USPSTF Advises Against Routine Serologic Screening for Genital Herpes Infection

The US Preventive Services Task Force (USPSTF) reaffirmed recommendations on serologic screening for genital herpes infection, as evidence indicates with moderate certainty that the harms outweigh the benefits of population-based screening among asymptomatic adolescents and adults.¹

Systematically evaluating the evidence on accuracy, benefits, and harms of routine serologic screening for herpes simplex type 2 (HSV-2) infection, 1 of 2 viruses (herpes simplex type 1) that cause genital herpes, findings of the reaffirmation process were published today in JAMA.

“Based on previous evidence, the USPSTF estimated that using the widely available serologic tests for HSV-2, nearly 1 of every 2 diagnoses in the general US primary care population could be false,” researchers noted. “At the current US estimated prevalence of 12%, true-positive results would likely further decrease and false-positive results would likely further increase.”

Genital herpes is a common sexually transmitted infection for which there is no cure. Certain populations are known to be disproportionately affected by HSV-2 infection, including US non-Hispanic Black adolescents and adults, whose estimated seroprevalence is nearly 3 times that in the general US population (35% vs 12%).

Pregnant individuals also show increased estimated seroprevalence (22%), with the disease posing risks for potential neonatal infection, which is uncommon but can result in substantial morbidity and mortality.

Antiviral medications may provide clinical benefits to symptomatic individuals, such as improved quality of life and prevention of transmission to sexual partners, but it remains unclear whether such treatment is warranted for asymptomatic people. Moreover, the precise prevalence of asymptomatic HSV-2 infection in the United States is difficult to determine because prevalence estimates rely on serologic screening tests that are limited by low predictive value.

With 2016 recommendations advising against routine serologic screening for HSV-2 infection among asymptomatic adolescents, adults, and pregnant persons, the USPSTF commissioned a reaffirmation evidence update to assess whether new and substantial evidence could be sufficient to change the prior recommendation.

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

“Two investigators independently evaluated the eligibility of all abstracts and articles and rated study quality using predefined criteria,” explained authors. “An analytic framework and 7 key questions (KQs) guided the evidence update.”

A total of 3119 abstracts and 64 full-text articles were reviewed, in which no new eligible studies yielded updated evidence regarding the KQs. Based on previous evidence, the USPSTF concluded that there may be potential social and emotional harms associated with a false-positive diagnosis and potential harms of unnecessary treatment with preventive antiviral medications in persons with a false-positive diagnosis.

The organization called for more studies to evaluate screening, detection, and management of asymptomatic genital HSV infection, including the following:

• Studies assessing screening test accuracy and predictive value in primary care settings in the United States that include asymptomatic persons, validating against an accepted criterion standard, and clearly specifying practical methods for confirmation of initial serologic results
• Studies that enroll enough participants from populations disproportionately affected by HSV (based on age, race, ethnicity, and sexual orientation) to understand screening accuracy and predictive value along with the benefits and harms of interventions in these specific populations
• Research to better clarify emerging associations of HSV infection with intermediate pregnancy outcomes (such as preterm labor and prolonged rupture of membranes) and potentially related neonatal morbidity and mortality

“Several comments supported the USPSTF's analysis and conclusions, noting that the recommendation is consistent with current clinical practice and guidelines from other organizations, including the CDC and the American College of Obstetricians and Gynecologists,” concluded researchers.

References

1. US Preventive Services Task Force. Serologic screening for genital herpes infection US Preventive Services Task Force reaffirmation recommendation statement. JAMA. Published online February 14, 2023. doi:10.1001/jama.2023.0057

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