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 herpes medicine



herpes
Expression and roles of herpes virus entry mediators A and C in cells of oral origin.

Hung SL, Cheng YY, Wang YH, Chang KW, Chen YT.

Institute of Oral Biology, National Yang-Ming University, Taipei, Taiwan.

The roles of viral glycoprotein D (gD) and cellular herpes virus entry mediators A (HveA) and C (HveC) in herpes simplex virus entry into oral cells were determined. Studies with purified truncated forms of gD-1, HveA and HveC indicated that these molecules may be involved in herpes simplex virus entry into oral cells. Moreover, HveA was expressed similarly in primary cultures of gingival keratinocytes and fibroblasts, whereas HveC was expressed at higher levels in gingival keratinocytes, as determined by RT-PCR and immunocytochemical staining. Further analysis using immunohistochemistry demonstrated that both HveA and HveC were expressed in epithelial cells, fibroblasts and vascular endothelial cells in gingival tissues. However, only HveC was detected in nerve fibers. Also, HveA was detected throughout the epidermis, whereas HveC was pronounced in the strata basale and spinosum. In conclusion, this study characterized HveA and HveC, molecules that may participate in entry of herpes simplex virus into oral cells.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12121471&dopt=Abstract herpes medicine



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 herpes medicine



herpes
[National survey of dermatologists]

[Article in French]

Fontaine J, Beauchet A, Saiag P.

Service de dermatologie, Hopital Ambroise-Pare, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt.

OBJECTIVE: The purpose of this survey was to ascertain current management practices of French dermatologists treating immunocompetent patients with cutaneomucosal herpes (ocular herpes excluded) as a prelude to the French consensus conference on this topic. METHOD: A random sample of French dermatologists were invited to respond to a telephone interview: 928 dermatologists were contacted. RESULTS: The 216 dermatologists who responded to the telephone interview provided care for five persons per month (pregnancy excluded) who consulted for orofacial or genital herpes. Nearly half of the dermatologists stated they do not talk about herpes spontaneously with their patients. When a suspect lesion is seen for the first time, 48 p. 100 of the dermatologists order one or two complementary exams. Their advice on prevention between partners basically concerns use of preservatives. Therapeutic attitudes vary depending on the type of herpes or the number of recurrences per year: 84 p. 100 of the dermatologists prescribe a specific antiviral treatment for patients with solar herpes. Virological proof of infection is not acquired in 84 p. 100 of the cases before initiating a long-term treatment for recurrence. The most widely used agents are valaciclovir 500 and aciclovir 200. CONCLUSION: This survey demonstrates a certain degree of divergence from the recommendations of the consensus conference. The participation rate appears to be satisfactory, but herpes serology is ordered too often and antiviral agents are not used in compliance with current guidelines. This survey will be redone after diffusion of the guidelines in order to evaluate their impact.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12122324&dopt=Abstract herpes medicine



herpes
Long term persistence of herpes simplex virus-specific CD8+ CTL in persons with frequently recurring genital herpes.

Posavad CM, Huang ML, Barcy S, Koelle DM, Corey L.

Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA. posavad u.washington.edu

Herpes simplex virus (HSV) establishes a lifelong infection in humans. Reactivation of latent virus occurs intermittently so that the immune system is frequently exposed to viral Ag, providing an opportunity to evaluate memory T cells to a persistent human pathogen. We studied the persistence of genital herpes lesion-derived HSV-specific CD8+ CTL from three immunocompetent individuals with frequently recurring genital HSV-2 infection. All CTL clones were HSV-2 type specific and only one to three unique clonotypes were identified from any single biopsy specimen. The TCRBV genes utilized by these clonotypes were sequenced, and clonotype-specific probes were used to longitudinally track these clonotypes in PBMC and genital lesions. CTL clonotypes were consistently detected in PBMC and lesions for at least 2 and up to 7 years, and identical clonotypes infiltrated herpes lesions spaced as long as 7.5 years apart. Moreover, these clones were functionally lytic in vivo over these time periods. Additionally, CTL clones killed target cells infected with autologous viral isolates obtained 6.5 years after CTL clones were established, suggesting that selective pressure by these CTL did not result in the mutation of CTL epitopes. Thus, HSV recurs in the face of persistent CD8+ CTL with no evidence of clonal exhaustion or mutation of CTL epitopes as mechanisms of viral persistence.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10878394&dopt=Abstract herpes medicine



herpes
Transfusion-Associated Infections with Cytomegalovirus and Other Human Herpesviruses.

Kuhn JE.

