genital herpes
Patients' perspectives on the burden of recurrent genital herpes.

Patel R, Boselli F, Cairo I, Barnett G, Price M, Wulf HC.

Department of Genito-Urinary Medicine, Royal South Hants Hospital, Brinton's Terrace, Southampton SO14 0YG, UK.

The purpose of this study was to quantify the impact of recurrent genital herpes (RGH) on health-related quality of life, healthcare resource and workplace productivity. This was a cross-sectional survey conducted in 5 countries (Australia, Denmark, Italy, The Netherlands and UK). Patients with a confirmed history of RGH completed the MOS 36-Item Short Form Health Survey (SF-36) and the Recurrent Genital Herpes Quality of Life questionnaire (RGHQoL). Questionnaires addressing frequency of access to healthcare services and workplace productivity were also completed and patients' medical history was obtained. Scores for 6 of the 8 domains of the SF-36 were significantly lower (P<0.001) i.e. worse, compared with scores for the normal population. The RGHQoL score was significantly lower in patients experiencing more frequent or more severe recurrences. Forty-five per cent of patients estimated that their work effectiveness was reduced by between 25% and 50% due to genital herpes symptoms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11564330&dopt=Abstract genital herpes



genital herpes
An interactive, computer-based program to educate patients about genital herpes.

Bensen C, Stern J, Skinner E, Beutner K, Conant M, Tyring S, Reitano M, Davis G, Wald A.

School of Nursing, University of Washington, Seattle, USA.

BACKGROUND AND OBJECTIVES: Education and counseling constitute a substantial portion of management of patients with genital herpes. Innovative methods for education about genital herpes are needed. GOAL: To test the ability of an interactive, computer-based program to educate patients about genital herpes. STUDY DESIGN: Persons seeking care at five urban offices were asked to participate. A knowledge test about genital herpes was administered before and after participation. Participants' satisfaction was assessed with a questionnaire. RESULTS: Four hundred thirty-five participants enrolled, and 428 completed the herpes knowledge test. Of six questions evaluated, a statistically significant increase in the proportion of correct answers was noted on five of six questions. Fifty-one percent of participants answered all the questions correctly after the program, compared with 39% before the program. Satisfaction with the program was very high. CONCLUSIONS: Innovative, computer-based programs can provide education and assist in the management of chronic sexually transmitted infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10417026&dopt=Abstract genital herpes



genital herpes
Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho.

Htun Y, Morse SA, Dangor Y, Fehler G, Radebe F, Trees DL, Beck-Sague CM, Ballard RC.

National Reference Centre for Sexually Transmitted Diseases, School of Pathology, South African Institute for Medical Research, Johannesburg, South Africa.

OBJECTIVE: To evaluate two protocols for the syndromic management of genital ulcer disease (GUD) in Lesotho, southern Africa and to compare the performance of these protocols with that of a conventional disease specific approach. METHODS: A cross sectional study was conducted among consecutive patients with GUD attending an STD clinic in Maseru, Lesotho. The clinical diagnoses were made by using predefined criteria at the initial visit before the performance of laboratory tests. Attempts were made to detect the specific aetiology of the genital ulcers using PCR assays and syphilis serology. The results of PCR assays and syphilis serology were used as the gold standard against which the performance of the management approaches were applied. RESULTS: Of 100 patients initially recruited into the study, Haemophilus ducreyi infection was detected in 56%, herpes simplex virus in 26%, Treponema pallidum in 23%, and lymphogranuloma venereum in 7%. No pathogens were detected in 6% of patients. 17% of patients had mixed infections. Sensitivity, specificity, positive and negative predictive values of the three management protocols for GUD were compared after applying each to the study population. Theoretically, the lowest correct treatment rate would have been obtained by using the disease specific protocol (62%) compared with more than 90% in both syndromic management protocols. Considerable overtreatment for primary syphilis would occur following application of both syndromic protocols. This would be the result of the overdiagnosis of chancroid, in particular the misdiagnosis of genital herpes as chancroid, which would receive treatment for syphilis unnecessarily. The HIV seroprevalence among these patients was 36%. A significantly higher rate of HIV seropositivity was detected among the patients with herpes simplex virus infection when compared with those patients having other causes of genital ulcer disease (58% v 27%; odds ratio 3.73; 95% CI 1.26-11.26; p = 0.01). CONCLUSIONS: Poor sensitivity, specificity, and predictive values were recorded when the disease specific protocol was applied to the study population. In contrast, the syndromic management protocols provided adequate treatment for more than 90% of patients with GUD. Protocol C, which identified a minority of cases of genital herpes, was found to have an advantage when compared with protocol B (all patients with genital ulcer disease treated for both syphilis and chancroid) in that 29% of genital herpes cases would receive appropriate counselling.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10023349&dopt=Abstract genital herpes



