Fast Five Quiz: Herpes Simplex Virus

Michael Stuart Bronze, MD


September 06, 2022

For an ideal HSV-2 workup and diagnosis, directly swab vesicular lesions within 72 hours of onset. Clinicians should avoid lesions that appear crusted over or healed. Swab locations include skin vesicles from sterile needle collection, the urethra from sterile swabbing, the cervix via the vaginal speculum, the rectum via proctoscopes, the conjunctiva from swabbing, and urine. Viral culture is still considered the criterion standard in the diagnosis of HSV, with virus recovery occurring in as many as 70% of patients with early vesicles.

HSV polymerase chain reaction (PCR) is the test of choice if direct swabbing is not possible and has a very high sensitivity especially in earlier stage lesions. PCR testing is faster and has a higher sensitivity that viral culture. HSV can be detected by an enzyme immunoassay and this has a sensitivity equal to that of viral culture in early stage lesions, but it is higher than culture in late stage lesions. The Tzanck smear cannot discern serotypes of HSV and has a lower sensitivity than other testing. False-positive Tzanck smear results may occur with varicella zoster infection. A positive Tzanck smear result should be confirmed with an additional test. Urinalysis and culture should be considered, as symptoms can resemble acute urinary tract infection; however, these do not replace other diagnostic tests.

Learn more about HSV-2 workup.


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