New USPSTF recommendations: Do not routinely screen for genital HSV infection in asymptomatic individuals

Routine serologic screening for genital herpes simplex virus infection in asymptomatic adolescents and adults, including pregnant women, is not recommended by the US Preventive Services Task Force (USPSTF), which concluded that the harms of such screening outweigh the benefits. Their newly released recommendations were published in the December 20 issue of the Journal of the American Medical Association.

“This is what we call a D recommendation, which is—do not do,” said Ann E. Kurth, PhD, RN, MSN, MPH, a member of the USPSTF, and dean of the Yale School of Nursing, Yale University, New Haven, CT. “Genital herpes is a commonly, sexually transmitted infection in the United States that unfortunately cannot be cured and is not easy to screen for,” she added.

One in 6 persons aged 14 to 49 years in the United States has genital herpes, according to estimates from the Centers for Disease Control and Prevention. Most cases have been caused by infection with HSV-2. The virus is caused by two subtypes, HSV-1 and HSV-2, but no treatments are available.

For this update on the 2005 screening recommendations, experts from the USPSTF reviewed evidence regarding the accuracy, benefits, and possible harm of serologic screening for HSV-2 infection in asymptomatic individuals; and the efficacy and harm of preventive medications and behavioral counseling interventions to reduce future symptomatic episodes and transmission to others.

Dr. Kurth and her fellow members of the USPSTF found that the currently available FDA-approved serologic screening test for HSV-2 is not suitable for population-based screening due to its low specificity, as well as to the lack of widely available confirmation testing, and its high false-positive rate. They also noted that although the rates of genital herpes caused by HSV-1 infection may be on the rise, serologic testing cannot determine the site of infection as oral or genital, and therefore is not useful for screening for asymptomatic genital herpes caused by HSV-1 infection.

The potential benefits of screening in asymptomatic adolescents and adults, including women who are pregnant, is small, members of the USPSTF also concluded, based on limited evidence from a small number of trials.

Furthermore, Dr. Kurth and colleagues also found evidence of moderate harm possibly arising due to screening in asymptomatic adolescents and adults, based on evidence from a small number of trials, the high false-positive rate of the test, and the potential to cause anxiety and disrupt personal relationships due to a diagnosis.

“Clinicians can’t easily screen for the disease and because there is no cure, there isn’t really all that much that can be done for people who aren’t having symptoms if they find out that they have genital infection. For that reason, given the inaccuracy of the available test, the fact that they will likely lead to false diagnoses in many asymptomatic people, we concluded that the harms of screening for herpes outweigh the benefits. And therefore, we recommend against screening for asymptomatic adults and adolescents,” Dr. Kurth said.

She added that this is unlike USPSTF recommendations for several other sexually transmitted diseases for which screening is advised, including chlamydia, gonorrhea, hepatitis B virus, HIV, and syphilis. But for these infections, specific treatments are available and counseling is also recommended, Dr. Kurth noted.