Adolescents and adults who show no symptoms of genital herpes should not be routinely screened for the condition, according to the U.S. Preventive Services Task Force (USPSTF).
The task force’s recommendation, released today in JAMA Network, reaffirms an earlier ruling it made on the matter in 2016. The task force concluded with moderate certainty “that the harms outweigh the benefits for population-based screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons.”
The harms include the fact that the most available serologic screening tests for genital herpes would inadvertently lead to an unacceptably high rate of false positive results if physicians used them for asymptomatic individuals.
The task force comprises volunteer primary care experts who assign letter grades A, B, C, D or I for certain preventive services. An A or a B grade means that the service is recommended because evidence shows that it is beneficial. Grade D means not recommended.
James Stevermer, M.D., the vice chairperson for clinical affairs and professor of family and community medicine at the University of Missouri and a task force member, said in a press release that “in fact, if current screening tests were used across all adolescents and adults, as many as half of the positive results could be wrong.”
The recommendation said: “Although serologic tests can detect the presence of HSV-1, seropositivity for HSV-1 does not indicate the site of infection, limiting usefulness of serologic testing to identify asymptomatic genital herpes.”
Also, the landscape has changed for herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2), arguably for the better for certain demographics. “Over the past 20 years, HSV-1 and HSV-2 estimated seroprevalence has steadily declined,” the study said. Nonetheless, “specific populations remain disproportionately affected by HSV infection.”
Researchers cite the 2015-16 National Health and Nutrition Examination Survey of persons aged 14 to 49 years. According to those data, Mexican-Americans have the highest incidence of HSV-1 at 72%, followed by non-Hispanic Blacks at 59%. In the general U.S. population, 48% have HSV-1.
“In pregnant persons, an estimated 22% of the U.S. population may be seropositive for HSV-2,” the recommendation said. “HSV seroprevalence increases with economic deprivation and decreases with educational attainment, suggesting that HSV disparities may be influenced by social determinants of health.”
The recommendation had been posted for public comment on the USPSTF website from Aug. 16, 2022, to Sept. 12, 2022. Some individuals expressed concern that HSV infection is not taken seriously. Others noted that individuals with asymptomatic genital herpes might unknowingly transmit the infection to their sexual partners. The task force said that it understands these concerns as well as the importance of sexual health. “
“The USPSTF strongly calls for additional research into high-quality, accurate screening tests and effective interventions to prevent negative health outcomes of genital HSV in asymptomatic adolescents, adult and pregnant persons,” the recommendation said.
Individuals with symptoms of genital herpes are often treated with antiviral medications that help to relieve the pain of outbreaks, prevent recurrences and the infection of sexual partners. An outbreak can include experiencing sores, bumps, pain, tenderness or itching in the genital area and fever.
Task force Vice Chairperson Michael Barry, M.D., said, “the Task Force encourages people who are experiencing symptoms, have a partner who has been diagnosed with herpes, or have any concerns related to their sexual health to talk to their healthcare professional about testing and treatment options. It is particularly important that people who are pregnant or planning to become pregnant speak with a healthcare professional if they have questions or concerns about their sexual health.”