genital herpes
The heterogeneous clinical spectrum of genital herpes.

Lautenschlager S, Eichmann A.

Outpatient Clinic of Dermatology, Triemli Hospital, Zurich, Switzerland. stlauten swissonline.ch

BACKGROUND AND OBJECTIVE: Most data of genital herpes have been collected in STD clinics in the USA where unrecognized forms accounted for 80% of HSV-2 infections. Our aim was to study the clinical features in an outpatient clinic of dermatology. METHODS: The charts of 170 patients, previously monitored prospectively for a HIV prevalence study, with culture-confirmed genital herpes or herpetic infection with HSV-2 at any other site presenting between 1995 and 1999 were analyzed. RESULTS: 111 (65%) men and 59 (35%) women were identified with a mean age of 44 years. Only 49% had a typical cluster of genital lesions. Eighty-six (51%) presented with either lesions at extragenital sites [mostly the buttocks 33/170 (19%), thigh 10/170 (6%), anal region 9/170 (5%) and fingers 8/170 (5%)] or showed morphologically atypical forms of isolated genital lesions [single ulcer 16/170 (9%), erosion 6/170 (4%), crust 3/170 (2%) and fissure, edema or erythema each 1/170 (1%)]. Women significantly presented more often with extragenital infections of HSV-2 [36/59 (61%)] than men [18/111 (16%)]. CONCLUSIONS: More than half of the patients with genital herpes of a mainly immunocompetent population presented with atypical manifestations. The underdiagnosis of genital herpes seems largely due to misinterpretation of atypical genital and extragenital lesions. Copyright 2001 S. Karger AG, Basel

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11385226&dopt=Abstract genital herpes



genital herpes
Relationship between antibodies to herpes simplex virus (HSV) and symptoms of HSV infection.

Cowan FM, Johnson AM, Ashley R, Corey L, Mindel A.

Department of Sexually Transmitted Diseases, University College London Medical School, United Kingdom.

To determine the relationship between antibodies to herpes simplex virus (HSV) types 1 and 2 and diagnosis of orolabial and genital herpes, a cross-sectional survey was done among 869 sexually transmitted disease clinic attendees and 1594 blood donors in London. Among clinic attenders, the prevalence of HSV-1 infection was 59.5% and that of HSV-2 infection was 22.7%, and among blood donors the prevalence was 44.6% and 7.6%, respectively. The sensitivity and specificity of a diagnosis of oral herpes for the presence of HSV-1 antibody was almost identical in the 2 groups (clinic attendees: sensitivity, 33.1%, and specificity, 91.4%; blood donors: sensitivity, 32.3%, and specificity, 94.3%). A diagnosis of genital herpes was less sensitive for antibody for HSV-2 among donors than among clinic attenders (P < .001); however, the specificity was similar in the 2 populations (clinic attendees: sensitivity, 32.1%, and specificity, 96.6%; blood donors: sensitivity, 17.5%, and specificity, 99.5%). False-positive clinical histories were also relatively common (clinic attenders, 12%; donors, 6%). The sensitivity of the diagnosis of genital herpes would be improved if accurate serologic assays for detection of HSV type-specific antibodies were more widely available.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8769602&dopt=Abstract genital herpes



genital herpes
Recurrent genital herpes in a population attending a clinic for sexually transmitted diseases.

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

Department of Dermatology and Venereology, Sahlgrenska University Hospital Goteborg, Sweden. gun-britt.lowhagen sahlgrenska.se

Patients with recurrent genital herpes attending a sexually transmitted disease clinic were studied and transmission of the infection was elucidated by evaluating serostatus in their partners. Of 84 patients attending for recurrent genital herpes, 94% had a herpes simplex virus type 2 (HSV-2) infection and only 6% (5 patients) a type 1 infection. The mean age of the patients was 36 years and the duration of their infection was up to 37 years (median 4 years). In most patients the number of recurrences had not decreased between the first year and the last year. About half had experienced a more severe first episode infection. Of the patients, 64% were not aware of asymptomatic shedding and the risk of sexual transmission without clinical symptoms. Of 67 steady partners of patients with genital HSV-2, 15% had a history of genital herpes. By HSV serology, HSV-2 antibodies (indicating subclinical genital herpes) were demonstrated in more than half of the partners. The duration of the relationship or condom use did not seem to influence the frequency of transmission to the partner, which may indicate an individual susceptibility for acquiring a genital HSV-2 infection. Eleven per cent of the patients were on suppressive antiviral therapy, while 39% had no experience of antiviral therapy. Type-specific HSV serology was found to be of value in counselling partners of patients with genital herpes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11411912&dopt=Abstract genital herpes



genital herpes
Acyclovir prophylaxis in late pregnancy to prevent neonatal herpes: a cost-effectiveness analysis.

Randolph AG, Hartshorn RM, Washington AE.

Department of Pediatrics and Obstetrics, Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA.

OBJECTIVE: To compare the cost-effectiveness of oral acyclovir prophylaxis in late pregnancy to the current strategy of cesarean delivery for genital herpes lesions in the prevention of neonatal herpes transmission from mothers with recurrent genital infections. METHODS: Decision analysis was used to evaluate the clinical outcomes and direct costs of a prevention program from the health care payer's perspective. Probabilities were obtained from the literature and experts. Cost data were based on hospital costs and a cohort of herpes-infected neonates. RESULTS: Acyclovir prophylaxis during late pregnancy followed by cesarean delivery for genital lesions at delivery in women with recurrent genital herpes requires 1818 women to follow this strategy to prevent one neonatal infection and 7.4 women to take acyclovir to prevent one outbreak of genital herpes at delivery, at a cost (above no intervention) of over $493,000 per neonatal infection prevented, $1.1 million per neonatal death or disability prevented, and $1444 per maternal outbreak prevented. Cesarean delivery for genital herpes lesions requires 386 women with recurrent herpes to undergo cesareans to prevent one neonatal infection, at a cost of more than $1.3 million per neonatal infection prevented and more than $3 million per neonatal death or disability prevented. If acyclovir is given and herpes lesions still occur, the incremental cost of requiring cesarean delivery for these women over vaginal delivery with culture and follow-up of exposed infants is more than $1.4 million per neonatal infection prevented. CONCLUSION: Oral acyclovir prophylaxis in late pregnancy for women with recurrent genital herpes is more cost-effective than the current strategy of cesarean delivery for all women presenting with genital herpes lesions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8841227&dopt=Abstract genital herpes



genital herpes
Survey of the management of genital herpes in general practice.

