herpes
Genital Herpes: Treatment Guidelines.

Woolley P.

Department of Genitourinary Medicine, Withington Hospital, Manchester, UK.

Genital herpes, usually caused by herpes simplex virus type 2 (HSV-2), is the most common cause of genital ulceration. The primary episode of genital herpes is generally the most painful. Subsequent recurrences are generally milder and localized. Diagnosis is made clinically, but should be confirmed by culture or serology. Management includes antiviral drug therapy--acyclovir, valacyclovir, or famciclovir--as well as analgesics. In addition, patient counseling and education are vital. Antiviral treatment decreases the severity and duration of primary genital herpes and of recurrences, and it may be used as a continuous suppressive therapy to decrease the incidence of recurrence. Pregnant women who have a history of genital herpes or recent primary infection should deliver by cesarean section in the presence of genital lesions at labor or primary HSV infection at any time during the third trimester to prevent transmission to the neonate. Part 1, "Genital Herpes: Recognizing the Problem," addresses the problems involved in diagnosing the infection and quantifying the epidemic.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9746692&dopt=Abstract herpes medicine



herpes
Genital Herpes: Recognizing the Problem.

Woolley P.

Department of Genitourinary Medicine, Withington Hospital, Manchester, UK.

Genital herpes, usually the result of an infection with herpes simplex virus type 2 (HSV-2), is the most common cause of genital ulceration. The first clinical episode is called primary genital herpes; recurrent HSV infection occurs in up to 80% of patients. Because not every individual who acquires the virus develops symptoms, it is difficult to estimate the prevalence of HSV infection. Transmission of virus occurs not only in the presence of apparent lesions, but asymptomatic viral shedding can also spread infection in the absence of lesions. The primary episode of genital herpes is generally the most painful, characterized by multiple and bilateral lesions and associated with tender inguinal lymphadenopathy as well as systemic symptoms. Subsequent recurrences are generally milder and localized. Diagnosis is made clinically, but should be confirmed by culture or serology. Part 2, "Genital Herpes: Treatment Guidelines," addresses aspects of treatment, including special considerations in treating pregnant women.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9746717&dopt=Abstract herpes medicine



herpes
Comparative molecular epidemiological investigation on different bovine herpes viruses.

Peshev R, Christensen L, Christova L.

Central Veterinary Research Institute, Sofia, Bulgaria.

Eight Bulgarian bovine herpes viruses, two Hungarian herpes viruses 1A, 3A, calves isolate named Mramor, buffalo isolate 723 and two referents BHV 1 strains were investigated by restrictase fragment pattern analysis. Migration profile of viral DNA by using different restrictase enzymes Hpa I, BamH I and Hind III were compared. Clearly differences among two Hungarian strains, calves isolate Mramor, buffalo isolate 723 and 8 Bulgarian and two referents BHV 1 strain was observed. The strain Sartze was determined as a genital type BHV 1, whereas Ozet, Tch.voda, Slivnitza, B. Budinov, Ptcelarovo, Vrana and Podgumer as a respiratory type. Hungarian strains 1A, 3A, calves isolate Mramor and buffalo isolate 723 had similar migration profile as swine herpes viruses. Hybridisation between the K 22 fragment and 8 bovine herpes viruses after Southern blotting were observed. That is evidence for genetic relation of these strains. Such hybridisation with Hungarian 1A, 3A, Mramor and buffaloes 723 strains were not observed. This fact allowed us to conclude that these strains are genetically different from BHV 1.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9775356&dopt=Abstract herpes medicine



herpes
Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic.

Scoular A, Gillespie G, Carman WF.

Department of Genitourinary Medicine, Glasgow Royal Infirmary, North Glasgow Hospitals University NHS Trust, Glasgow, UK. anne scoular.demon.co.uk