Of all human herpes viruses, human cytomegalovirus (HCMV) is the most significant cause of transfusion-associated (TA) morbidity and mortality. The problem of TA HCMV infection differs from that of other transfusion-transmitted infections in that only certain groups of patients require HCMV-free blood or blood components, i.e. seronegative pregnant women, premature infants of low birth weight who are born to seronegative mothers, seronegative recipients of allogeneic bone marrow transplants from seronegative donors, seronegative AIDS patients, and seronegative immunosuppressed patients in general. HCMV is strictly cell-associated, and transmission appears to be due to reactivation of latent virus in white blood cells. TA HCMV infec-tion in risk groups can be minimized by selection of HCMV-seronegative donors. Since transmission of HCMV from seropositive donors by blood components containing fewer than 10 7 leukocytes per unit is unlikely, leukodepletion of transfusion products by filtration is an effective alternative to the use of seronegative blood products. Other human herpes viruses causing TA infections are Epstein-Barr virus (EBV) and the human herpes viruses 6 and 7 (HHV-6, HHV-7), whereas transmissions of herpes simplex viruses (HSV-1, HSV-2) and varicella-zoster virus (VZV) by blood transfusion - if occurring at all - are extremely rare events. Frequency and clinical significance of TA infections with the human herpes virus 8 (HHV-8) have not yet been fully elucidated. Despite the low seroprevalence of HHV-8 in Germany, its oncogenic potential merits attention, and strategies to prevent transmission and spread of HHV-8 by blood and blood products should be discussed. Copyright 2000 S. Karger GmbH, Freiburg

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10878482&dopt=Abstract herpes medicine



herpes
[National survey of gynecologists-obstetricians and general practitioners]

[Article in French]

Fontaine J, Beauchet A, Saiag P.

Service de dermatologie, Hopital Ambroise-Pare, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt.

OBJECTIVE: The purpose of this survey was to ascertain current practices of French gynecologists-obstetricians (GO) and general practitioners (GP) treating immunocompetent patients with cutaneomucosal herpes (ocular lesions excluded) as a prelude to the French consensus conference on this topic. METHODS: A random sample of French GOs and GPs were invited to respond to a telephone interview: 330 GOs and 331 GPs were contacted. RESULTS: Response rate was 24 p. 100 among the GOs who could be contacted (49 responses) and 14 p. 100 among the GPs (45 responses). More than half the GPs cared for 1 to 5 cases of orofacial or genital herpes monthly. When a suspect lesion is seen for the first time, 51 p. 100 of the GOs order one or two tests to achieve virology proof: 65 p. 100 order herpes serology and 47 p. 100 PCR. For the GPs, 56 p. 100 do not order a complementary exam. Advice on prevention between partners basically concerns use of preservatives. The therapeutic attitude varies depending on the type of herpes and the number of recurrences per year. The most widely used agent is valaciclovir. A specific antiviral agent is prescribed for non-ocular herpes by 92 p. 100 of the GOs and 98 p. 100 of the GPs. Virological proof of herpes infection is not obtained by 65 p. 100 of the GOs and 78 p. 100 of the GPs before initiating long-term treatment for recurrence. Genital herpes during pregnancy appears to be rare; 57 p. 100 of the GOs had less than one case over the last five years. Only 33 p. 100 of them discuss herpes spontaneously with their consultants. When a suspect genital lesion is observed during pregnancy, 82 p. 100 seek virological proof. When there is a risk of neonatal herpes, the type of delivery depends on the type of herpes infection and the date of occurrence during the pregnancy. Cesarean section is performed systematically by 63 p. 100 of the GOs when there is a primary herpes infection after 34 weeks gestation. Most practitioners did not respond concerning their attitude for exams and surveillance for the infant. DISCUSSION: The number of responding practitioners was too small in this study to provide a representative sample. This study will be renewed with a larger sample of GOs in order to obtain reliable data. For general practitioners, there is a need for education concerning management of cutaneomucosal herpes which should be provided at the same time as the consensus conference guidelines are distributed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12122325&dopt=Abstract herpes medicine



herpes
Herpes zoster in immunocompetent and immunocompromised Japanese children.

Takayama N, Yamada H, Kaku H, Minamitani M.

Department of Pediatrics, Tokyo Metropolitan Komagome Hospital, Japan. takyamnd-k komagome-hospital.bunkyo.tokyo.jp

BACKGROUND: To confirm epidemiological features of herpes zoster among children with or without immunosuppression, herpes zoster patients who had presented to this hospital were retrospectively investigated. METHODS: Medical records were reviewed for the 92 cases of pediatric herpes zoster patients diagnosed during the period from 1981 to 1998. The age at onset of herpes zoster and of varicella, the interval between varicella and zoster, the dermatomal distribution of herpes zoster and complications were compared between immunocompetent and immunocompromised children. RESULTS: The mean age at onset of zoster in immunocompetent children was 8.5 +/- 4.0 years and in immunosuppressed children was 9.7 +/- 3.8 years. The age at onset of varicella was significantly lower (1.6 +/- 1.8 years) in immunocompetent than in immunosuppressed children (4.6 +/- 2.7 years). The interval between varicella and zoster was 6.2 +/- 3.2 years in immunocompetent children. More than 80% of patients with acute leukemia or malignant lymphoma had herpes zoster within 2 years after diagnosis of malignancy. Lesions of herpes zoster were most frequently found in the thoracic nerve regions. Five of 11 zoster patients with cutaneous dissemination, three of five zoster patients having aseptic meningitis and three of four patients complicated facial palsy were children without underlying disease. CONCLUSIONS: The present study confirmed that varicella in the first year of life was a risk factor in immunocompetent children, as reported previously. Herpes zoster in children without immunosuppression was found not to be as mild as generally accepted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10881585&dopt=Abstract herpes medicine