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Task Force: Making a Call on Routine Genital Herpes Screening

Task Force: Making a Call on Routine Genital Herpes Screening
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U.S. Preventive Services Task Force


U.S. Preventive Services Task Force (click to view)

U.S. Preventive Services Task Force

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A U.S. federal task force is prepared to recommend that teens, adults and pregnant women not be routinely tested for genital herpes if they don’t have signs of infection.

About one in every six Americans between the ages of 14 and 49 has genital herpes, according to the U.S. Centers for Disease Control and Prevention.

The disease, which is transmitted through vaginal, anal and oral sex, causes symptoms like blisters, discharge, burning and bleeding between periods. Though symptoms can be treated, genital herpes is incurable.

In support of its proposed guidelines, the U.S. Preventive Services Task Force says the benefit of routine herpes screening is small, because early treatments aren’t likely to make much of a difference.

“Because there’s no cure, there isn’t much doctors and nurses can do for people who don’t have symptoms,” Dr. Maureen Phipps said in a news release from the task force, of which she is a member. Phipps is chairwoman of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Rhode Island.

The task force also says screening people who have no signs of herpes may cause harm, because the blood test can be inaccurate.

The task force does, however, recommend screening for other sexually transmitted infections such as chlamydia, gonorrhea, syphilis and HIV. It also recommends health care professionals counsel patients who are at high risk of developing sexually transmitted diseases.

Summary of Recommendations

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

Draft Recommendation Statement
Genital Herpes Infection: Serologic Screening

This opportunity for public comment expires on August 29, 2016 at 8:00 PM EST

Importance

Genital herpes is a prevalent sexually transmitted infection (STI) in the United States; the Centers for Disease Control and Prevention (CDC) estimates that almost one in six persons ages 14 to 49 years have genital herpes.1 Genital herpes infection is caused by two subtypes of HSV (HSV-1 and HSV-2). Unlike other infections for which screening is recommended, HSV infection may not have a long asymptomatic period during which screening, early identification, and treatment might alter its course. Antiviral medications may provide symptomatic relief from outbreaks; however, they do not cure HSV infection. Although vertical transmission can occur between an infected pregnant woman and her infant during vaginal delivery, interventions can help limit transmission. Neonatal herpes infection, while uncommon, can result in substantial morbidity and mortality.

Detection

In the United States, most cases of genital herpes historically have been caused by infection with HSV-2. There is adequate evidence that the most widely used currently available serologic screening test for HSV-2 approved by the U.S Food and Drug Administration is not suitable for population-based screening due to its low specificity, lack of widely available confirmatory testing, and high false-positive rate. Rates of genital herpes due to HSV-1 infection in the United States may be increasing. There is no serologic screening test for genital herpes resulting from HSV-1 infection.

Benefits of Early Detection and Intervention

Based on limited evidence from a small number of trials on the potential benefit of screening and interventions among asymptomatic populations and an understanding of the natural history and epidemiology of genital HSV infection, the USPSTF concluded that the evidence is adequate to bound the potential benefits of screening in asymptomatic adolescents and adults, including those who are pregnant, to be no greater than small.

Harms of Early Detection and Intervention

Based on evidence on potential harms from a small number of trials, the high false-positive rate, and the potential anxiety and disruption of relationships related to diagnosis, the USPSTF found that the evidence is adequate to bound the potential harms of screening in asymptomatic adolescents and adults, including those who are pregnant, as at least moderate.

USPSTF Assessment

The USPSTF concludes with moderate certainty that the harms outweigh the benefits for population-based screening in asymptomatic adolescents and adults, including those who are pregnant.

Readings & Resources (click to view)

 

  • Centers for Disease Control and Prevention. Genital herpes: CDC fact sheet. http://www.cdc.gov/std/herpes/stdfact-herpes.htmThis link goes offsite. Click to read the external link disclaimer. Accessed July 12, 2016.
  • U.S Preventive Services Task Force. Behavioral counseling interventions to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(12):894-901.
  • U.S Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(12):902-10.
  • U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(1):58-66.
  • U.S. Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(1):51-60.
  • U.S. Preventive Services Task Force. Screening for syphilis infection in nonpregnant adults and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(21):2321-7.
  • Patel R, Rompalo A. Genital herpes infections. In: Zenilman JM, Shahmahnesh M, eds. Sexually Transmitted Infections: Diagnosis, Management, and Treatment. Burlington, MA: Jones & Bartlett; 2012.
  • Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med. 1999;131(1):14-20.
  • Centers for Disease Control and Prevention (CDC). Seroprevalence of herpes simplex virus type 2 among persons aged 14-49 years—United States, 2005-2008. MMWR Morb Mortal Wkly Rep. 2010;59(15);456-9.
  • Watts DH, Brown ZA, Money D, et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol. 2003;188(3):836-43.
  • Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol. 2003;102(6):1396-403.
  • Brown ZA, Wald A, Morrow RA, et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA. 2003;289(2):203-9.
  • ACOG practice bulletin. Management of herpes in pregnancy. Number 8 October 1999. Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000;68(2):165-73.
  • Flagg EW, Weinstock H. Incidence of neonatal herpes simplex virus infections in the United States, 2006. Pediatrics. 2011;127(1):e1-8.
  • Handel S, Klingler EJ, Washburn K, Blank S, Schillinger JA. Population-based surveillance for neonatal herpes in New York City, April 2006-September 2010. Sex Transm Dis. 2011;38(8):705-11.
  • Mahnert N, Roberts SW, Laibl VR, Sheffield JS, Wendel GD Jr. The incidence of neonatal herpes infection. Am J Obstet Gynecol. 2007;196(5):e55-6.
  • Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev. 2008(1):CD004946.
  • Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med. 2004;350(19):1970-7.
  • Feltner C, Grodensky CA, Middleton JC, et al. Serologic Screening for Genital Herpes Infection: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 149. AHRQ Publication No. 15-05223-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
  • Melville J, Sniffen S, Crosby R, et al. Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment. Sex Transm Infect. 2003;79(4):280-5.
  • Rosenthal SL, Zimet GD, Leichliter JS, et al. The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection. Sex Transm Infect. 2006;82(2):154-7; discussion 157-8.
  • American Academy of Family Physicians. Clinical preventive service recommendation: genital herpes simplex virus infection. http://www.aafp.org/patient-care/clinical-recommendations/all/genital-herpes.htmlThis link goes offsite. Click to read the external link disclaimer. Accessed July 12, 2016.
  • American College of Obstetricians and Gynecologists. ACOG-endorsed documents. http://www.acog.org/Resources-And-Publications/Endorsed-DocumentsThis link goes offsite. Click to read the external link disclaimer. Accessed July 12, 2016.
  • Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015: genital HSV infections. http://www.cdc.gov/std/tg2015/herpes.htmThis link goes offsite. Click to read the external link disclaimer. Accessed July 12, 2016.
  • ACOG Committee on Practice Bulletins. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol. 2007;109(6):1489-98.

 

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