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Radiological & Non Radiological Testing in Herpes Simplex Viruses

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If you have had a cold sore, then you are familiar with the Herpes Simplex Virus. There are two types of the virus, HSV-1 and HSV-2. HSV-1 is the virus that produces cold sores on the lips, but it can also cause sores around the genitals.

HSV-2, which is also known as genital herpes, causes sores around the genitals of both men and women who have it. In rare cases, herpes can affect other areas of the body, such as the eyes and brain. Encephalitis caused by HSV-1 is rare, but it has the potential to cause significant brain damage or death.

Radiological Testing For HSV-1
MRI is the preferred modality for evaluating the brain. However, early in the clinical course of the disease, MRI results may be negative. A negative MRI does not rule out HSV encephalitis. Therapy should be empirically continued until laboratory tests definitely exclude the diagnosis.

Early imaging with CT scanning or radionuclide studies may also reveal normal findings. CT scanning may not reveal abnormalities until 3-5 days after symptom onset, by which time the patient may be stuporous and comatose. As noted above, in the acute setting, even contrast-enhanced MRIs may be negative.

Tests Used for HSV-2
There are four different tests that can detect HSV and they are usually performed when there are sores around the genital area. The tests most often performed include:

Herpes Viral Culture Test
This test is performed by taking a sample of the cells or fluid of a fresh sore and placing them in a culture cup. While this test is very accurate when performed during the clear blister phase, it often does not detect the virus when done on ulcerated sores or when the virus is dormant.

Herpes Virus Antigen Detection Test
When this test is used to detect HSV, the cells from a fresh sore are scraped off and put on a microscope slide. The test looks for markers, known as antigens, on the cells that are infected with the virus. This test may be done either in place of a viral culture or in addition to one.

Polymerase Chain Reaction (PCR) Test
This test can be performed by taking a sample of the cells or fluid from a sore, conducting a blood test, or testing other applicable fluids, such as spinal fluid, for HSV. The PCR test is done to find the genetic material of the virus and can tell the difference between HSV-1 and HSV-2.

The PCR is not commonly performed on herpes sores, and spinal fluid is only used when the virus has caused an infection involving the brain. When herpes has infected the brain area, imaging tests like an MRI may be performed using a radiolabeled antiviral drug.

Antibody Tests
Although not as accurate as a viral culture, blood tests are performed to find antibodies that will help fight the herpes infection. The antibodies are created by the immune system as a response to the virus' presence.

When these tests are performed and the virus is found, your doctor can then treat you for the herpes virus.

For extra reading, here is great informative post on herpes testing and what you need to know about it.

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