The ethical deliberations below are made within a Swedish context, where the estimated seroprevalence is 15-20% and most cases of sexually transmitted infections are treated at STD clinics. 10, 11 The model identifies the people involved, formulates the relevant ethical principles, and assesses and weighs the ethical benefits and costs. We have devised a framework for identifying and analysing the ethical conflicts inherent in screening for HSV-2 in asymptomatic individuals. HSV infection may have consequences for partners and offspring-some of them serious and even lethal.Ī comprehensive ethical model is needed which considers the concerns of both individuals and public health. But the issue in this case is not simply an individual one. Respect for individual autonomy often makes discussions about interventions that are justified by concerns for public health difficult and non-productive. Likewise, a proportion will wrongly be labelled as non-infected. In low prevalence populations, 30-40% of the tested individuals will wrongly be diagnosed as being infected, and even in high prevalence groups, such as those attending a sexually transmitted disease (STD) clinic, around 10% are at risk of a false diagnosis. The wide variation in seroprevalence of HSV-2 makes prevalence important in assessing the value of a test. The positive predictive value of a test may be very low if the prevalence is low, even with a high sensitivity and a high specificity ( table 1). Predictive values depend on the sensitivity and specificity of a test and, most importantly, on the occurrence of the disease in the groups being tested. The western blot assay is expensive, labour intensive, and unlikely to become widely available. 7 The more commonly used tests could be verified by an assay with maximal specificity-for example, western blot. Sensitivity of the commercial tests is usually more variable than specificity. Commercial tests for HSV generally have sensitivities and specificities of about 95%.
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