目的:描述可用于生殖器和新生儿疱疹的血清学和分子工具,以及它们在不同临床情况下的使用。
方法:来自MedLine数据库的书目调查和国际临床实践指南咨询。
结果:妊娠期生殖器疱疹或新生儿疱疹的病毒学确认必须依靠PCR(专业共识)。HSV类型特异性血清学(IgG)将允许确定患者的免疫状态(在没有临床病变的情况下)。然而,目前没有证据证明妊娠期进行HSV血清学检测是合理的(专业共识).如果孕妇的生殖器病变之前没有报告任何生殖器疱疹,建议通过PCR和HSV型特异性IgG进行病毒学确认,以区分真正的原发感染,与第一生殖器表现相关的非原发感染,复发(C级)。HSVIgM对生殖器疱疹(C级)的诊断无效。如果孕妇有生殖器疱疹的个人病史,但没有病变,不管胎龄是多少,不建议进行生殖器采样或血清学(专业共识)。如果复发,如果病变是疱疹的特征,病毒学确认是不必要的(专业协议)。然而,如果病变不是特征性的,应通过PCR进行病毒学确认(专业共识)。出生时,一旦怀疑新生儿疱疹(有症状的新生儿),应收集HSVPCR样本(最好在开始抗病毒治疗之前,但不得延迟治疗),或在分娩时患有疱疹病变的母亲出生的无症状新生儿的24小时后(专业共识)。用于病毒学确认的临床样品应至少包括血液和外周位置。在新生儿疱疹的临床表现的情况下,第一个样本PCR阳性,早产,或与分娩时第一生殖器表现相关的母体原发感染或非原发感染,如果存在,还应收集CSF以及新生儿的病变样本(专业共识)。如果PCR阴性但有新生儿疱疹的有力证据,应重复取样(专业共识)。HSV血清学对诊断新生儿疱疹(C级)无用。
结论:妊娠期生殖器疱疹或新生儿疱疹的病毒学诊断必须依靠PCR。法国可用的PCR测定法非常可靠。特异性IgG专用于限制性适应症。
OBJECTIVE: To describe serological and molecular tools available for genital and neonatal herpes, and their use in different clinical situations.
METHODS: Bibliographic investigations from MedLine database and consultation of international clinical practice
guidelines.
RESULTS: Virological confirmation of genital herpes during pregnancy or neonatal herpes must rely on PCR (Professional consensus). HSV type-specific serology (IgG) will allow determining the immune status of a patient (in the absence of clinical lesions). However, there is currently no evidence to justify universal HSV serological testing during pregnancy (Professional
consensus). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type-specific IgG in order to distinguish a true primary infection, a non-primary infection associated with first genital manifestation, from a recurrence (Grade C). HSV IgM is useless for diagnosis of genital herpes (Grade C). If a pregnant woman has personal history of genital herpes but no lesions, whatever the gestational age, it is not recommended to perform genital sampling nor serology (Professional consensus). In case of recurrence, if the lesion is characteristic of herpes, virological confirmation is not necessary (Professional Agreement). However, if the lesion is not characteristic, virological confirmation by PCR should be performed (Professional
consensus). At birth, HSV PCR samples should be collected as soon as neonatal herpes is suspected (symptomatic neonate) (best before beginning antiviral treatment but must not delay the treatment), or after 24hours of life in case of asymptomatic neonate born to a mother with herpes lesions at delivery (Professional
consensus). Clinical samples for virological confirmation should include at least blood and a peripheral location. In case of clinical manifestations of herpes in the neonate, first samples PCR positive, preterm birth, or maternal primary infection or non-primary infection associated with first genital manifestation at delivery, CSF should also be collected as well as samples of lesions in the neonate if present (Professional
consensus). Sampling should be repeated in case of PCR negative but strong evidence of neonatal herpes (Professional consensus). HSV serology is useless for diagnosis of neonatal herpes (Grade C).
CONCLUSIONS: Virological confirmation for diagnosis of genital herpes during pregnancy or neonatal herpes must rely on PCR. PCR assays available in France are very reliable. Specific IgG are dedicated to restricted indications.