BACKGROUND: Polymerase chain reaction (PCR) has well established advantages over culture for diagnosis of herpes viruses, but its technical complexity has limited its widespread application. However, recent methodological advances have rendered PCR more applicable to routine practice. Aim: To compare automated PCR with viral culture for diagnosis of genital herpes. METHODS: We studied 236 patients presenting with clinical features suggestive of genital herpes at an inner city genitourinary medicine clinic. Two swabs were taken from each patient. Cell culture and typing were performed by standard methods. Automated PCR was performed using the LightCycler instrument and the infecting viral type was determined by restriction endonuclease digestion of amplicons. RESULTS: 109 patients (46%) had a positive test for herpes simplex virus (HSV). In 88, both PCR and culture were positive; in 21 PCR only was positive. With both detection methods, lesion duration and morphology were associated with HSV detection. Compared with culture alone, use of PCR increased sensitivity by 13.3% in specimens from vesicular lesions, by 27.4% from ulcerative lesions, and by 20.0% from crusting lesions. CONCLUSIONS: We advocate adoption of automated PCR as an efficient HSV detection and typing method for diagnosis of genital herpes in routine clinical practice. PCR allowed rapid laboratory confirmation of the diagnosis and increased the overall HSV detection rate by 24%.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11872854&dopt=Abstract herpes medicine



herpes
The clinical characteristics of intraoral herpes simplex virus infection in 52 immunocompetent patients.

Eisen D.

Dermatology Research Associates, Cincinnati, OH 45230, USA.

OBJECTIVE: Intraoral herpes simplex virus infection is commonly mistaken for recurrent aphthous stomatitis. The purpose of this study was to describe the clinical features of intraoral herpes simplex virus infection. STUDY DESIGN: Fifty-two immunocompetent patients with culture-positive intraoral herpes simplex virus infection were studied. RESULTS: The median age of the patients was 42 years. One third of the patients exhibited single ulcers; the remaining patients displayed multiple lesions. In 47 of 52 cases, the ulcers occurred on keratinized surfaces of the oral cavity; however, 5 patients had persistent ulcerations on nonkeratinized mucosa, a typical feature of herpetic ulcers in immunosuppressed patients. Of 27 patients with histories of recurrences, 22 were previously incorrectly diagnosed with recurrent aphthous stomatitis. CONCLUSIONS: Herpes simplex virus infection of the oral cavity can usually be differentiated from other causes of recurrent oral ulcerations on the basis of its clinical appearance and distribution. The recognition of atypical features may prevent unnecessary and costly treatments for unrelated though clinically similar-appearing disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9798227&dopt=Abstract herpes medicine



herpes
Significance of herpes zoster in HIV/AIDS in Kweneng district, Botswana.

Edhonu-Elyetu Y.

OBJECTIVE: To determine the relevance of herpes zoster eruption or scar relative to other symptoms and signs of HIV/AIDS and to look for a syndromic model that could be used in the diagnosis of HIV infection. DESIGN: Retrospective case-control study on data from the results of HIV request forms in the district from 1st January 1993 to 31st March 1996. HIV request forms bearing ELISA positive results represented the cases. SETTING: All the 55 health facilities and one district hospital in Kweneng district, Botswana. SUBJECTS: Six hundred and forty one valid request forms across all age groups and both sexes were analysed. MAIN OUTCOME MEASURES: Proportion of herpes zoster among cases and controls. Sensitivity and specificity test values for herpes zoster as a screening test. Logistic regression on 11 symptoms and signs found to have a significant relationship to ELISA either on the chi 2 test or on tests for the attributes of an ideal screening test. RESULTS: Herpes zoster ranked sixth as the most common sign associated with a positive ELISA result. The difference in the proportion of herpes zoster among cases and controls was highly significant, (chi 2 = 13.1, OR 3.75, CI =1.7-9.3. p = 0.0003). The following also had a significant relationship; chronic diarrhoea, persistent generalised lymphadenopathy (PGL) and non-healing genital ulcers. In addition, herpes zoster and chronic diarrhoea were highly specific and had high positive predictive values for a positive HIV ELISA positive result in 95.5% cases; chronic diarrhoea, weight loss, herpes zoster, persistent generalised lymphadenopathy and non-healing genital ulcers. CONCLUSION: Herpes zoster is an important predictor of HIV/AIDS in Kweng district (PPV = 90%). Used in the above model, prediction rises up to 95.5%. In the absence of an HIV ELISA test, this model alone could be sufficient for a clinical diagnosis of HIV infection, at least in Kweneng. It is also suggested that the presence or a history of herpes zoster scar or eruption be elevated to the status of a major sign in the World Health Organization (WHO) clinical definition for AIDS surveillance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9803626&dopt=Abstract herpes medicine



herpes
The ectodomain of a novel member of the immunoglobulin subfamily related to the poliovirus receptor has the attributes of a bona fide receptor for herpes simplex virus types 1 and 2 in human cells.

