Going for three: what is the role for triplex testing for HSV-1, HSV-2, and VZV?

Area of Science:

• Virology
• Infectious Diseases
• Diagnostic Microbiology

Background:

• Herpes simplex virus-1 (HSV-1), HSV-2, and varicella zoster virus (VZV) are common causes of mucocutaneous lesions.
• Diagnostic methods have evolved to nucleic acid amplification tests (NAATs), but current testing is often not undertaken or is specific for only HSV or VZV.
• This approach can lead to missed diagnoses, impacting patient management and infection control.

Purpose of the Study:

• To highlight the limitations of current diagnostic testing for HSV-1, HSV-2, and VZV.
• To emphasize the critical need for accurate viral identification in mucocutaneous lesions.
• To explore the potential benefits of triplex NAATs for improved patient care and infection prevention.

Main Methods:

• Review of diagnostic approaches for HSV-1, HSV-2, and VZV.
• Analysis of a study highlighting missed viral diagnoses in clinical practice.
• Discussion of the implications of accurate viral identification for treatment and infection control.

Main Results:

• Provider-ordered testing frequently misses the causative virus (HSV-1, HSV-2, or VZV).
• Clinical diagnosis alone is often insufficient to differentiate between HSV-1, HSV-2, and VZV.
• Inaccurate diagnosis leads to suboptimal patient management, including incorrect antiviral dosages and duration, and inappropriate infection control measures.

Conclusions:

• Accurate identification of HSV-1, HSV-2, and VZV is critical for appropriate patient management and infection prevention.
• Broader availability and implementation of triplex NAATs can improve diagnostic accuracy.
• Further research is needed to define optimal use cases for triplex testing.