Test Catalog

Test Id : VHSV

Herpes Simplex Virus (HSV), Culture From Neonates, Varies

Useful For
Suggests clinical disorders or settings where the test may be helpful

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)

Method Name
A short description of the method used to perform the test

Virus Culture by Shell-Vial

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.


Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

HSV Culture from Neonates

Lists additional common names for a test, as an aid in searching

Herpes 1 and 2 (Culture)

Herpes or Herpes Simplex Virus Culture

Viral Isolation

Specimen Type
Describes the specimen type validated for testing


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.


Question ID Description Answers
Q00M0075 Specimen Source

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Submit only 1 of the following specimens:


Specimen Type: Swab

Supplies: M4-RT (T605)

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
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

Stool: 5 g

Urine: 0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Other Frozen Swab with wood handle Gel swabs Blood Bone marrow/bone Tissue Lymph node

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Varies Refrigerated 7 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

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)

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

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
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

No virus isolated

Provides information to assist in interpretation of the test results

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.

Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

This test should not be performed on patients older than 4 weeks of age. It is intended for the recovery of herpes simplex virus (HSV) in suspected cases of congenital herpes. For patients older than 4 weeks of age, detection of HSV by real-time PCR is recommended.


A negative result does not rule out the possibility of congenital HSV infection.


Real-time PCR for HSV is the recommended test for all cases of central nervous system disease caused by this virus. Viral culture is an insensitive approach for detection of HSV in spinal fluid.

Supportive Data

Herpes simplex virus (HSV) shell-vial is a standard method that has been compared to real-time PCR in several published studies. Data from these studies suggest that real-time PCR increased the detection rate for HSV-1 and HSV-2 by up to 62.5%.(5,6)


Despite the increased sensitivity of real-time PCR compared to routine viral culture, detection of live virus may be useful in cases of suspected congenital herpes infection when the ability to distinguish between the presence of active, replicating virus and inactive virus or viral nucleic acid is important.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

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

Method Description
Describes how the test is performed and provides a method-specific reference

This test is intended for use in the identification and typing of herpes simplex virus (HSV) in cell culture. The test can detect and distinguish between HSV-1 and HSV-2 in shell-vial cultures (MRC-5 cells) before the development of cytopathic effect (Pre-CPE). This test uses monoclonal antibodies (DHI/Quidell), labeled with fluorescein isothiocyanate, which react specifically with HSV-1 and HSV-2. The testing process involves the inoculation of shell vials containing a monolayer of cells on a 12-mm circular cover slip at the base of the vial. Specimen is inoculated into the shell vial and infection of the cells is enhanced by low-speed centrifugation, which is thought to enhance viral infection of the cell monolayer. After incubation at 35 degrees C to 37 degrees C, monoclonal antibodies directed against immediate early antigens of replicating HSV are added, and viral-specific foci visualized by fluorescence microscopy.(Paya CV, Wold AD, Smith TF: Detection of cytomegalovirus infections in specimens other than urine by the shell vial assay and conventional tube cell cultures. J Clin Microbiol 1987;25:755-757)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information


Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

Until Reported

Performing Laboratory Location
Indicates the location of the laboratory that performs the test


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Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

87254 x 2

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
VHSV HSV Culture from Neonates 43697-2
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
VHSV HSV Culture from Neonates 43697-2

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports