Genital herpes (GH) is the fourth most common sexually transmitted infection diagnosed at genitourinary medicine (GUM) clinics in the United Kingdom.¹ There are two herpes simplex virus (HSV) types; HSV-2 is almost entirely associated with genital disease whereas HSV-1 is associated with both oropharyngeal and genital disease. In some,^2–7 although not all,⁸ areas of the United Kingdom HSV-1 accounts for more than 50% of first episodes of GH. Differentiating between HSV types yields important prognostic information. Genital infection with HSV-1 shows a milder natural history than infection with HSV-2 and both symptomatic recurrences and subclinical shedding are less frequent.^9–16

GH is classified as primary when an HSV seronegative person acquires HSV-1 or HSV-2; initial non-primary when a person with antibody against one virus type acquires the opposite type; and recurrent. Primary and initial infections are often asymptomatic or unrecognised, but can become symptomatic at any time.^9,12,14 Thus a first episode of GH may represent a recently acquired or a long lasting infection. Most asymptomatic individuals with HSV-2 subsequently develop symptomatic disease.¹⁴

GH is a lifelong infection that can cause substantial morbidity to those infected and have serious consequences, including neonatal herpes and increased risk for HIV acquisition and transmission.¹⁷ As clinical signs and symptoms are often subtle, most infections are unrecognised and undiagnosed.^18,19 Infected people shed the virus intermittently, regardless of whether lesions are clinically apparent.¹⁵

RECOMMENDED TESTS

Screening of asymptomatic GUM clinic attendees by either HSV antibody testing (evidence level IV, recommendation grade C)^20–24 or HSV detection in genital specimens (evidence level IIa, recommendation grade B)^18,20 is not recommended at present, although this area is under active review.

HSV antibody testing

Testing for HSV type specific antibodies can be used to diagnose HSV infection in asymptomatic …