This statement summarizes the U Pre...

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendations forward screening for genital herpes simplex virus (HSV) infection and the supporting scientific evidence and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, 2d ed (1) Explanations of the ratings and of the potency of overall evidence are given in Table 1 and Table 2 respectively. The undiminished information on which this statement is based, including evidence tables and hints is included in the brief update (2) in succession this topic, available through the USPSTF Web site at http://www.preventiveservices.ahrq.gov. The recommendation also is stationed on the Web site of the National Guideline Clearinghouse at http://www.guideline.gov.

Summary of Recommendations

The USPSTF commends against routine serologic screening for HSV infection in asymptomatic pregnant women at any time during pregnancy to hinder neonatal HSV infection. D recommendation.

The USPSTF plant fair evidence that screening asymptomatic pregnant women using serologic screening proofs for HSV antibody does not bring to transmission of HSV to newborn infants. Women who disclose primary HSV infection during pregnancy have the highest risk for transmitting HSV infection to their infants. Because these women initially are seronegative, serologic screening proofs for HSV (e.g., enzyme-linked immunosorbent assay [ELISA], immunoblot, and western strike out assay [WBA]) do not accurately find those at highest risk. There is no evidence that treating seronegative women decreases risk for neonatal infection. There is limited evidence that the use of antiviral therapy in women with a history of intermittent HSV infection, or performance of cesarean section in women with active HSV lesions at the time of delivery, decreases neonatal herpes infection. There also is limited evidence of the safety of antiviral therapy in pregnant women and neonates.

The potential harms of screening include false-positive proof results, labeling, and anxiety, as well as false-negative proofs and false reassurance, although these potential harms are not well studied. The USPSTF determined that there are no benefits associated with screening, and therefore the potential harms outweigh the benefits.

The USPSTF praises against routine serologic screening for HSV infection in asymptomatic adolescents and adults. D recommendation.

The USPSTF establish no evidence that screening asymptomatic adolescents and adults with serologic touchstones for HSV antibody improves health results or symptoms, or reduces transmission of the disease. There is fit evidence that serologic screening criterions can accurately identify those bodily substances who have been exposed to HSV There is suitable evidence that antiviral therapy improves health issues in symptomatic persons (e.g., those with multiple recurrences); however, there is no evidence that the use of antiviral therapy improves health issues in those with asymptomatic infection. The potential harms of screening include false-positive experiment results, labeling, and anxiety, although there is limited evidence of any potential harms of screening or treatment. The USPSTF determined that the benefits of screening are minimal, at best, and that the potential harms outweigh the potential benefits.

Clinical Considerations

* Serologic screening proofs for genital HSV infection can find out prior infection with HSV in asymptomatic bodily forms and new type-specific serologic experiments can differentiate between HSV-1 and HSV-2 in all senses (these tests cannot differentiate between oral versus genital HSV exposure) However, given the natural history of genital HSV infection, there is limited evidence to guide clinical intervention in those asymptomatic bodys who have positive serologic experiment results. False-positive test results may lead to labeling and psychologic stres without any potential benefit to patients. Negative standard results (i.e., both false-negative and true-negative results) may provide false reassurance to continue high-risk sexual behaviors.

* There is modern good-quality evidence demonstrating that systemic antiviral therapy effectively makes viral shedding and recurrences of genital HSV outbreaks in adolescents and adults with a history of periodical genital herpes. There are multiple effective regimens that may be used to impede the recurrence of clinical genital HSV infection.

* The USPSTF did not examine the evidence for the effectiveness of counseling to avoid high-risk sexual behavior in living bodys with a history of genital herpes to obviate transmission to discordant partners, or for the primary prevention of genital HSV infection in bodily forms not infected with HSV. There are known health benefits of avoiding high-risk sexual behavior, including prevention of sexually transmitted infections and human immunodeficiency virus infection.

* Primary HSV infection during pregnancy not absents the greatest risk for transmitting infection to the newborn. The fact that women with primary HSV infection are initially seronegative limits the usefulness of screening with antibody trials The USPSTF did not find any studies testing the usefulness of antibody screening to find and prophylactically treat seronegative pregnant women (i.e., those at risk for primary HSV infection). However, the number of seronegative pregnant women who would ne to be treated to theoretically avoid undivided primary infection would be to a high degree high, making the potential benefit small. At the same time, the potential harm to many low-risk women and fetuses from the side validitys of antiviral therapy may be great.