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Inability of Enzyme Immunoassays to Discriminate between Infections with Herpes Simplex Virus Types 1 and 2

Rhoda Ashley, PhD; Anne Cent, MS; Vanna Maggs, BS; Andre Nahmias, MD; and Lawrence Corey, MD
[+] Article and Author Information

Grant Support: By grant NIH AI-20381.

Requests for Reprints: Rhoda Ashley, PhD, University of Washington, Department of Laboratory Medicine, Division of Virology, c/o Children's Hospital Medical Center, P. O. Box C-5371, 4800 Sand Point Way NE, Seattle, WA 98105.

Current Author Addresses: Drs. Ashley and Corey, Ms. Cent, and Ms. Maggs: University of Washington, Department of Laboratory Medicine, Division of Virology, c/o Children's Hospital Medical Center, P. O. Box C-5371, 4800 Sand Point Way NE, Seattle, WA 98105.

Dr. Nahmias: Head, Division of Pediatric Infectious Diseases, Emory University, Grady Memorial Hospital, 69 Butler Street SE, Atlanta, GA 30333.


© 1991 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1991;115(7):520-526. doi:10.7326/0003-4819-115-7-520
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Objective: To determine the accuracy of three commercial enzyme immunoassays in detecting and subtyping antibodies to herpes simplex virus type 1 or 2.

Design: Cross-sectional.

Setting: Referral medical center.

Patients: Ninety patients with culture-positive lesions caused by infection with herpes simplex virus type 1 or 2. The results of Western blot and glycoprotein G immunodot enzyme assays showed that an additional 53 patients had subclinical herpes simplex virus type 2 infection, that another 20 patients had subclinical herpes simplex virus type 1 infection, and that 23 patients were seronegative.

Measurements: Three commercial enzyme immunoassays were used to determine herpes simplex virus antibody subtypes.

Main Results: All three commercial assays performed poorly in all patient groups (except in patients who were seronegative for herpes simplex virus). Among the 40 patients with a first episode of genital herpes, seroconversion to the appropriate viral type was shown by the three assays in only 33%, 55%, and 75% of cases. Among patients with recurrent genital herpes, the three commercial assays identified more than 90% of patients with only herpes simplex virus type 2 antibodies but failed to identify herpes simplex virus type 2 infections in 58% to 76% of patients with antibodies to both virus subtypes. The three assays correctly identified only 55%, 75%, and 85% of the 53 "silent carriers" of herpes simplex virus type 2. Overall, the three enzyme immunoassays detected herpes simplex virus type 2 antibodies in 60%, 62%, and 93% of patients with subtype 2 infections and falsely detected type 2 antibodies in 8%, 27%, and 49% of patients with type 1 infections.

Conclusion: Currently licensed enzyme immunoassays give inaccurate or misleading results about the correct herpes simplex virus infecting subtype.

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