How is herpes simplex diagnosed?

When something appears in, on, or around a person’s mouth, genitals, or anus and he or she thinks it might be herpes, it is important to get to the doctor when the symptoms are present. The reason is that herpes is best diagnosed upon visual examination and taking a culture of the area by swabbing the rash, bumps, sore, or blister. Once the symptoms have healed or disappeared, it is not possible to diagnose in this way.

Another option is a blood test. If a person is infected with the virus, the antibodies will appear in their blood sample. However, while the lab can detect if a person has HSV-1 or HSV-2, the results cannot decipher where future outbreaks may occur. The reason is that both viruses can infect either location.  Since herpes is spread through skin-to-skin contact, it depends on the area that was exposed to the virus.

Physical exam: Signs and symptoms associated with herpes viral infections in humans can vary greatly depending upon the specific virus infecting the individual. Healthcare providers diagnose this group of infections by visual inspection and by taking a sample from the sore(s) for testing in a laboratory. Between outbreaks, these herpes infections can be difficult to diagnose. Viral diagnostic tests can also be performed to determine what type of herpes virus is infecting the individual.

Immunofluorescence assay: Immunofluorescence is a diagnostic technique used to identify antibodies to a specific virus. In the case of herpes zoster, the technique uses ultraviolet rays applied to a preparation composed of cells taken from the patient's zoster blisters. The specific characteristics of the light, as seen through a microscope, will identify the presence of the antibodies. This test is less expensive, more accurate, and faster than a viral culture.

Polymerase chain reaction (PCR): Polymerase chain reaction (PCR) uses a piece of the DNA of the virus, which is then replicated millions of times until the virus is detectable. A sample of the individual's tissue from a sore is prepared and analyzed in a complicated laboratory test. This technique is expensive but is useful for unusual cases, such as identifying infection in the brain and spinal cord. This type of testing would be used to detect the presence of the herpes simplex virus in those who have genital sores, encephalitis (inflammation of the brain), and in newborns suspected of having neonatal herpes (a rare but serious condition where herpes is contracted during birth). A pregnant woman who has been diagnosed with herpes may be monitored regularly prior to delivery to identify a reactivation of her infection (which would indicate the necessity for a caesarean section to avoid infecting the baby). The primary methods of testing for the virus are the herpes culture and HSV DNA testing.

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