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Herpes Simplex Virus Type 1 & 2 by PCR

HSV PCR, Herpes Simplex Virus (HSV) Type 1 & 2 by PCR, HSV 1 & 2 by Detection PCR

Test Codes

EPIC: LAB6401, Beaker: IHSVG

Department

Molecular Pathology

Specimen Collection Criteria

Collect: ONE of the following specimen types:

• Amniotic Fluid: 1.0 mL fluid in a sterile collection container or syringe with the needle removed. (Minimum: 0.5 mL) 
• Cerebrospinal Fluid (CSF): 1.0 mL CSF in a sterile collection container. (Minimum: 0.5 mL)
• Skin/Mucous Membranes: Swab the lesion and place in viral transport medium.
• Ocular (Aqueous or Vitreous) Fluids: Submit 1.0 mL vitreous fluid (not the dilute fluid in the cassette) in a sterile collection container. (Minimum: 0.2 mL)
• Vesicles: Puncture the vesicle and collect the vesicle fluid with a swab. Place the swab in viral transport medium.
• Special Situation - Neonatal Surface Culture for HSV:
  • Culture, Virus is the preferred testing option and is mandated by the American Academy of Pediatrics. HSV by PCR should also be performed using the same specimen collected for Culture, Virus.
  • Indicate specimen source as "neonate-surface" on the requisition or in the electronic ordering system.
• Plasma*: Submit a Lavender-top EDTA tube (Minimum: 1.0 mL) ; Pediatric: submit 2 Microtainers^®
• Bronchoalveolar Lavage (BAL): Submit in a sterile collection container. (Minimum: 0.5 mL)
• Sputum (Expectorated, Tracheal, Trans-Tracheal, Nasotracheal, Endotracheal): Submit in a sterile collection container. (Minimum: 0.5 mL)
• Serum (In-Patient orders only)*: Submit a Gold-top SST tube (Minimum: 1.0 mL); Pediatric: submit 2 Microtainers®

*Blood, serum or plasma will only be helpful in the detection of disseminated HSV infection – this is most common in neonates and immunocompromised individuals. 

Other specimen types require approval of the Medical Director of Molecular Pathology or Microbiology.

Physician Office/Draw Specimen Preparation

Maintain all specimen types refrigerated (2-8°C or 36-46°F) prior to transport.

Preparation for Courier Transport

Transport: All specimen types, at room temperature (20-26°C or 68-78.8°F) or refrigerated (2-8°C or 36-46°F).

Rejection Criteria

• Heparinized specimens.
• Specimens with gross bacterial contamination.

In-Lab Processing

Refrigerate (2-8°C or 36-46°F) specimens if testing will not be performed within 48 hours of the time of collection.

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): 48 hours
Refrigerated (2-8°C or 36-46°F): 30 days
Frozen (-20°C/-4°F or below): 30 days

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days

Laboratory

Royal Oak Clinical Molecular Pathology Laboratory

Performed

Sunday – Saturday.
Results available within 24 hours for CSF, ocular or pediatric specimens. Results for all other specimen types available in 2-3 days.

Reference Range

Negative.

Test Methodology

Real-Time Polymerase Chain Reaction (PCR), followed by Melting Curve Analysis.

Interpretation

A negative result does not rule out HSV infection.

Clinical Utility

This assay provides a highly sensitive and specific test for the diagnosis of Herpes Simplex Virus encephalitis and other HSV infections.

Routine screening for genital HSV infection in asymptomatic individuals is not recommended. Serologic testing for possible HSV exposure/symptoms should refer to HSV 1 (IgG) and HSV 2 (IgG) antibody testing EPIC (LAB5837) SOFT (HSVGS).

Clinical Disease

Two serotypes of Herpes Simplex Virus (HSV) have been identified: HSV-1 and HSV-2.

• Primary HSV-1 infections usually occur after contact with infected saliva or a person with oral lesions. Most HSV-1 infections are asymptomatic. Patients with HSV-1 infections can present with gingivostomatitis, conjunctivitis, keratitis, and herpetic whitlow. Gingivostomatitis is common in children under 5 years of age and is characterized by the presence of painful vesicular lesions of the palate, buccal mucosa, pharynx, tongue and the floor of the mouth. Lesions resolve within 2 - 3 weeks after primary infection and 4 - 7 days after recurrent infection.
  
• HSV-1 infections are responsible for more than 95% of Herpes Simplex Virus encephalitis cases. HSV encephalitis is the most commonly reported viral infection of the central nervous system, accounting for 10 - 20% of all viral encephalitis in the United States. Left untreated, HSV encephalitis is a vicious, often fatal neurologic infection. Epidemiologic studies indicate that HSV encephalitis may have a biphasic distribution with increased incidence of disease occurring in patients who are 5 - 30 years of age and in patients greater than 50 years of age.
  
• Historically, HSV-1 had been associated with oral infections and HSV-2 had been associated with genital infections. This distinction is no longer true, 30 - 50% of genital herpes infections are caused by HSV-1 and 5 - 20% of oral infections are caused by HSV-2. HSV reactivation depends on the virus type and the anatomic site of infection.
  
• Primary HSV-2 infections typically present as herpes genitalis and are characterized by extensive, bilaterally distributed papules or vesicles that merge to form large pustular or ulcerative lesions. Lesions often crust after 10 - 15 days and resolve within 2 - 4 weeks. Patients with primary infections may also present with fever, inguinal lymphadenopathy and dysuria.
  
• Neonates with HSV infections have the highest incidence of visceral and CNS infections of any patient population with more than 70% of untreated cases producing disseminated or CNS infections. The mortality rate for neonatal infections is 65%. Less than 10% of neonates develop normally following HSV infection.

Epidemiology

HSV-1 infections are generally acquired during childhood. By age 60, up to 90% of the population has antibodies to HSV-1. HSV-2 infections are usually acquired after puberty and antibody prevalence rates seem to correlate with past sexual activity. Over the past ten years, HSV-1 prevalence rates have steadily declined while the prevalence rates for HSV-2 appear to be rising.

Incubation Period

The incubation period ranges from 1-26 days and with a mean of 6-8 days.

Transmission

Transmission of HSV typically occurs through close personal contact (kissing, sharing eating utensils, etc.) Or through some form of sexual contact. Virus is shed during primary infection, during episodes of recurrent herpes, and periodically in the absence of any clinically apparent disease. Asymptomatic shedding is a significant source of virus transmitted to susceptible hosts.

CPT Codes

87529
LOINC: Type 1  16130-7, Type 2  16131-5

Contacts

Last Updated

10/7/2023