Utilizing a Herpes Simplex Virus (HSV) Type Specific Antibody Test to Determine HSV 2 Sero-prevalence and Test Acceptance in STD Clinic Settings

Background:
The 2006 CDC STD Treatment Guidelines recommend the use of virologic and type-specific serologic tests for diagnosing genital herpes in STD clinic settings.

Objective:
To determine the feasibility of performing herpes type-specific serology testing in STD clinics.

Method:
Three Illinois STD clinics collected an extra blood tube from consenting clients. Specimens were tested for HSV 1 and 2 antibodies. Acceptance and sero-prevalence rates were determined.

Result:
Test acceptance rate was 74% (2,068 out of 2,802). HSV 1 and 2 sero-prevalence rates were 55% (1,146 out of 2,074) and 27% (558 out of 2,074), respectively. Risk factors were similar for persons testing positive and negative.

Conclusion:
The 74 % HSV test acceptance rate indicates most STD clinic clients want to know their HSV 1 and 2 sero-status. Integrating HSV antibody testing into the STD clinic setting is time consuming, challenging and may interrupt STD clinic flow. Asymptomatic clients are often shocked and upset with the test results and desire suppressive therapy. Routinely providing testing in Illinois STD clinics is project to cost at least $175,000 per year and may be cost prohibitive.
Data indicated many clients have been infected with HSV 2 and did not know their status. Clients with HSV 2 positive test results required multiple, intense counseling sessions which was time consuming. Training STD clinic counseling staff was labor intensive.

Implications:
HSV antibody testing can be routinely administered in an STD clinic setting, but counseling for HSV 2 positive clients is time consuming and may impede clinic flow. Clients positive for HSV 2 can be educated to identify when they are most infectious and what measures to take to decrease HSV transmission to sex partners and neonates.