USPSTF reaffirms recommendation against routine serologic screening for genital herpes

The U.S. Preventive Services Task Force still does not recommend serologic screening for genital herpes infection in adults who do not exhibit signs or symptoms, according to a final recommendation statement published in JAMA.

The D-grade recommendation is consistent with the task force’s previous guidance in this area and calls for more research focusing on test accuracy, predictive value and management of asymptomatic genital herpes simplex virus (HSV).

In a press release, USPSTF Member James Stevermer, MD, MSPH, a professor of family and community medicine at the University of Missouri, said the task force found that screening for HSV in asymptomatic individuals “does not improve their overall health.”

“This is due in large part to the fact that the tests used to screen for genital herpes have limitations and a significant chance that the results will say a person has the infection when they do not,” he said. “In fact, if current screening tests were used across all adolescents and adults, as many as half of the positive results could be wrong.”

According to WHO data, HSV type 2 infections affected an estimated 491 million individuals aged 15 to 49 years in 2016, while 3.7 billion — or 67% of the world’s total population — had HSV type 1 infections the same year.

“The task force encourages people who are experiencing symptoms, have a partner who has been diagnosed with herpes, or have any concerns related to their sexual health to talk to their healthcare professional about testing and treatment options,” USPSTF Vice Chair Michael Barry, MD, a professor of medicine at Harvard Medical School, said in the release. “It is particularly important that people who are pregnant or planning to become pregnant speak with a healthcare professional if they have questions or concerns about their sexual health.”

The recommendation was based on an analysis of 3,119 abstracts and 64 full-text articles, none of which provided new evidence that sufficiently addressed screening accuracy, risk assessment and harms and benefits.

In a related editorial, Mark D. Pearlman, MD, Professor Emeritus of Obstetrics and Gynecology and Professor Emeritus of Surgery at the University of Michigan Health System, wrote that “while some may be disappointed or even disagree” with the recommendation, recent trends of decreased HSV prevalence offer hope.

Additionally, “from a clinical perspective, many experts do recommend providing targeted serotesting to populations at specific risk for adverse outcomes; for example, counseling pregnant persons to undergo serologic screening for HSV-1 and HSV-2 when the nonpregnant partner is known to have genital or oral herpes and the pregnant person is uncertain of their infection status or serostatus,” Pearlman wrote.

Other targeted strategies recommended by the CDC include “screening for HSV-2 antibody in the presence of recurrent or atypical genital symptoms with negative HSV polymerase chain reaction assay or culture results, a clinical diagnosis of genital herpes without laboratory confirmation, or in patients at higher risk for infection who ‘might need to be assessed for genital herpes symptoms’ to confirm the diagnosis,” Pearlman wrote.

“Of note, the current CDC STI guidelines and ACOG both concur with the USPSTF that routine screening in the general population or routine screening during pregnancy are not recommended,” he added.

References:

• Asher G, et al. JAMA. 2023;doi:10.1001/jama.2022.20356
• Herpes simplex virus. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus. Accessed Feb. 13, 2023.
• Mangione C, et al. JAMA. 2023;doi:10.1001/jama.2023.0057
• Pearlman D. JAMA. 2023;doi:10.1001/jama.2022.24870
• U.S. Preventive Services Task Force issues final recommendation statement on serologic screening for genital herpes infection. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/genital-herpes-screening-final-rec-bulletin.pdf. Published Feb. 14, 2023. Accessed Feb. 14, 2023.