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Test ID VHSV Herpes Simplex Virus (HSV), Culture From Neonates, Varies

Useful For

An aid in the diagnosis of congenital herpes simplex virus (HSV) infection in patients younger than 35 days old through the recovery of HSV using viral culture (shell-vial)

Reporting Name

HSV Culture from Neonates

Specimen Type


Ordering Guidance

This test should only be performed on patients younger than 35 days old. It is intended for the recovery of herpes simplex virus in suspected cases of congenital herpes.


If enterovirus or hand, foot, and mouth disease is suspected order test VIRNR / Viral Culture, Non-Respiratory. Indicate "Looking for Enterovirus" in order comments.


Spinal fluid (CSF) specimens: order HSVC / Herpes Simplex Virus (HSV), Molecular Detection, PCR, Spinal Fluid.

Shipping Instructions

Specimen must be transported at refrigerate temperature.

Necessary Information

Specimen source is required.

Specimen Required

Submit only 1 of the following specimens:


Specimen Type: Swab


-M4-RT (T605)

-Bartels FlexTrans VTM-3 mL (T892)

-Jiangsu VTM-3 mL (T891)

Sources: Ocular, Rectal, Skin, Dermal, Mouth, Nasopharynx, Conjunctiva, Eye, Anus

Container/Tube: Multimicrobe media (M4-RT) (T605) or other viral transport media (M4 or M5)

Specimen Volume: Swab

Collection Instructions: Place swab back into multimicrobe media (M4-RT, M4, or M5)

Additional Information: Swab with a wood handle has been shown to be toxic to some viruses and is not acceptable for culture.


Specimen Type: Urine

Container/Tube: Sterile container

Specimen Volume: 1 mL


Specimen Type: Stool

Container/Tube: Sterile container

Specimen Volume: 5 to10 g

Specimen Minimum Volume

Stool: 5 g
Urine: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Refrigerated 7 days

Clinical Information

Herpes simplex virus (HSV) types 1 (HSV-1) and 2 (HSV-2) are DNA viruses that cause localized infections of the skin, oral mucosa, oral cavity, eyes, genital tract, and central nervous system (CNS).(1,2) Systemic disease may occur. Primary infection typically results in no symptoms or localized pain and lesions at the site of infection (usually the oral or genital areas). After a primary infection, the virus enters a latent state. Latent virus may or may not reactivate in the future. Typically, the primary infection is more severe than subsequent reactivations. However, not all individuals have symptoms during the primary infection and the first recognized symptoms may be in the setting of a reactivation.


HSV infections are common. Seroprevalence of HSV-1 and HSV-2 in the United States (2005-2010) is 53.9% and 15.7%, respectively.(3) HSV-1 has historically been associated with oral lesions, but increasingly it is also a cause of genital herpes. Both HSV-1 and HSV-2 can cause severe CNS disease. In particular, HSV encephalitis in neonates is considered a medical emergency. Even with antiviral medication, there is significant morbidity and mortality associated with HSV encephalitis, especially in neonates.


Fetal and neonatal HSV infections can be acquired in utero or at the time of delivery. The greatest risk for transmitting HSV is when the mother experiences a primary HSV infection, but there is also increased risk of transmission during periods of reactivation. Primary infection and reactivation may not be symptomatic, but nevertheless result in viral transmission to the fetus or newborn.


Diagnostic methods for HSV include routine viral culture, molecular testing by PCR, and serology. It is difficult to recover HSV from spinal fluid (CSF) specimens using viral culture, and a serologic response to HSV is not detectable immediately after infection.


Detection of HSV by real-time PCR is now recognized as the most sensitive approach to diagnose HSV infection, especially CNS-associated HSV disease. However, it is still recommended to test neonates by viral culture when testing for potential congenital herpes by peripheral (eg, skin) swab, since PCR may detect low levels of HSV DNA or inactive virus in the absence of infectious viral particles. Infants younger than 4 weeks of age may have detectable HSV DNA on them that was shed by an infected mother, even in the absence of active HSV infection in the infant. On the other hand, a positive result by viral culture indicates the presence of live virus, suggesting active infection in the newborn.(4)

Reference Values

No virus isolated


Recovery of herpes simplex virus (HSV) from clinical specimens supports the diagnosis of congenital HSV infection. A negative result by shell vial assay should be interpreted in the context of the patient's clinical presentation and exposure history. Furthermore, testing by real-time PCR for this virus should be considered prior to ruling out HSV disease.

Clinical Reference

1. Schiffer JT, Corye L: New concepts in understanding genital herpes. Curr Infect Dis Rep Nov 2009;11(6):457-464

2. Sauerbrei A, Eichhorn U, Hottenrott G, Wutzler P: Virological diagnosis of herpes simplex encephalitis. J Clin Virol 2000;17(1):31-36

3. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. Herpes Simplex. Edited by LK Pickering. 29th edition. Elk Grove Village, IL: American Academy of Pediatrics, 2012

4. Bradley H, Markowitz LE, Gibson T, McQuillan GM: Seroprevalence of Herpes Simplex Virus types 1 and 2-United States, 1999-2010. J Infect Dis 2014 Feb 1;209(3):325-333

5. Stranska R, Schuurman R, de Vos M, van Loon AM: Routine use of a highly automated and internally controlled real-time PCR assay for the diagnosis of herpes simplex and varicella-zoster virus infections. J Clin Virol 2004 May;30(1):39-44

6. Espy MJ, Uhl JR, Mitchell PS, et al: Diagnosis of herpes simplex virus infections in the clinical laboratory by LightCycler PCR. J Clin Microbiol 2000;38(2):795-799

Day(s) Performed

Monday through Sunday

Report Available

2 to 4 days

CPT Code Information

87254 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
VHSV HSV Culture from Neonates 43697-2


Result ID Test Result Name Result LOINC Value
VHSV HSV Culture from Neonates 43697-2

Method Name

Virus Culture by Shell-Vial

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.