genital herpes
Genital ulcers in a primary health clinic in Rwanda: impact of HIV infection on diagnosis and ulcer healing (1986-1992).

Bogaerts J, Kestens L, van Dyck E, Tello WM, Akingeneye J, Mukantabana V.

Laboratory of Microbiology, Centre Hospitalier de Kigali, Belgo-Rwandan Medical Cooperation, Rwanda.

During 1986-88 and 1990-92, 1025 (97%) out of 1057 genital ulcer patients in Kigali, Rwanda, were tested for HIV antibodies and for infection with Treponema pallidum, Haemophilus ducreyi and herpes simplex virus. Overall, 57% of men and 80% of women had antibodies to HIV-1. The most frequent laboratory diagnoses were chancroid (27%), syphilis (19%) and genital herpes (19%) among men and syphilis (35%), genital herpes (23%) and chancroid (20%) among women. HIV-1 seroprevalence increased sharply over time among men but not among women. The clinical presentation of ulcers as well as laboratory diagnoses were similar in the HIV-1 seropositive and seronegative groups. The relative frequency of all laboratory diagnoses remained unchanged over time. HIV-1 seropositivity had no impact on ulcer healing. Advanced immunodeficiency was diagnosed among 12% of the HIV-1 seropositive patients and was significantly associated with increasing age and genital herpes.

PIP: A study conducted at the Centre Medico-Social de Bilyogo, a primary health clinic located in an area of Nyamirambo, Kigali (Rwanda), where prostitution is widespread, assessed the frequencies of the causes of genital ulcer disease. Out of 1057 consecutive genital ulcer patients tested in 1986-88, 57% of men and 80% of women were infected with HIV-1. The most frequent laboratory diagnoses were chancroid (27%), syphilis (19%), and genital herpes (19%) among men and syphilis (35%), genital herpes (23%), and chancroid (20%) among women. During follow-up in 1990-92, HIV-1 seroprevalence increased sharply among men of all ages and women under 30 years of age. HIV-1 seropositivity had no effect on the clinical presentation of ulcers or on the time required for ulcer healing. Advanced immunodeficiency, diagnosed among 12% of HIV-positive patients, was significantly associated with increasing age and genital herpes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9863586&dopt=Abstract genital herpes



genital herpes
Evaluation of a novel, anti-herpes simplex virus compound, acyclovir elaidate (P-4010), in the female guinea pig model of genital herpes.

Jennings R, Smith TL, Myhren F, Phillips J, Sandvold ML.

Division of Molecular and Genetic Medicine, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom. r.jennings shef.ac.uk

The antiviral effect of acyclovir elaidate in the female guinea pig model of genital herpes was investigated in a series of experiments. The antiherpesvirus effects of this novel compound, 9-(2'-[trans-9"-octadecenoyloxyl]ethoxymethyl)guanine (code no. P-4010), were studied in both primary and recurrent genital herpes in the female guinea pig, following oral gavage or intraperitoneal injection, with different formulations of the compound, and in comparison with acyclovir (ACV) or penciclovir (PCV). The results indicate that compound P-4010 has a greater capability than either ACV or PCV in reducing the clinical symptoms of primary genital herpes induced following the inoculation of herpes simplex virus type 2 (HSV-2) intravaginally into guinea pigs. In addition, the administration of P-4010 twice daily over a 10-day period by the intraperitoneal route (15 to 40 mg/kg of body weight/day) or by oral gavage (50 to 200 mg/kg/day), commencing 4 h subsequent to intravaginal HSV-2 infection, resulted in a degree of reduction in the incidence and severity of spontaneous, recurrent genital herpes in these animals. The findings are discussed in the light of the value and relevance of the female guinea pig model of genital herpes for the assessment of anti-herpes simplex virus compounds.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9869565&dopt=Abstract genital herpes



