Herpes simplex virus (HSV) types 1 and 2 are highly prevalent in the general population of the United States. The seroprevalence of HSV-2 and HSV-1 were 17% and 58%, respectively, in a cohort aged 14 to 49 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2004.1 Seroprevalence is substantially less among adolescents and young adults. Approximately 80% of infected individuals are unaware of their infection and the majority of infections are transmitted by these individuals.2
Type-specific serological assays for HSV became commercially available in 1999, making possible wide-scale screening for HSV-1 and HSV-2. However, the value of HSV screening is controversial. Proponents argue that on detection, asymptomatic carriers can be counseled to use prevention methods and, thus, reduce the possibility of transmission to uninfected partners. Opponents point out the possibility that large numbers of asymptomatic individuals may receive a diagnosis of a stigmatized, chronic infection, with substantial transmission potential, but there are no substantial data to support the effectiveness of HSV screening in changing sexual behaviors or preventing transmission.
The important questions that a clinician must consider in determining the value of HSV screening among asymptomatic sexually active adolescents and young adults are derived from the Wilson and Jungner classic public health report3 on criteria for use of a screening test and include the following: (1) Is the disease an important public health problem? (2) Is an accurate screening test available and is it acceptable to the population? (3) Does screening improve health outcomes and symptoms or reduce transmission of disease? (4) Are the costs and risks of screening less than the benefits?