Genital Herpes Testing Still Not Recommended for Pregnant Women

While the genital herpes outbreak spreads throughout the U.S., testing for herpes simplex 2 (HSV-2) is not recommended for most people because of its debatable benefit.

The U.S. Preventive Services Task Force posted its final recommendation statement on serologic screening for genital herpes infections on February 14, 2023.

Based on the evidence, the Task Force continues (since 2016) to not recommend serologic screening for genital herpes in people without signs or symptoms because the benefit of screening does not outweigh the risks, such as those generated from false negative test results.

This recommendation is a D grade, which means there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

Genital herpes is a common sexually transmitted infection (STI) in about 16% of young people in the U.S. that, unfortunately, has no cure.

Moreover, herpes vaccine candidates will continue in clinical trials in 2023.

"The Task Force found that screening for genital herpes in people without signs and symptoms does not improve their overall health," says Task Force member James Stevermer, M.D., M.S.P.H., in a related media statement.

"This is largely because the tests used to screen for genital herpes have limitations and a significant chance that the results will say a person has the infection when they do not."

"In fact, if current screening tests were used across all adolescents and adults, as many as half of the positive results could be wrong."

According to a related article published by The JAMA Network, the estimated seroprevalence of HSV-2 in US non-Hispanic Black adolescents and adults (35%) is nearly three times that in the general US population (12%).

An estimated 22% of pregnant women in the U.S. may be seropositive for HSV-2. 

The Task Force recommendation in 2023 does not apply to people who have a past genital herpes infection, including people who are in between outbreaks.

Symptoms of genital herpes can include sores, bumps, pain, tenderness, itching in the genital area, and fever. Experiencing these and other symptoms are known as having an "outbreak."

The Task Force recognizes that pregnant women have different and distinct preventive health needs. These women can transmit genital herpes to their children, most often during vaginal delivery, known as neonatal herpes.

Fortunately, neonatal herpes is uncommon, but when it does happen, it can have serious consequences for the baby.

However, the evidence shows that the harms still outweigh the benefits of screening pregnant women without signs and symptoms.

"The Task Force encourages people who are experiencing symptoms, have a partner who has been diagnosed with herpes, or have any concerns related to their sexual health to talk to their healthcare professional about testing and treatment options," commented Task Force vice chair Michael Barry, M.D.

"It is essential that women who are pregnant or planning to become pregnant speak with a healthcare professional if they have questions or concerns about their sexual health."

While screening for genital herpes among asymptomatic people is not beneficial, the Task Force recognizes the importance of sexual health.

The Task Force has positive recommendations on screening for other STIs, including chlamydia, gonorrhea, syphilis, and HIV, and behavioral counseling to prevent STIs among people at increased risk.

These diseases also do not have U.S. Food and Drug Administration (FDA) approved vaccines in 2023.

Fortunately, there are FDA-approved vaccines to protect people from HPV cancers, Mpox Vaccines, and certain Hepatitis infections.

Notes:

1. The USPSTF says the precise prevalence of asymptomatic HSV-2 infection in the US is difficult to determine because prevalence estimates rely on serologic testing without confirmation with Western blot.

2. The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that improves people's health nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. No industry conflicts of interest were disclosed.