THE RELIABILITY OF SEROLOGICAL TESTS FOR THE DIAGNOSIS OF GENITAL HERPES - A CRITIQUE

The reliability and limitations of the currently used routine tests fo r herpes simplex virus type 2 (HSV-2) antibody in Australia are review ed. Six case reports illustrate the clinical dangers of overinterpreta tion of the currently available kits and the need for a readily availa ble specific HSV-2 antibody test. In Sydney, HSV-2 causes approximatel y 85% of primary genital herpes and > 95% of recurrent genital herpes. Due to the extensive serological cross-reactivity between HSV-1 and H SV-2, currently available ''type specific'' commercial assays cannot r eliably distinguish between the 2. Isolation of herpes simplex virus ( HSV) or detection of HSV antigen in vesicle fluid is the preferred dia gnostic test but may be overlooked or patients may have no visible les ions. The only accurate techniques for detecting HSV-2 specific antibo dy are the Western blot assay and an enzymatic immunoassay using glyco protein G (gG-2), a component of the HSV-2 envelope. These tests, whic h still are restricted to research laboratories can be used to accurat ely identify people with previous exposure to HSV-2 (IgG) or to diagno se primary infection where virus isolation has not been performed or i s impossible. Current commercially available antibody tests may have e xtensive cross-reactivity.