Thursday, November 08, 2007

The Herpes Test: In a Doctor's Office Near You!

I recently linked to a Medscape article on some new technologies approved by the FDA. I wrote a rather unenthusiastic review of one of them (a device for measuring the white blood cell count in the doctor's office) and now I want to briefly discuss another one.

Focus Diagnostics has developed a point-of-care (POC) test for the herpes simplex 2 virus which causes the majority of genital herpes. POC means it can be done at a doctor's office. It takes less than 15 minutes, can be done from a blood sample, presumably doesn't require the patient to have active lesions, and is more accurate than previous blood tests.

Ordinarily, I'm not big on most POC tests because they don't really solve any major diagnostic or therapeutic conundrums. Some such as blood sugar tests are helpful because patients' diabetes medications can be immediately adjusted depending on what the test shows. Coumadin clinics that monitor patients who are taking blood thinners use POC tests that tell how thin the patients' blood really is. Again, this information is helpful immediately because the blood thinner drug's dosage can then be adjusted accordingly.

Having a rapid, accurate test for genital herpes that doesn't require visible sores may very well be helpful because of the counseling that may result because of it. A patient may be reassured with his negative results or...he may have to be educated on the nuances of this life-long and contagious disease as well as the implications for any sexual partners the patient may have.

I think that a test such as this one can strongly alter the dynamics involved in treating herpes. First of all, I can easily imagine patients being brought in by their significant others (not to mention prospective significant others) for "screening". Previously, there was no reliable way to do this.

Also, I believe that there are many people, who for whatever reasons, suspect that they might have herpes but don't really want to know. Being in a condition of ignorant bliss perhaps helps them avoid unpleasant ethical dilemmas such as sidestepping concerns of spreading the disease to unknowing partners. I think a test such as this one will make the perpetuation of such bliss more problematic because again, the patient can be tested even in the absence of lesions.

Some patients have only one outbreak of the disease and can in theory go through life without having to confront the fact that they may despite the lack of active lesions, still be able to spread it. As long as it can't be proven that the patient "knew" he was infected, he can't be held civilly liable for infecting someone else. A test such as this one makes it far more difficult to maintain plausible deniability.

Doctors using this test will have to be very thorough in consenting their patients I would think. Patients would have to be completely informed of the medical, ethical, and even legal implications of its results because they may not be well-understood by many of them.

Just some things to ponder.

By the way, the test's name is HerpeSelectExpress. To me this name connotes a shipping company...with decidedly undesirable cargo.

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