Serologic test a must for suspected genital herpes. (Often Misdiagnosed).

NEW YORK--"The clinical diagnosis of genital herpes is both insensitive and nonspecific [and] should be confirmed by laboratory testing."

So say the Centers for Disease Control and Prevention's most recent Sexually Transmitted Diseases Treatment Guidelines. Citing the insensitivity, nonspecificity, and general unreliability of unaided clinical diagnosis for genital herpes, the guidelines, which were issued last year, call for routine use of the three Food and Drug Administration--approved serologic testing methods: HerpeSelect-1 or -2 ELISA IgG, HerpeSelect 1 and 2 Immunoblot IgG, and POCkit HSV-2.

The guidelines are eminently sensible and very welcome, Dr. Jeffrey Gilbert said at a meeting on pediatric, adolescent, and young adult gynecology sponsored by Mount Sinai School of Medicine.

According to the CDC, 25% of all people over the age of 12 years in the United States are seropositive for herpes simplex virus (HSV) type 2. Of people who experience first-episode primary outbreaks of HSV-2, 89% will have an average of five recurrences in the next year.

"There is a lot of confusion about herpes," said Dr. Gilbert, medical director of the STD Center of Excellence at Montefiore Medical Center, New York.

Many herpes cases are missed either because they present atypically or because the patients don't fit physicians' preconceptions of an at-risk individual. Physicians are pretty good at recognizing primary infections, he said, but they often miss recurrent disease, as well as anal or cervical lesions.

On the other hand, a lot of individuals with other diseases are misdiagnosed with herpes. For example, fixed drug eruptions can sometimes manifest with herpeslike genital lesions, as can allergic contact dermatitis following exposure to condoms, semen, or benzocaine sprays used by some men to delay ejaculation.