USPSTF advises against the routine serological screening for Herpes in teens and adult.

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The WHO estimated that half a billion people worldwide aged 15-49 years have genital infection caused by Herpes virus. In USA, nearly one out of six people aged 14 to 49 years have it.[1]

Globally, WHO estimated that two-thirds of the population under 50 are infected with herpes simplex virus type 1.[2]

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Genital herpes is caused by two type of viruses, Herpes simplex type1(HSV-1) and Herpes Simplex type 2 (HSV-2), a virus that almost exclusively causes genital infections.  HSV-1 is a closely related virus that causes both oro-labial herpes (“cold sores”) and genital herpes.[3]

The US Preventative Services Task Force (USPSTF) released an evidence statement and updated it’s 2005 recommendation on serological screening for genital herpes online on December 20, 2016 in JAMA and its own website.

The USPSTF recommends against routine serologic screening for genital herpes simplex virus (HSV) infection in asymptomatic adolescents and adults, including those who are pregnant.

Screening is indicated for certain high risk groups like men who have sex with men and HIV positive individuals.

After thorough review of evidence, USPSTF concluded that harms of screening outweigh the benefits because the current serological test used gives large number of false positive results and no confirmatory test is widely available.

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Ann E. Kurth, PhD, MPH, a task force member said in a USPSTF news release “Despite genital herpes being common, testing is not generally helpful for people without symptoms, in part because early identification does not improve a person's health as there is no cure for herpes.” She further added “In addition, because current screening methods are often inaccurate, harms of screening include high false-positive rates and potential anxiety and disruption of personal relationships related to diagnosis."

Currently HerpeSelect® (Focus Diagnostics, Cypress, CA) is the most widely used FDA approved enzyme immunoassay for the qualitative detection of type specific HSV-2 IgG with sensitivity of 97 to 100% and specificity of 72 to 91%.

"Given the test characteristics of the most widely used serologic screening test for HSV-2 and a population infection prevalence of 15 percent, screening 10,000 people would result in approximately 1,485 true-positive and 1,445 false-positive results," the final recommendation statement said.[4]

False positive results lead to emotional and mental trauma along with unnecessary treatment with antiviral medications.

Diagnostic testing is indicated in persons who have recurrent HSV infection or belong to certain high risk groups like persons living with HIV infection.

The task force clarified its stand about HSV-1 infection, noting that although HSV-1 infection can be identified by serologic tests, the tests cannot determine if the site of infection is oral or genital.

The USPSTF recommends intensive behavioral counseling interventions to reduce the likelihood of acquiring a sexually transmitted infection for all sexually active adolescents and for adults at increased risk. The USPSTF has also issued recommendations on screening for other sexually transmitted infections, including chlamydia and gonorrhea, hepatitis B virus, HIV, and syphilis.

The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists (ACOG), and the CDC do not recommend routine serologic screening for genital HSV infection in asymptomatic adolescents or adults.

The AAFP released its own recommendations that mirror the USPSTF statement.

In an accompanying editorial in JAMA by  Edward W. Hook III, MD, School of Medicine, Department of Microbiology, The University of Alabama at Birmingham, calls for improving performance of new and currently available tests.

He also acknowledged the lack of progress in test performance since the last USPSTF update in 2005. “The current USPSTF recommendation should serve to renew efforts to develop better tests for HSV, to improve management strategy, and to address the pervasive and harmful stigma associated with genital herpes," he concludes.

Link to the full article -http://jamanetwork.com/journals/jama/fullarticle/2593575

Link to the accompanying  editorial -http://jamanetwork.com/journals/jama/article-abstract/2593550

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[1] https://www.cdc.gov/std/herpes/stdfact-herpes.htm

[2] http://www.who.int/mediacentre/news/releases/2015/herpes/en/

[3] http://jamanetwork.com/journals/jama/article-abstract/2593550

[4] http://www.aafp.org/news/health-of-the-public/20161221uspstfgenitalherpes.html