To confirm a diagnosis of genital herpes in a patient presenting with typical symptoms, the recommended diagnostic test is to take a virology swab from any active genital or extragenital lesions for herpes simplex virus (HSV) detection. This direct detection method is the primary approach in clinical practice and should be performed promptly when lesions are present to maximise diagnostic yield NICE CKS.
Polymerase chain reaction (PCR) testing of the swab is preferred due to its high sensitivity and specificity, allowing for accurate detection and typing of HSV-1 or HSV-2, which is important for clinical management and counselling NICE CKS.
Serological testing using HSV type-specific serology may be considered in certain cases, such as when lesions are not present or for screening sexual partners to assess risk of acquisition, but it is not the first-line diagnostic tool for confirming active infection NICE CKS.
In summary, the key diagnostic step is lesion swabbing with PCR testing for HSV DNA, supported by type-specific serology when appropriate. This approach aligns with UK clinical guidelines and is supported by international literature emphasizing molecular methods for accurate diagnosis NICE CKS; Domeika et al. 2010Vauloup-Fellous 2017.
Key References
- CKS - Syphilis
- CKS - Herpes simplex - genital
- NG60 - HIV testing: increasing uptake among people who may have undiagnosed HIV
- CG156 - Fertility problems: assessment and treatment
- (Domeika et al., 2010): Guidelines for the laboratory diagnosis of genital herpes in eastern European countries.
- (Vauloup-Fellous, 2017): [Genital herpes and pregnancy: Serological and molecular diagnostic tools. Guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF)].