TABLE 12.

Comparison of cell culture and real-time PCR for the laboratory detection of herpes simplex virus infections from dermal and genital specimens

ReferenceCultureReal-time PCRComments
No. of specimensNo. positive (%)CellsNo. of specimensNo. positive (%)Test platform/gene target
Ryncarz et al. 1999 (422)335 (genital tract)162 (48.4)Human diploid fibroblast (24-well microtiter plates) rapid culture technique335248 (74.0)ABI Prism/glycoprotein BFirst study of laboratory diagnosis of genital tract specimens by real-time PCR
Espy et al. 2000 (118)200 (genital, 160; dermal, 38; ocular, 2)69 (34.5)MRC-5 (shell vials)20088 (44)LightCycler/DNA polymerase, thymidine kinaseFeasibility study performed by developmental technologists
Espy et al. 2000 (115)500 (genital, 288; dermal, 192; ocular, 20)158 (31.6)MRC-5 (shell vials)500225 (45)LightCycler/DNA polymerase, thymidine kinaseImplementation study performed by technologists performing laboratory testing for diagnostic purposes
Koenig et al. 2001 (229)104 (genital and dermal)43 (41.3)Rabbit kidney (tubes)10455 (52.9)LightCycler/glycoprotein DSYBR Green I dye detection system
Aldea et al. 2002 (4)118 (genital tract)28 (23.7)A-549; MRC-5 (tubes)11834 (28.8)LightCycler/DNA polymerase, thymidine kinaseSYBR Green I dye detection system
Burrows et al. 2002 (57)26236 (13.7)26275 (28.6%)LightCycler/DNA polymeraseLightCycler PCR detected and subtyped HSV in 99% (66/67) of HSV-positive specimens, compared to 81% (54/67) by rapid antigen or 57% (36/63) by culture
van Doornum et al. 2003 (506)668 anogenital (dermal, ocular, oral, bronchoalveolar lavage)199 (29.8)Human embryonic lung fibroblasts (24-well microtiter plates), rapid culture technique688240 (34.9)ABI Prism/glycoprotein D, glycoprotein G17 (culture) and 27 (PCR) specimens were positive for VZV
Wald et al. 2003 (526)36,471 specimens (mucosal swabs obtained from a variety of anatomic sites) from 296 subjects1,087 (2.9)Human diploid fibroblasts (microtiter plates), rapid culture technique36,4614,415 (12.1)ABI Prism/glycoprotein BOf 4,464 samples positive by more than one test (cell culture and PCR) 3,377 (75.7%) were positive by PCR only; 49 (1.1%) were positive by culture only. This study is the most extensive comparison between virus isolation and detection of a pathogen by PCR. Transport of specimens during summertime likely reduced the detection rate of HSV in cell cultures compared to molecular amplification. This conclusion is consistent with the results of a publication demonstrating the stability of nucleic acids after storage (201)