Importance
Genital herpes is a prevalent sexually transmitted infection (STI) in
the United States; the Centers for Disease Control and Prevention (CDC)
estimates that almost 1 in 6 persons aged 14 to 49 years have genital
herpes.1
Genital herpes infection is caused by 2 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. Although vertical
transmission of HSV can occur between an infected pregnant woman and her
infant during vaginal delivery, interventions can help reduce
transmission. Neonatal herpes infection, while uncommon, can result in
substantial morbidity and mortality.
Detection
In the past, most cases of genital herpes in the United States have
been caused by infection with HSV-2. Adequate evidence suggests that the
most widely used, currently available serologic screening test for
HSV-2 approved by the US Food and Drug Administration is not suitable
for population-based screening, based on its low specificity, the lack
of widely available confirmatory testing, and its high false-positive
rate. Rates of genital herpes due to HSV-1 infection in the United
States may be increasing. While HSV-1 infection can be identified by
serologic tests, the tests cannot determine if the site of infection is
oral or genital; thus, these serologic tests are not useful for
screening for asymptomatic genital herpes resulting from HSV-1
infection.
Benefits of Early Detection and Intervention
Based on limited evidence from a small number of trials on the
potential benefit of screening and interventions in asymptomatic
populations and an understanding of the natural history and epidemiology
of genital HSV infection, the USPSTF concluded that the evidence is
adequate to bound the potential benefits of screening in asymptomatic
adolescents and adults, including those who are pregnant, as no greater
than small.
Harms of Early Detection and Intervention
Based on evidence on potential harms from a small number of trials,
the high false-positive rate of the screening tests, and the potential
anxiety and disruption of personal relationships related to diagnosis,
the USPSTF found that the evidence is adequate to bound the potential
harms of screening in asymptomatic adolescents and adults, including
those who are pregnant, as at least moderate.
USPSTF Assessment
The USPSTF concludes with moderate certainty that the harms outweigh
the benefits for population-based screening for genital HSV infection in
asymptomatic adolescents and adults, including those who are pregnant.