Use of type-specific HSV serology in the management of a 37-year-old woman diagnosed with primary genital herpes

Abstract

A 37-year-old woman attended a Genitourinary Medicine Clinic in London, UK, concerned about the reliability of a culture-based diagnosis of genital herpes that she had received while abroad. She was in a longterm monogamous relationship with a partner who recalled no history of genital herpes. She was unsure as to how she had acquired genital herpes and wished to know whether she was newly infected. Typespecific serological testing indicated a true primary herpes simplextype-2 (HSV-2) infection. The patient's partner did not attend the clinic but reported a (negative blood test for herpes) at a clinic elsewhere. No details were provided as to the type of assay used, so the possibility that this result was inaccurate cannot be ruled out. It is possible that he may have been an asymptomatic carrier of HSV (either HSV-2 or both HSV-1 and-2) or had mild unrecognized symptoms of genital HSV. This case highlights the advantages and pitfalls of using a type-specific serological test for the diagnosis of genital herpes and also the need for appropriate counselling. An initial explanation of the significance of the HSV culture result she received abroad may have reduced the patient's anxiety about the reliability of the initial diagnosis.