Herpes simplex virus infections and current methods for laboratory detection

Herpes simplex virus (HSV) is endemic in all societies throughout the world and produces year-round infections in all age groups. While orofacial and genital skin infections predominate, a significant minority of individuals develop more serious herpetic disease in the eye, meninges, and brain tissue. Perinatal infection of the newborn has a high likelihood of dissemination to multiple visceral organs, and immunocompromised patients can develop aggressive necrotizing skin lesions, as well as disseminated disease. HSV is not fastidious and is easily propagated in vitro; virus culture methods are straightforward and currently are offered in many community hospital microbiology laboratories. However, amplified nucleic acid probe assays have now been developed that are significantly more sensitive than culture, have fewer specimen collection and transport constraints, and can generate reliable results the same day of testing. Recent innovations in HSV antibody assays that use serotype 1- and serotype 2- specific reagents can now provide accurate serological separation of HSV-1 and HSV-2 infections by ELISA and Western blot (immunoblot) methods. Community hospitals should anticipate more frequent requests for these more sensitive and specific diagnostic tests. When reliable commercial assays become available, new serological and molecular tests may be within the scope of the community hospital laboratory.