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Sex Transm Infect 2002;78:430-434 doi:10.1136/sti.78.6.430
  • Original Article

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

  1. A J Copas1,
  2. F M Cowan1,
  3. A L Cunningham2,
  4. A Mindel2
  1. 1Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK
  2. 2University of Sydney and Westmead Hospital, Sydney, Australia
  1. 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
  • Accepted 28 June 2002

Abstract

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.

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