A comparison of PCR with virus isolation and direct antigen detection for diagnosis and typing of genital herpes

• Published in: Journal of medical virology Vol. 55; no. 2; pp. 177 - 183
• Main Authors: Slomka, M. J., Emery, L., Munday, P. E., Moulsdale, M., Brown, D. W. G.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.06.1998; Wiley-Liss
• Subjects: Animals; Antibodies, Monoclonal - immunology; Antigens, Viral - analysis; Biological and medical sciences; Cell Culture Techniques; Cercopithecus aethiops; Female; first episode infection; Fluorescent Antibody Technique; genital herpes; Herpes Genitalis - diagnosis; Herpes Genitalis - immunology; Herpes Genitalis - pathology; Herpes Genitalis - virology; Herpesvirus 1, Human - genetics; Herpesvirus 1, Human - immunology; Herpesvirus 1, Human - isolation & purification; Herpesvirus 2, Human - genetics; Herpesvirus 2, Human - immunology; Herpesvirus 2, Human - isolation & purification; HSV typing; Human viral diseases; Humans; Immunoenzyme Techniques; Infectious diseases; Male; Medical sciences; PCR; Polymerase Chain Reaction - methods; Recurrence; recurrent infection; Restriction Mapping; Sensitivity and Specificity; Vero Cells; Viral diseases; Viral diseases of the genital and urinary system; virus isolation in cell culture; England; United Kingdom; Great Britain; Europe; Human; Cell culture; Prevalence; Typing; Herpesviridae; Alphaherpesvirinae; Herpes; Recurrent; Enzyme immunoassay; Epidemiology; Genital diseases; Infection; Virus; Polymerase chain reaction; Type specificity; Viral disease; DNA; Herpesvirus hominis; Diagnosis; Comparative study
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/(SICI)1096-9071(199806)55:2<177::AID-JMV15>3.0.CO;2-F

Patients attending the genitourinary medicine clinic at Watford General Hospital, UK, were examined for clinical signs of genital herpes infection. Genital swabs were taken from 194 patients (126 female, 68 male) who presented with genital ulceration or symptoms which were suggestive of genital herpes infection. Swabs from these patients were tested by three methods: (i) Detection of herpes simplex virus (HSV) antigen by direct HSV enzyme immunoassay (EIA), (ii) HSV isolation in Vero cell culture and (iii) HSV polymerase chain reaction (PCR). HSV was detected in 76 patients (39%) by EIA, in 93 (48%) by isolation in cell culture, and in 115 (59%) by PCR. Isolation by cell culture has been considered as the “gold standard” for the detection of HSV in genital lesions, but in this study HSV PCR was significantly more sensitive. Comparison of the three methods was as follows: Cell culture vs. PCR: Sensitivity 93/115 (80.9%), Specificity 79/79 (100%). HSV EIA vs. PCR: Sensitivity 75/115 (65.2%), Specificity 78/79 (98.7%). HSV EIA vs. Cell culture: Sensitivity 75/93 (80.7%), Specificity 100/101 (99%). EIA was less effective in detecting HSV among recurrent than among first episode infections, in comparison to culture or HSV PCR. This is the first comparison of HSV PCR with two other routine diagnostic methods for confirming genital herpes infection in a symptomatic population. The infecting HSV type was identified by restriction digestion of 108 HSV amplicons: HSV‐1: 37/108 (34%), HSV‐2: 71/108 (66%). In this population HSV‐1 causes a significant proportion of genital herpes cases, and HSV‐1 genital infection was detected in significantly more first episode infections (40.3%) than among recurrent infections (22.2%). J. Med. Virol. 55:177–183, 1998. © 1998 Wiley‐Liss, Inc.