Cocchi F, Menotti L, Mirandola P, Lopez M, Campadelli-Fiume G.

Department of Experimental Pathology, Section on Microbiology and Virology, University of Bologna, Bologna, Italy.

We report on the functional cloning of a hitherto unknown member of the immunoglobulin (Ig) superfamily selected for its ability to confer susceptibility to herpes simplex virus (HSV) infection on a highly resistant cell line (J1.1-2 cells), derived by exposure of BHKtk- cells to a recombinant HSV-1 expressing tumor necrosis factor alpha (TNF-alpha). The sequence of herpes virus Ig-like receptor (HIgR) predicts a transmembrane protein with an ectodomain consisting of three cysteine-bracketed domains, one V-like and two C-like. HIgR shares its ectodomain with and appears to be an alternative splice variant of the previously described protein PRR-1 (poliovirus receptor-related protein). Both HIgR and PRR-1 conferred on J1.1-2 cells susceptibility to HSV-1, HSV-2, and bovine herpes virus 1. The viral ligand of HIgR and PRR-1 is glycoprotein D, a constituent of the virion envelope long known to mediate viral entry into cells through interaction with cellular receptor molecules. Recently, PRR-1, renamed HveC (herpes virus entry mediator C), and the related PRR-2, renamed HveB, were reported to mediate the entry of HSV-1, HSV-2, and bovine herpes virus 1, and the homologous poliovirus receptor was reported to mediate the entry of pseudorabies virus (R. J. Geraghty, C. Krummenacher, G. H. Cohen, R. J. Eisenberg, and P. G. Spear, Science 280:1618-1620, 1998; M. S. Warner, R. J. Geraghty, W. M. Martinez, R. I. Montgomery, J. C. Whitbeck, R. Xu, R. J. Eisenberg, G. H. Cohen, and P. G. Spear, Virology 246:179-189, 1998). Here we further show that HIgR or PRR-1 proteins detected by using a monoclonal antibody to PRR-1 are widely distributed among human cell lines susceptible to HSV infection and commonly used for HSV studies. The monoclonal antibody neutralized virion infectivity in cells transfected with HIgR or PRR-1 cDNA, as well as in the human cell lines, indicating a direct interaction of virions with the receptor molecule, and preliminarily mapping this function to the ectodomain of HIgR and PRR-1. Northern blot analysis showed that HIgR or PRR-1 mRNAs were expressed in human tissues, with the highest expression being detected in nervous system samples. HIgR adds a novel member to the cluster of Ig superfamily members able to mediate the entry of alphaherpes viruses into cells. The wide distribution of HIgR or PRR-1 proteins among human cell lines susceptible to HSV infection, coupled with the neutralizing activity of the antibody in the same cells, provides direct demonstration of the actual use of this cluster of molecules as HSV-1 and HSV-2 entry receptors in human cell lines. The high level of expression in samples from nervous system makes the use of these proteins in human tissues very likely. This cluster of molecules may therefore be considered to constitute bona fide receptors for HSV-1 and HSV-2.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9811737&dopt=Abstract herpes medicine



herpes
Urinary retention due to herpes virus infections.

Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Uchiyama T, Minamide M, Ito H.

Department of Urology, Chiba University, School of Medicine, Chiba City, Japan.

Urinary retention is uncommon in patients with herpes zoster and anogenital herpes simplex. Seven patients (four men, three women) with a mean age of 68.1 years (range, 35-84) with urinary retention due to herpes zoster (n = 6) or anogenital herpes simplex (n = 1) were studied. Six patients had unilateral skin eruption in the saddle area (S2-4 dermatome) and one patient with herpes zoster had a skin lesion in the L4-5 dermatome. All patients had detrusor areflexia without bladder sensation, and two of them had inactive external sphincter on electromyography at presentation. Clean intermittent catheterization was performed, and voiding function was recovered in 4-6 weeks (average, 5.4) in all patients. Urodynamic study was repeated after recovery of micturition in three patients, and they returned to normal on cystometrography and external sphincter electromyography. Acute urinary retention associated with anogenital herpes infection has been thought to occur when the meninges or sacral spinal ganglia were involved, and, in conclusion, this condition may be considered to be reversible.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9829425&dopt=Abstract herpes medicine