USPSTF advises against routine serological screening for genital herpes infection

The United States Preventive Services Task Force (USPSTF) has reaffirmed its recommendations for serological screening for genital herpes infection. This is because evidence shows with moderate certainty that the harms outweigh the benefits of population-based screening in asymptomatic adolescents and adults.¹

A systematic evaluation of the evidence on the accuracy, benefits, and harms of routine serological screening for herpes simplex type 2 (HSV-2) infection, one of the two viruses that cause genital herpes (herpes simplex type 1) and the results of the revalidation process were announced today.of jam.

“On the basis of previous evidence, the USPSTF found that using widely available HSV-2 serologic tests, nearly 1 in 2 diagnoses in the general U.S. primary care population may be false. We estimated that there is,” the researchers point out. “With an estimated prevalence of 12% in the United States today, true-positive results are likely to decline further, and false-positive results may increase further.”

Genital herpes is a common sexually transmitted disease with no cure. Certain populations, including non-Hispanic black adolescents and adults in the United States, are known to be disproportionately affected by HSV-2 infection, with an estimated seroprevalence approximately three times that of the general United States population. (35% vs. 12%).

Pregnant individuals also show an estimated increased seroprevalence (22%), and the disease puts the disease at risk for neonatal infection, which, although rare, can result in substantial morbidity and mortality. bring.

Antiviral drugs may offer clinical benefits to symptomatic individuals, such as improving quality of life and preventing transmission of sexual partners, but such treatment may not be justified in asymptomatic people. Furthermore, it is difficult to determine the exact prevalence of asymptomatic HSV-2 infection in the United States. This is because prevalence estimates rely on serological screening tests that are limited by low predictive value.

In its 2016 recommendations against routine serological screening of asymptomatic adolescents, adults, and pregnant persons for HSV-2 infection, the USPSTF requested an update of the evidence of reconfirmation. , assessed whether there was sufficient new substantive evidence to change previous recommendations.

They conducted a systematic review of PubMed/MEDLINE, The Cochrane Library, EMBASE, and trial registries for studies from 30 September 2015 to 16 January 2022.² Additional sources included retrieved articles, external experts, and public commenter reference lists with ongoing surveillance of the literature up to 22 July 2022.

“Two researchers independently assessed all abstracts and articles for eligibility and assessed study quality using predefined criteria,” the authors explained. “An analytical framework and seven key questions (KQs) guided the evidence update.”

A total of 3,119 abstracts and 64 full-text articles were reviewed, but no eligible studies provided new, up-to-date evidence for KQ. Based on previous evidence, the USPSTF has assessed the potential social and emotional harm associated with false-positive diagnoses and the potential for unnecessary treatment with prophylactic antivirals in persons with false-positive diagnoses. concluded that there could be significant harm.

The organization called for further research to evaluate screening, detection, and management of asymptomatic genital HSV infections, including:

• Evaluate the accuracy and predictive value of screening tests in the U.S. primary care setting, including asymptomatic individuals, validate against accepted reference standards, and define practical methods for confirming initial serological results Designated research
• Disproportionately affected by HSV (based on age, race, ethnicity, and sexual orientation) to understand the accuracy and predictive value of screening, along with the benefits and harms of interventions in these specific populations Studies enrolling enough participants from a population
• Studies to better define new associations between HSV infection and mid-gestation outcomes (such as preterm birth and prolonged rupture of membranes) and potentially associated neonatal morbidity and mortality

“Noting that several comments support the USPSTF’s analysis and conclusions and are consistent with current clinical practice and guidelines from other organizations, including the CDC and the American College of Obstetricians and Gynecologists,” the researchers said. concluded.

References

1. United States Preventive Services Task Force. Serological Screening for Genital Herpes Infection Reaffirmed Advisory Statement of the United States Task Force on Preventive Services. jamPublished online February 14, 2023. doi:10.1001/jama.2023.0057

2. Asher GN, Feltner C, Harrison WN, Schwimmer E, Schwimmer C, Jonas DE. Serological screening for genital herpes: an updated evidence report and systematic review from the US Preventive Services Task Force. jamPublished online on February 14, 2023.