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Serologic Testing for HSV
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Morbidity has been improved more modestly: the proportion of patients with disseminated disease who are developing normally at 1 year has increased from 50 to 83%. The proportion of patients with neurologic morbidity following CNS disease has remained essentially unchanged over the past three decades.
The total number of patients who are developing normally following HSV CNS disease has increased due to the improved survival. Although additional therapeutic advances in the future are possible, more immediate methods for further improvements in outcome for patients with this potentially devastating disease lie in an enhanced awareness of neonatal HSV infection and disease.
Until recently, the commercially available serologic assays were unable to distinguish between HSV-1 and HSV-2 antibodies, severely limiting their utility. In the past few years, type-specific antibody assays have been approved by the Food and Drug Administration and are on the U.S. market. These include tests manufactured by Diagnology and MRL; tests by at least three additional companies are under development.
A number of additional tests which claim to distinguish between HSV-1 and HSV-2 antibody are commercially available but have such high cross-reactivity rates that they should be avoided. It is important to note that serologic testing identifies only past infection and cannot identify the site of HSV infection: patients with cold sores due to HSV-1 will test HSV-1 seropositive regardless of whether they also have genital HSV-1 infection.
With these type-specific assays, however, it is now possible to identify serodiscordant couples in which the woman is HSV-2 seronegative, and the partner is seropositive. Women in such couples are at risk for acquiring primary genital HSV infection during pregnancy and are thus at higher risk of transmitting the virus to their babies during birth.
At present the optimal application of these type-specific assays has not been determined. Recent studies documenting the efficacy of condom use and of antiviral suppression of the seropositive partner in preventing the acquisition of genital herpes suggest that successful interventions based on knowledge of a couple's serologic status can be devised.
In contrast to other congenital and neonatal infections, serologic diagnosis of neonatal HSV infection is not of great clinical value. With the availability of reliable type-specific assays, one barrier to interpreting serologic results in babies with suspected HSV disease has been removed. However, the presence of transplacentally acquired maternal immunoglobulin G still confounds the assessment of the neonatal antibody status during acute infection.
That's because the large proportions of the adult American population are HSV-1 and HSV-2 seropositive. Serial antibody assessment may be useful in the very specific circumstance of a mother who has a primary infection late in gestation and transfers very little or no antibody to the fetus. In general, however, serologic studies play no role in the diagnosis of neonatal HSV disease.
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About the Author
staff of Nature Power Company, which is a network company dedicated to promoting customers' websites and developing softwares. You can go to the following websites to learn more about our natural organic products. http://www.bcured.net http://www.naturespharma.org
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