Herpes Simplex Virus Type 2 Screening in Persons with and Without HIV: Evidence, Challenges, and Future Directions.
Review
Overview
abstract
PURPOSE OF REVIEW: Herpes simplex virus type 2 (HSV-2) infection is one of the most prevalent sexually transmitted infections worldwide, with implications for HIV acquisition, transmission, and disease progression. This review synthesizes current evidence and guidance on HSV-2 serologic screening, emphasizing its relevance for HIV prevention and care. RECENT FINDINGS: International guidelines advise against routine general population-level serologic screening for HSV-2 in asymptomatic persons. Key limitations include poor test specificity, the absence of potent antivirals or therapeutic vaccines, lack of curative therapy, no demonstrated population-level benefit, and psychosocial harms associated with diagnosis. Current practice instead emphasizes diagnostic testing in symptomatic persons and targeted screening in defined contexts—such as among people with HIV in specific clinical situations, sex partners of those with HSV-2 infection, certain pregnant women, persons seeking sexual health care, and persons with recurrent or atypical symptoms—where results may directly inform management. Emerging technologies, including highly specific assays, novel potent antivirals, therapeutic vaccines, and curative strategies, may eventually shift the cost–benefit balance of general screening. SUMMARY: Evidence supports targeted rather than general population-level screening to maximize clinical benefit while minimizing harm. New evidence demonstrating that interventions can achieve measurable population-level reductions in disease burden or transmission, together with future advances in diagnostics and therapeutics, may eventually justify integrating routine HSV-2 screening into broader contexts, including into HIV prevention and care.
