There are basically five ways to diagnose herpes in a patient. Herpes testing should not just include detection of the virus but its type and location as well. Knowing the type and location of the virus is important in assessing risks for transmission. Diagnostic measures in herpes testing include clinical examination, viral culture, Polymerase Chain Reaction (PCR), non-type specific blood tests and type-specific blood tests.
Clinical examination of a patient includes history and physical examination. The doctor may ask about the patient?s sexual partners and practices. A timeline should be constructed as sores usually appear two to three weeks after the infection. Other important questions include presence of pain, itching, tingling, difficulty in urinating, et cetera. Physical examination includes checking for location of sores and swellings of the lymph nodes. Clinical examination is important in assessing the signs and symptoms of herpes but it does not confirm an infection by herpes as the symptoms may be seen in other diseases, the symptoms may present atypically or symptoms may not be present at all.
The second step in herpes testing is viral isolation and culture, which is the most valid test for herpes. The test is effective only when active viral shedding from open sores is present. Viral culture can identify the location of infection and make a distinction between HSV-1 and HSV-2.
PCR distinguishes between HSV-1 and HSV-2 as well. It is more sensitive than viral culture that produces many false negatives. Active viral shedding is also a prerequisite for this procedure.
Non-type specific blood tests in herpes testing include Enzyme-linked Immunosorbent Assay (ELISA). It can identify the presence of herpes infection but cannot differentiate the two types. Other blood tests which may be requested for herpes testing include detection of IgM and IgG antibodies but these are not specific to herpes and these are only reliable after a certain period of time after the infection.
Type-specific blood tests for detection of herpes include Western blot, Immunoblot test or a more specific type of ELISA. These blood tests do not require active viral shedding from open sores.
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