Patients & physicians often present with ACUTE lesions &, directly or indirectly, want to know if it is herpetic. Local gynecologic speakers tell us that acute, apparently "first" lesions, can be managed as if herpetic until several weeks later when serologic testing can then be performed at a time when the antibody level has become detectible. Or they want to know if a CHRONIC HSV status is type I or II. Type I tends to infrequently recurr; type II tends to frequently recurr.

In our lab, this " Herpes Select 2" is a type-specific western-blot-like "strip immunoblot" for IgG antibodies test on patient's serum which differentiates between HSV I & II by antibody detection of either the IgG HSV I type specific glycoprotein gG-1 or the IgG HSV II type specific glycoprotein gG-2. The reagent antigens are by recombinant preparations (Focus Technology's HerpesSelect Immunoblot (IB) strip tests). Color producing reactions are by ELISA. The one for HSV II has, by comparison to UW-WB testing, a sensitivity of 97-100% and a specificity of 94-98% in clinical trials. We started reporting this test from LML on 29 October 2004. [HSV testing]

• persons (1) with a lesion NOT due to herpes & (2) who have never had HSV II.
• HSV II infected persons whose Ab level has not yet reached detectibilty.
• previously infected persons who (1) did not mount a detectible level of Ab (may or may not be "immune") or (2) whose antibody level has receeded to nondetectible levels.
• previously infected persons who have become seriously immunocompromised and cannot produce detectible Ab.

 Elevated, reactive, or positive results:

• true evidence of HSV II present or past infection.
• false positive of undetermined etiology: the lower the disease prevalence in the population of the tested patient (high prevalence in STD clinic...expected low prevalence in children), the lower the positive predictive value (a positive test of 98% specificity when the expected disease prevalence is only 3% has a positive predictive value of just 0.61).

References:

1. Ashley RL, "Performance and Use of HSV...", Herpes 9 (2):38-45, 2002. (JBC & LML)
2. Focus Diagnostic's website about this.

(posted 30 October 2004; lates addition 7 November 2007)