Type-specific HSV tests help guide management in pregnancy. (Transmission Risk Less with HSV-2).

WASHINGTON -- The new type-specific herpes simplex virus serology tests may turn out to be particularly useful in helping guide obstetric management of women who experience outbreaks during pregnancy and in counseling couples who are discordant for HSV infection.

Other potential uses include confirmation of a clinical diagnosis, diagnosing recurrent genital lesions or atypical genitourinary symptoms, and possibly screening populations at high risk for HSV infection, Dr. Anne M. Rompalo said at an update on sexually transmitted diseases sponsored by OB.GYN. NEWS and Boston University.

Accurate specific serology assays that can distinguish between HSV-1 and HSV-2 became commercially available in 1999, but as yet there is no consensus on exactly how and when they should be used. In Sexually Transmitted Diseases Treatment Guidelines 2002, the Centers for Disease Control and Prevention said, "Al though serologic assays for HSV-2 should be available for persons who request them, screening for HSV-1 or HSV-2 infection in the general population is not indicated."

However, new data that have come out since the CDC guidelines were released suggest that the assays may indeed provide useful information that could influence treatment and assist in counseling discordant couples, said Dr. Rompalo, who served on the committee that wrote the guidelines.

One of the studies, published early this year, is the first to actually demonstrate that cesarean section protects against neonatal transmission of HSV. Among infants of 202 women from whom HSV was isolated during labor, the rate of neonatal HSV infection was 5%. The HSV transmission rate among women who underwent cesarean delivery was 1.2%, compared with 7.7% with vaginal delivery (JAMA 289[2]:203-09, 2003).

Other risk ...