Pregnant women should be asked if they or their partners have a history of HSV infection. Caesarean section should be considered for pregnant women with active lesions at term and patients with genital herpes should be referred for specialist opinion at least 4 weeks before term.
Deep ulcerated anogenital lesions and disseminated infections may occur in patients with HfV infection and other deficiencies of immune functioa
The diagnosis can usually be made on clinical grounds; the differential diagnosis includes syphilis, chancroid and lymphogranuloma venereum. HSV may coexist with other STDs and appropriate investigations should be undertaken. HSV infection may be associated with a false positive FTA-ABS test (see p.25) but may also coexist with syphilis.
The diagnosis of HSV can be confirmed by culture of the virus. A positive diagnosis is usually available in 1 to 4 days but 14 days are required for a negative result. Rapid diagnosis may be made by examination of smears from ulcers for multinucleated cells and characteristic intranuclear inclusions or by the use of commercially available kits for the detection of HSV-2 antigens by ELISA or immunofluorescence techniques.
Microbiological confirmation is desirable if acyclovir is to be used and is required for an NHS authority to prescribe acyclovir to suppress recurrent infections.
Serological tests have no role in diagnosis. The only practical role for serology is to define persons who are seronegative and therefore susceptible.