. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Geretti, A M (2006). Genital herpes. Sex. Transm. Infect. 82: iv31-iv34 [Full Text]  
• Song, B, Dwyer, D E, Mindel, A (2004). HSV type specific serology in sexual health clinics: use, benefits, and who gets tested. Sex. Transm. Infect. 80: 113-117 [Abstract] [Full Text]