In this low-prevalence population, the positive predictive value of the Focus HSV-2 ELISA test was low. This finding, together with those reported elsewhere, indicates that caution is warranted when recommending HSV screening in low-prevalence or heterogeneous populations. Consideration should be given to raising the cutoff index value for defining a positive test result.
Objective-The authors examined the feasibility of conducting serologic testing for the herpes simplex virus 2 (HSV-2) among university students and assessed the psychosocial impact of an HSV-2 diagnosis.Methods-The authors recruited a convenience sample of 100 students (aged 18-39 years) without a history of genital herpes from 1 university between September 2004 and March 2006. Participants received HSV-2 antibody testing by Focus ELISA and Western Blot assays and completed a questionnaire that addressed psychological functioning. Twenty-eight participants completed the questionnaire again at a 3-month follow-up visit.Results-The study revealed (1) low test-reliability in the student population, (2) that positive test results may cause a decline in psychological well-being, and (3) that substantial resources are required to support students with positive HSV-2 results.Conclusions-Test performance, psychological impact, and availability of resources for counseling students with positive diagnoses should be considered before implementing HSV testing programs. Keywords clinical medicine; mental health; sexually transmitted diseaseIn the United States, approximately 17% of adults are infected with herpes simplex virus type 2 (HSV-2) and 58% are infected with herpes simplex virus type 1 (HSV-1). 1 More than twothirds of those infected are unaware of their infection, and the majority of infections are transmitted by these individuals. 2 Herpes infections are associated with substantial morbidity and transmission and acquisition of the human immunodeficiency virus (HIV). 3 University students (at either the undergraduate or the graduate level) often engage in sexual behaviors that put them at high risk for contracting HSV and other sexually transmitted diseases (STDs). Several studies have documented high levels of sexual risk behavior among college students in the form of inconsistent or no condom use, multiple lifetime sex partners, and alcohol and other drug use combined with sexual activity. [4][5][6][7] The most recent national survey on HSV rates indicates that 10.6% of 20-to 29-year-olds are infected with HSV-2 and 54.4% are infected with HSV-1. 1 Although HSV-1 has historically been the primary cause of oral-
Reactive lymph node. A cryostat section immunostained for IgM (TRITC) and counterstained with Gill's haematoxylin afterformalin fixation. Both haematoxylin nuclear staining (a) and IgM immunofluorescence (b)
Case Description: A 64 year-old male presented with left-sided weakness and altered level of consciousness after a suspected seizure. MR Brain demonstrated right mesial temporal lobe diffusion restriction. Empiric antiviral and antibiotic treatments were initiated despite CSF negative for HSV/VZV and enteroviruses. Lumbar puncture on admission day five was unchanged and empiric treatments were discontinued. On day 13 he deteriorated into status epilepticus necessitating ICU transfer. A third lumbar puncture demonstrated elevated protein and HSV-1 positive PCR. Acyclovir was restarted with guarded prognosis. Discussion: Detection of HSV-1 in CSF is considered the diagnostic gold standard for HSV-1 encephalitis. The validated multiplex assay used in Alberta, Canada has a 95% level of detection significantly better than the recommended threshold for HSV laboratory diagnosis. Previous reports have indicated that CSF PCR may be negative early in the disease course. Others have suggested that initially negative/follow up positive HSV PCR cases may represent secondary reactivation or release from underlying tissue damage. Consideration of the full clinical picture is crucial in patients with HSV negative PCR. Continuation of antiviral therapy may be appropriate in select HSV PCR negative patients.
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