Diagnosis

History and examination.

The gold standard is viral culture. The sensitivity of the culture depends on the timing of the swab

• definitive diagnosis of an active lesion is best made through a viral culture
  • optimum collection time is when the lesions are in the vesicular phase. Because of the difficulty in obtaining an adequate sample, the sensitivity of the viral culture can be approximately 50%.

Now various other diagnostic methods are available in addition to viral culture (1):

• other methods for HSV detection include polymerase chain reaction testing, and antibody-based tests, including Western blot assay and type-specific glycoprotein G serologic test
  • serologic tests are used to detect previous HSV infection in asymptomatic patients or to diagnose infection in a symptomatic patient when culture is not feasible or the clinical syndrome is unclear
    • Western blot assay is considered the gold standard in serologic screening tests for genital HSV infection, with a sensitivity and specificity greater than 99%.

Reference:

• 1) Bavis MP et al. Genital Herpes: Diagnosis, Treatment, and Counseling in the Adolescent Patient. The Journal for Nurse Practitioner 2009;5(6): 415-420.