What is the role of PCR in the workup of herpes simplex virus (HSV) infections?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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PCR results are positive early in the course of herpes simplex virus encephalitis and remain positive during the first week of therapy. PCR may be used to detect herpes simplex virus in skin lesions.

Herpes simplex virus PCR results should be interpreted cautiously because neither the specificity nor the sensitivity of the analyses is 100%. In addition, performance of these tests may vary among laboratories. Failure to detect HSV DNA by PCR testing of genital lesion swabs does not necessarily rule out a diagnosis of HSV infection, as viral shedding can be intermittent. [11] Testing results should be correlated with clinical manifestations and the course of illness in determining their diagnostic significance.

One study evaluated the utility of quantitative herpes simplex virus PCR levels for prognosis and management of neonatal HSV disease and found a correlation between plasma HSV levels and clinical presentation of neonatal HSV disease and mortality, but not neurologic outcome. [71]

Following analysis of data extracted from the Pediatric Health Information System (PHIS) database, Gaensbauer et al reported that strategies for diagnosis and empirical treatment of suspected HSV encephalitis beyond the neonatal period have trended toward the approach common for neonates without evidence of an increase in disease incidence. [72]

Additional laboratory evaluations (e.g., evaluation of CSF) are necessary in evaluating disseminated infection or infection involving single or multiple organ systems.

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