genital herpes
Sexually transmitted diseases in 1161 HIV-positive patients: a 38-month prospective study in southern Spain.

Munoz-Perez MA, Rodriguez-Pichardo A, Camacho Martinez F.

Department of Dermatology, Virgen Macarena Hospital, School of Medicine of Sevilla, Spain.

BACKGROUND: HIV infection is primarily a sexually transmitted disease (STD), but intravenous drug use (IDU) is the main risk factor for HIV infection in certain areas, including southern Europe. A number of prospective studies of dermatological findings in HIV-1 infected patients have been published, almost all from countries where homosexuality is the main risk factor of HIV infection and without correlation with CD4 cell counts. No STD data is included in those studies. OBJECTIVE: To determine the incidence of STDs in a cohort of 1161 HIV-1-positive patients from Spain, in the previous medical history and during the prospective study. METHODS: We prospectively examined 1161 HIV-1-positive patients for 38 months, 986 men and 175 women. IDU was the risk factor in 74%, while homosexuality was a risk factor in only 9%. CDC stage II was predominant (51%), while stage IV was less frequent (39%). The mean CD4 cell count was 353/mm3. Patients' past and present medical history of STDs was obtained. CD4 cells/mm3 counts were measured at each visit. RESULTS: Six hundred and eighty-four patients had a past history of STD, whilst new infections were diagnosed in 258 individuals (22%) during the 38-month study. Pediculosis pubis (26%), gonorrhoea (22%), syphilis (13%), genital candida infection (11%) and condyloma acuminatum (10%) were the commonest previous STDs, followed by non-gonococcal urethritis (NGU) (5%), genital herpes (4%) and trichomoniasis (2%). During the 38-month study period and with strong recommendation of condom use for sexual intercourse, condyloma acuminatum (7%), scabies (6%), syphilis (4%) and genital herpes (3%) were commonly diagnosed, followed by gonorrhoea (1.8%), NGU (1.6%), genital candida infection (1.5%), pediculosis pubis (0.6%) and trichomoniasis (0.3%). Only genital herpes had a statistically significant association with advanced stage (P = 5.12 x 10(-6)) and low CD4 cell counts (180 +/- 166 cells/mm3). CONCLUSION: Despite the predominance of the IDU factor among our patients, the incidence of STDs in the past medical history was surprisingly high. The incidence of STD during the study was also high, despite the advice of using condoms after the diagnosis of HIV infection. STDs may accelerate the course of HIV infection and be a poor prognostic indicator in these patients. If an HIV-1-positive patient can acquire an STD, he/she can also transmit HIV infection. This indicates that new publicity campaigns are still needed to stop HIV and STDs infection among HIV-positive patients as well as in the general population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9883433&dopt=Abstract genital herpes



genital herpes
Genital herpes. Type-specific antibodies for diagnosis and management.

Ashley RL.

Division of Virology, University of Washington School of Medicine, Seattle, USA.

The high incidence of unrecognized genital herpes infections and the role of such undiagnosed infections in continuing the spread of genital herpes has been due, in part, to the limited availability of accurate serologic assays for herpes simplex virus types 1 (HSV-1) and 2 (HSV-2). Type-specific serology test kits for HSV diagnosis have been developed and are expected to be widely available in 1998. Clinicians should understand the proper application of these new test and in addition, should be aware that older, inaccurate test will remain on the market for the foreseeable future.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9891682&dopt=Abstract genital herpes