title: Is HSV serology useful for the management of first episode genital herpes?
abstract: BACKGROUND
  First episode genital herpes simplex virus (HSV) infections can be classified into three groups, primary genital herpes (no previous exposure to HSV), non-primary first episode (IgG antibody to HSV of the non-presenting type), and first episode with pre-existing IgG HSV antibodies. The use of IgM to classify first episode genital herpes has not been evaluated.
  
  
  OBJECTIVE
  To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HSV-1 and HSV-2 IgM antibodies for the diagnosis of first episode genital herpes, when compared with clinical diagnosis.
  
  
  METHODS
  Patients with a first clinical episode of genital herpes were recruited. Sera were tested for IgG antibodies to HSV-2 using an indirect enzyme linked immunosorbent assay (ELISA). Equivocal results were resolved by western blot. HSV-1 IgG and IgM and HSV-2 IgM antibodies were detected using western blot.
  
  
  RESULTS
  157 patients were recruited. 31 were excluded (missing data or no detectable antibodies and negative viral isolation). Therefore, 126 patients were included in the analysis. 23 (18.3%) had primary genital herpes, 34 (27.0%) non-primary first episode, and 69 (54.8%) had pre-existing genital herpes. The specificity and PPV of HSV IgM was 100%; the sensitivity was 79% and the NPV 85%.
  
  
  CONCLUSIONS
  IgM HSV serology may be useful in the management of some patients with first episode genital herpes and provide an indication of the source of infection. Drawbacks include the low sensitivity and NPV, lack of availability, IgM antibodies may occasionally be produced in response to recurrent infection and, finally, IgM antibodies may take up to 10 days to develop and last 7-10 days.
authors.affiliation: Sexually Transmitted Infections Research Centre, The University of Sydney, Marian Villa, Westmead Hospital, Westmead, NSW 2145 Australia.
authors.forename: J
authors.initials: J
authors.lastname: Page
authors.forename: J
authors.initials: J
authors.lastname: Taylor
authors.forename: R L
authors.initials: RL
authors.lastname: Tideman
authors.forename: C
authors.initials: C
authors.lastname: Seifert
authors.forename: C
authors.initials: C
authors.lastname: Marks
authors.forename: A
authors.initials: A
authors.lastname: Cunningham
authors.forename: A
authors.initials: A
authors.lastname: Mindel
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D015153:Blotting, Western; D005260:Female; D006558:Herpes Genitalis / Q000097:blood / Q000145:classification / Q000175:diagnosis*; D018259:Herpesvirus 1, Human / Q000276:immunology*; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D012680:Sensitivity and Specificity
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M