Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Herpes Virus Simplex Virus II 
      
Antigen, from Lesion Smear

PCR molecular testing is near. But this is a classical DFA type of test (direct fluorescent antibody) for HSV II antigen (Ag) within infected cells from the patient (if any infected cells were actually dislodged into the sample from the patient). HSV II is a  DNA virus of the herpes group. This HSV II virus is closely related to HSV I, the "fever blister" virus. Both produce painful blisters and ulcerations, and the virus can be dormant in the location and erupt and re-erupt with sores. Since about 1990, there are antiviral agents which may cure an initial infection if caught and treated very early; cures are less likely once established, though treatment may help decrease the severity. Since oral sex has become so prevalent in modern times, the differentiation between an infection with HSV I and HSV II is less reliable for purposes of blaming an etiology. That is, a person could engage in oral sex with one partner and acquire HSV II from that infected partner. The person may or may not have an obvious sore to indicate having caught the disease; then, through kissing only, that person may pass the HSV II on to another person who has not engaged in any sort of genital sex. That is, it is possible for a righteous virgin to get HSV II of the lips or mouth.

 In testing, there can be serious test cross-reactions in serological (blood serum) tests of the patient's blood for HSV antibodies, but that is not a problem in the HSV I & II antigen test. An air-dried Pap smear of the cervix or vagina, or air-dried smear or scrape or touch prep of vulvar, penile, oral, or cutaneous lesions can be tested. A reagent antibody against HSV II Ag is layered onto the slide followed by attachment of a fluorescing reagent which attaches to any HSV II Ag-Ab complexes. These are viewed under a fluorescent microscope, and appropriately shaped ("morphospecific") fluorescent targets are indicative of a positive test. The virus is located in epithelial cells; so, it is of great importance that any test sample include (often requiring scraping) those cells and not just pus or protein and salve and ulcer crust (the greatest likelihood of an optimal sample is when dealing with what seems to still be a blister/vesicular lesion). A Tzank prep smear could be prepared exactly similarly as a duplicate sample in order to obtain faster preliminary results. The "positive" DFA test is to be overstained by Wright's or Pap staining and the positivity correlated with viropathic epithelial cells. If there is DFA "positivity" but smear is devoid of viropathic cells, it is a situation of "indeterminate positive staining for HSV, etc.". A blood sample for possible HSV II serological testing (should the DFA and/or Tzank be negative or indeterminate) can be drawn at the same time and serum removed and reserved for possible further testing. But, remember that a small primary lesion may fail to generate a detectible primary antibody response! See HSV I.

Negative test status:
  • unsatisfactory sample (the single greatest source of "false negatives") in an HSV II lesion in an infected person...the lab may indicate this with a message such as "acellular smear" and may suggest this possibility with a message such as "minimal cellular material present"..."indeterminate due to scant cellularity.
  • sample from a virus-particle-poor stage in the evolution of an HSV II  lesion in an infected person (a rare reason for a "false negative")
  • some other type of herpes-like lesion in a person who does not have HSV II [HERE].

 (1) DFA positive and (2) morphologically positive test results:

  • HSV II infection
  • false positive (no particular reason...all tests have at least an extremely low false positive rate & no test is free of this defect)...guard against this by overstaining the DFA prep as a Tzank prep to make sure that the "positivity" is morphospecific.

Test Synonyms

Other names for this exact or approximate agent are:   

  • Herpes simplex virus II

(posted about 2000; latest adjustment 21 September 2012)

 
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