Comparative Evaluation of CLIA and ELISA Serological Assays for HSV-1 IgG with Western Blot Confirmation in a Clinical Cohort

IntroductionHerpes simplex virus type 1 (HSV-1) is highly prevalent worldwide, making accurate serological testing essential for both clinical diagnosis and epidemiological surveillance. Automated chemiluminescent immunoassays (CLIAs) offer operational advantages over enzyme-linked immunosorbent assays (ELISAs); however, their diagnostic performance relative to Western blot (WB) confirmation in high-prevalence settings remains insufficiently characterized. Hypothesis/Gap StatementThe comparative diagnostic accuracy of CLIA- and ELISA-based assays for HSV-1 IgG detection, when benchmarked against a WB reference standard in endemic populations, remains unclear. AimThis study aimed to evaluate HSV-1 IgG seroprevalence and diagnostic performance of one CLIA and two ELISA platforms using Western blot as the reference method. MethodologyFour hundred archived serum samples from adult male craft and manual workers in Qatar were tested using the Mindray CL-900i CLIA, HerpeSelect ELISA, NovaLisa ELISA, and Euroimmun Western blot. Seroprevalence, diagnostic accuracy, and interassay agreement were assessed using WB as the reference standard, with equivocal and indeterminate results excluded from analysis. ResultsHSV-1 IgG seroprevalence estimates were comparable across assays: HerpeSelect 72.5%, Mindray 70.5%, NovaLisa 66.3%, and Western blot 66.5%, with no statistically significant differences (all p > 0.05). The Mindray CLIA demonstrated the highest diagnostic performance (sensitivity 95.7%, specificity 88.9%, accuracy 93.4%) and strong agreement with Western blot ({kappa} = 0.85). HerpeSelect showed substantial agreement ({kappa} = 0.81), while NovaLisa exhibited lower specificity. ConclusionCLIA- and ELISA-based assays produced comparable HSV-1 seroprevalence estimates in this high-prevalence population; however, diagnostic accuracy varied across platforms. The CLIA platform demonstrated the strongest agreement with Western blot, supporting its use in high-throughput settings, while confirmatory testing remains important to minimize misclassification. Key PointsO_LIWhat is known: HSV-1 serological diagnosis relies mainly on ELISA assays, while automated CLIA platforms are increasingly used in high-throughput laboratories but remain insufficiently evaluated against Western blot confirmation. C_LIO_LIWhat is new: This study provides a large head-to-head comparison of CLIA and ELISA platforms for HSV-1 IgG detection using Western blot as the reference standard in a high-prevalence population. C_LIO_LIClinical implications: Automated CLIA systems demonstrated strong diagnostic accuracy and may represent reliable high-throughput alternatives for HSV-1 serological screening in clinical laboratories. C_LI Impact StatementAccurate serological diagnosis of herpes simplex virus type 1 (HSV-1) is essential for clinical management, epidemiological surveillance, and public health decision-making, particularly in populations where infection is highly prevalent. This study adds to the existing literature by providing a large, head-to-head comparison of automated chemiluminescent immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) platforms for HSV-1 IgG detection, benchmarked against Western blot confirmation in a real-world, high-prevalence setting. By demonstrating that different serological platforms can yield similar population-level seroprevalence estimates yet differ in diagnostic accuracy and specificity, this work highlights the risk of misclassification when confirmatory testing is not considered. The findings are of broad relevance to clinical microbiology laboratories, diagnostic services, and public health surveillance programs that rely on serological assays for HSV-1 screening. The study represents an incremental but important step in refining assay selection and interpretation, supporting more reliable laboratory diagnostics and improved understanding of HSV-1 infection burden in endemic populations. Data Availability StatementThe data that support the findings of this study are available from the corresponding author upon reasonable request.