genital herpes
First episodes of genital herpes in a Swedish STD population: a study of epidemiology and transmission by the use of herpes simplex virus (HSV) typing and specific serology.

Lowhagen GB, Tunback P, Andersson K, Bergstrom T, Johannisson G.

Department of Dermatology, Sahlgrenska University Hospital, Goteborg, Sweden. Gun-Britt.Lowhagen sahlgrenska.se

OBJECTIVES: To determine the proportion of herpes simplex virus type 1 (HSV-1) and HSV type 2 (HSV-2) in first episodes of genital herpes. To evaluate the use of HSV specific serology for classifying first episodes of genital herpes and for defining HSV serostatus in the patients' sexual partners. METHODS: 108 consecutive patients with first episodes of genital herpes seen at three STD clinics in Sweden from 1995 to 1999 were included in the study. HSV culture and typing were performed and serum was tested for antibodies against a type common HSV antigen and a type specific HSV-2 antigen, glycoprotein G2 (gG2). A structured interview including questions about sexual behaviour and sexual partners was taken. "Steady" partners were offered a blood test for HSV serology and counselling. RESULTS: Of 108 patients, 11 had a negative HSV culture. Of the 97 who were HSV culture positive, 44% (43/97) were typed as HSV-1 and 56% (54/97) as HSV-2. For 86 of these 97 patients, HSV serology from the initial visit was available. Of 52 primary infections, thus initially seronegative, 64% were HSV-1 infections and of 19 female primary infections 16 (84%) were HSV-1. In 17% the first episode of genital herpes corresponded to the first clinical recurrence of an infection acquired earlier in life. There was a significant correlation between having orogenital sex and being infected with HSV-1 and also a history of labial herpes in the partner. Only 20% of partners of patients with an HSV-2 infection had a history of genital herpes. CONCLUSIONS: Almost half of first episodes of genital herpes are caused by HSV-1. In young women with a primary genital infection, HSV-1 is much more frequent than HSV-2. Besides HSV typing, we found specific HSV serology of value for classifying first episodes and for diagnosing a subclinical HSV-2 infection in partners. Anamnestic data supported the suggestion that the orogenital route of transmission was common in genital HSV-1 infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10961194&dopt=Abstract genital herpes



genital herpes
HSV-2 specific serology should be offered routinely to antenatal patients.

Brown ZA.

Department of Obstetrics and Gynecology, University of Washington, Seattle 98195-6460, USA.

The most devastating consequence of genital herpes is neonatal herpes. It is clear that the majority of newborns acquire their infection by contact with infected genital secretions during delivery from an asymptomatic mother who acquired a first episode of genital herpes near the time of labour. Since the majority of cases of first episode genital herpes during pregnancy are unrecognised, the prevention of neonatal transmission will depend upon the identification of the HSV serologically discordant couple and the institution of appropriate interventions by mid pregnancy. Therefore, the precis of this discussion paper is that universal HSV serological testing should be performed at the first prenatal visit. As a corollary, type specific HSV serology will need to be commercially available and relatively inexpensive. In any country, pregnant women and their partners represent a broad, cross section of sexually active adults. The vast majority present themselves to the health care system for care during their pregnancies which is a period of time in which the focus of care is primarily preventive and during which women are generally motivated and compliant. This is truly the 'golden opportunity' to identify patients already infected as well as those at risk for acquiring genital herpes. Information regarding genital herpes and methods of preventing transmission to susceptible partners and newborn infants can easily be added to educational programmes which have already become an institution within prenatal care. Copyright 2000 John Wiley & Sons, Ltd.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10815025&dopt=Abstract genital herpes



genital herpes
Can a multimedia educational computer-based program on genital herpes teach patients about their disease?

Wald A, Stern JO, Skinner EP, Beutner K, Conant MA, Tyring SK, Reitano MV, Davis G.

University of Washington, Washington, Seattle, USA

Objective: Education of patients with genital herpes about their disease is time consuming. To evaluate the effectiveness of an educational computer program, we developed a multimedia interactive presentation to teach patients about genital herpes. Such programs can supplement clinician visits for patients with genital herpes, or those at risk for HSV acquisition.Methods: Patients seeking care for genital herpes, or those at risk for HSV acquisition, were asked to participate in the program during routine clinic visits at 5 physician's offices nationwide. A self-administered 7 item herpes knowledge questionnaire was given before and after participation. An additional questionnaire evaluating the satisfaction with the program was also self-administered at completion.Results: 428 patients were enrolled and completed the pre- and post-knowledge questionnaire and 332 patients completed the satisfaction survey. On the pre-test, 20.1% of patients answered all questions correctly, 65.4% answered correctly 4 to 6 questions, and 14.5% 3 or less. On the post-test, 32.9% of patients answered all questions correctly, 61.5% answered correctly 4 to 6 questions, and 5.6% 3 or less (P <.001 for pre- and post-test comparison). A positive change in knowledge between pre- and post-test was seen on 6 of 7 items (P <.001 for all 6). The overall satisfaction with the program was high: the mean rating was 6.2 on a scale 1 (poor) to 7 (excellent).Conclusion: Computer-based education programs about genital herpes may provide a useful adjunct to teaching in physician offices and result in knowledge gain about the disease, at least short-term. Such programs may assist in management of chronic sexually transmitted infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10838278&dopt=Abstract genital herpes



genital herpes
Labial adhesion as a complication of primary genital herpes in young women

Omar H.

University of Kentucky,., Lexington, KY, USA.

Background: Genital herpes is a common sexually transmitted disease in adolescents. It may be associated with significant morbidity if not diagnosed on time or not properly treated. The objective of this study was to determine the incidence of labial adhesion secondary to primary herpes in young women and the possible predisposing factors for this complication.Methods: Analysis of the clinical data regarding primary genital herpes in young women in the adolescent clinic at a university hospital in outpatient clinic setting. Cases of primary genital herpes seen between December 1(st) 1998 and November 30(th) 1999 were included.Results: A total of 34 female adolescents with age range 12-19 years were diagnosed with primary genital herpes during this time period. 7 patients (20.6%) were found to have severe labial adhesion at time of diagnosis. All 7 patients were seen by other providers prior to their visit to the adolescent clinic and 4 were correctly diagnosed. All 7 patients were given antiviral therapy, but none was given local treatment. At time of diagnosis all 7 patients had anuria for more than 24 hours and severe pain and discomfort. 3 patients had Diabetes Mellitus (one of these was also pregnant) and one patient had asthma. The age range for these 7 patients was 13-17. Treatment with local anesthetics helped resolve the adhesion in 5 patients and surgical treatment was needed in the remaining two patients.Conclusion: Labial adhesion is a common, severe complication of primary genital herpes in young women. Very young age, chronic medical conditions, incorrect diagnosis and lack of topical treatment may predispose to the development of this complication. Use of topical therapy should be an integral part of the comprehensive treatment for primary genital herpes in female adolescents to alleviate discomfort and prevent urinary retention and labial adhesion.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=0010869985&dopt=Abstract genital herpes