Woolley PD, Chandiok S.

Department of Genitourinary Medicine, University Hospital of South Manchester, UK.

In a questionnaire survey of the management and treatment of genital herpes in the community by general practitioners (GPs) in 16 UK cities considered to have good access to genitourinary services, the mean number of cases seen per GP in the previous 12 months was 1.37 for first episodes and 0.96 cases for recurrent episode genital herpes. First episode genital herpes was regularly managed solely in the community by 21% of responding GPs, while 45% of those referring directly to the genitourinary medicine clinic initiated treatment prior to referral; the vast majority prescribing acyclovir. Overall, three-quarters of GPs prescribed oral acyclovir for first episode genital herpes. Recurrent genital herpes was regularly treated solely in the community by 47% of responding GPs, while 53% of those referring directly to the genitourinary medicine clinic initiated treatment prior to referral. There was almost equal usage between acyclovir cream and tablets in the treatment of recurrent infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8799784&dopt=Abstract genital herpes



genital herpes
Asymptomatic herpes simplex virus type 2 (HSV-2) infection among pregnant women in Turkey.

Duran N, Yarkin F, Evruke C, Koksal F.

Department of Microbiology, Faculty of Medicine, Mustafa Kemal University, Turkey. nizamduran hotmail.com

BACKGROUND & OBJECTIVES: A large proportion of individuals with serologic evidence of infection with herpes simplex virus type 2 (HSV-2) are asymptomatic. HSV-2 is the main cause of genital herpes infections. The acquisition of genital herpes during pregnancy has been associated with spontaneous abortion, premature labour and congenital and neonatal herpes. The present study was undertaken to determine asymtomatic genital HSV-2 shedding and seroprevalence of HSV-2 infection among asymptomatic pregnant women at the time of delivery in Adana, Turkey. METHODS: Asymptomatic 130 pregnant women without a history of genital herpes were enrolled in the study. HSV-2 shedding was determined by viral culture of the swabs collected from cervix and vulva and HSV-2 antigen was detected by direct immunofluorescence assay (IFA), HSV-2 IgG and IgM antibodies were detected by HSV-2 type specific IgG and IgM enzyme-linked immunosorbent assay (ELISA). RESULTS: HSV-2 IgG and IgM antibodies were found in 82 (63.1%) and 18 (11.3%) of 130 pregnant women. HSV-2 type-specific antigen was detected in 22 (16.9%) pregnant women by IFA test, 17 (13.1%) of whom had HSV-2 IgM antibodies. HSV-2 was isolated only in 3 women. INTERPRETATION & CONCLUSION: The seroprevalence of HSV-2 (63.1%) and genital HSV-2 infection (16.9%) was high among asymptomatic pregnant women in Adana, Turkey. Therefore, to reduce the risk of neonatal herpes, HSV-2 type-specific antibodies should be detected in pregnant women using serological tests that allow to identify women with asymptomatic or subclinical genital HSV-2 infection and those susceptible to primary genital HSV-2 infection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15347860&dopt=Abstract genital herpes



genital herpes
The psychosocial impact of testing individuals with no history of genital herpes for herpes simplex virus type 2.

Miyai T, Turner KR, Kent CK, Klausner J.

STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, California 94103, USA.

BACKGROUND: Although approximately 20% of the population has a genital herpes (HSV-2) infection, 80% of these infections are unrecognized or asymptomatic. Serologic identification of HSV-2 leads to recognition of infection, which could lead to behavioral changes that reduce transmission. However, there has been concern that HSV-2 testing among persons without symptoms will cause substantial psychosocial harm. GOAL: The goal of this study was to assess the psychosocial impact of an HSV-2 diagnosis among individuals without a history of genital herpes attending a sexually transmitted disease (STD) clinic. STUDY: We conducted a cohort study of persons with no history of genital herpes attending an STD clinic and seeking herpes testing. Two follow-up interviews were conducted 1 week and 3 months after persons received their test results. Serum was tested using HerpeSelect 2. Psychosocial morbidity was assessed at baseline and each follow up using a mental health score, sexual attitude score, and perception of genital herpes score. RESULTS: Twenty-one percent (41 of 196) of participants tested positive for HSV-2 antibody. Among patients who were HSV-2-positive, there was no significant change in mental health score from baseline during either follow-up visit, nor was there any difference compared with persons who were HSV-2-negative. Patients who were HSV-2-positive did have a decline (P = 0.01) in their sexual attitude scores at the 1-week follow up compared with persons who were HSV-2-negative, indicating a decrease in positive sexual attitude, but this difference no longer remained at the 3-month follow up (P = 0.74). Patients who were HSV-2-positive viewed having genital herpes as significantly less traumatic than patients who were HSV-2-negative at both follow-up visits (P <0.01). CONCLUSION: There was no apparent lasting adverse psychosocial impact of detecting HSV-2 infection among individuals without a history of genital herpes seeking herpes testing at an STD clinic.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15480111&dopt=Abstract genital herpes