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USPSTF recommends against routine serologic screening for genital herpes
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The U.S. Preventative Services Task Force recently updated its 2005 recommendation on screening for genital herpes by issuing a recommendation statement and evidence report advising against routine serologic screening for genital herpes simplex virus infection in asymptomatic adolescents and adults.
“Genital herpes is a prevalent STI in the United States; the CDC estimates that almost one in six persons aged 14 to 49 years have genital herpes,” the USPSTF wrote in its recommendation statement. “Genital herpes infection is caused by two subtypes of HSV: HSV-1 and HSV-2. Unlike other infections for which screening is recommended, HSV infection may not have a long asymptomatic period during which screening, early identification, and treatment may alter its course. Antiviral medications may provide symptomatic relief from outbreaks; however, these medications do not cure HSV infection.”
The USPSTF based its recommendations on a systematic review of 17 studies including 9,736 participants that investigated the accuracy and harms of serologic screening tests for HSV-2. The investigators also reviewed literature for randomized clinical trials that compared screening with no screening or compared preventive medications with placebo; however, such trials were not identified or indicated heterogeneous and inconsistent results. Overall, the task force found that serologic screening for genital herpes heightened the risk for false-positive test results and potential psychosocial harms.
The update, a D-grade recommendation, suggests that the harms of serologic screening for genital HSV infection outweigh the benefits. The task force recommends, with moderate certainty, that clinicians not routinely screen asymptomatic adolescents and adults, including those who are pregnant, for genital HSV infection.
In an accompanying editorial, Edward W. Hook III, MD, from the department of microbiology at the University of Alabama at Birmingham, argued that this USPSTF recommendation should be of concern for both clinicians and parents. The lack of evidence and limited strength of the recommendation should encourage federal agencies such as the NIH to develop enhanced tests and screening strategies for diagnosing HSV, he wrote.
“While it is disappointing that so little progress in test performance has occurred in the more than a decade since the 2005 USPSTF recommendation against general population screening for this important and widespread STI, the current USPSTF recommendation should serve to renew efforts to develop better tests for HSV, to improve management strategy, and to address the pervasive and harmful stigma associated with genital herpes,” Hook concluded. – by Alaina Tedesco
References:
Feltner C, et al. JAMA. 2016;doi:10.1001/jama.2016.17138.
USPSTF. JAMA. 2016;doi:10.1001/jama.2016.16776.
Hook EW. JAMA. 2016;doi:10.1001/jama.2016.17139.
Disclosure: The USPSTF is supported by the Agency for Healthcare Research and Quality (AHRQ). Hook reported receiving support from Hologic and Roche Molecular, Becton Dickinson and Cepheid.
Perspective
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Aaron E. Glatt, MD
Routine serologic screening looking for evidence in the blood of prior herpes simplex virus genital infection (HSV-1 and HSV-2) in asymptomatic adolescents and adults is not indicated, according to the USPSTF’s updated recommendation. Treatment of asymptomatic patients in this setting is not indicated, and therefore screening in this fashion usually offers no practical benefit to a patient. Indeed, as opposed to appropriate screening for other sexually transmitted diseases, using such nonspecific herpes antibody testing to diagnose genital infection in asymptomatic adults is fraught with error, with the risk for false-positive test results and potential psychosocial harm being significant. Such testing is therefore not clinically warranted or beneficial for optimal patient care. I fully concur with the wise words of Dr. Ed Hook in his accompanying editorial to the USPSTF recommendation: “The recommendation against serologic screening for genital HSV is warranted.”
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