FROM JAMA
Asymptomatic adolescents and adults, including pregnant women, should not undergo routine serologic screening for genital herpes because the harms of this approach outweigh the benefits, according to an updated US Preventive Services Task Force (USPSTF) Recommendation Statement published online in JAMA.
The USPSTF last addressed screening for herpes simplex virus (HSV) in a 2005 Recommendation Statement, which advised against routine screening of asymptomatic patients at that time. “A small number” of clinical trials examined the issue since then, so the group commissioned a review of the literature through October 2016 to incorporate any new findings into the update, said Kirsten Bibbins-Domingo, MD, PhD, chair of the USPSTF and lead author of the update, and her associates.
The evidence review committee, led by Cynthia Feltner, MD, of the department of medicine, University of North Carolina at Chapel Hill, reviewed 17 pertinent studies involving 9,736 individuals. They found that no randomized clinical trial has been performed comparing screening against no screening ( JAMA. 2016 Dec 20;316[23]:2531-43. doi: 10.1001/jama.2016.17138 ).
Dr. Feltner and her colleagues concluded that current serologic screening tests produce a high rate of false-positive results – as much as 50% – and that those in turn lead to psychosocial harms such as distress and disruption of personal relationships, as well as increased costs and potential medical harm associated with confirmatory testing and unnecessary treatment.
Given the false-positive rates of the most widely used screening tests and the 15% prevalence of genital herpes in the general population, “screening 10,000 persons would result in approximately 1,485 true-positive and 1,445 false-positive results.” Moreover, confirmatory testing is offered only at a single research laboratory, said Dr. Bibbins-Domingo, professor of medicine at the University of California, San Francisco, and her associates on the Task Force.
Based on these findings and given the natural history and epidemiology of genital herpes, they characterized the potential benefits of routine screening as “no greater than small,” and the harms as “at least moderate” ( JAMA. 2016 Dec 20;316[23]:2525-30. doi: 10.1001/jama.2016.16776 ).
The American Academy of Family Physicians, the American College of Obstetrics and Gynecology, and the Centers for Disease Control and Prevention also recommend against routine HSV screening of adolescents and adults, including pregnant women, the investigators noted.
The USPSTF is an independent, voluntary group that evaluates preventive health care services and is funded by the Agency for Healthcare Research and Quality by mandate of the U.S. Congress. The authors’ financial disclosures are available at www.uspreventiveservicestaskforce.org.
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