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Genital Herpes Simplex SerologySerology Fifty percent to ninety percent of adults have antibody to HSV. Because of the high incidence of antibodies to herpes simplex in the population, assay of a single serum specimen is not of great value. Subtyping. There are two serotypes of HSV. HSV-1 infections are primarily oropharyngeal; genital infections can also be caused by this serotype. HSV-2 infections are primarily genital but are also detected in the mouth. HSV-1 seropositivity is usually associated with orolabial infection. Herpes simplex virus type 2 seropositivity is usually associated with genital infection. HSV-1 is now a significant cause of genital herpes and is implicated in 5% to 30% of all first-episode cases. The proportion of HSV-1 among initial genital herpes infections is higher among men who have sex with men (46.9%) than among women (21.4%) and is lowest among heterosexual men (14.6%). Receptive oral sex significantly increased the odds that initial infections are HSV-1 rather than HSV-2. Genital HSV-1 may often be acquired through contact with a partners mouth. Type-specific Serologic Tests Type-specific and nonspecific antibodies develop during the first several weeks following infection and persist indefinitely. Almost all HSV-2 infections are sexually acquired. Therefore HSV-2 antibody indicates anogenital infection, but the presence of HSV-1 antibody does not distinguish anogenital from orolabial infection. Persons with subclinical or unrecognized infections are best diagnosed by type-specific antibody tests. |