genital herpes
Efficacy and safety of valacyclovir for the suppression and episodic treatment of herpes simplex virus in patients with HIV.

Warren T, Harris J, Brennan CA.

Westover Heights Clinic, 2330 NW Flanders, Ste. 207, Portland, OR 97210, USA. TWESTOVER aol.com

Three randomized controlled trials of valacyclovir for the management of recurrences of genital herpes in HIV-infected persons were conducted between 1991 and 2002. One study evaluated episodic therapy for the treatment of genital herpes, and 2 studies evaluated continuous suppressive therapy. Valacyclovir at 1000 mg twice daily for 5 days was comparable to acyclovir at 200 mg 5 times daily in accelerating healing of a single episode of genital herpes (hazard ratio, 1.0; 95% confidence interval [CI], 0.8-1.2; P=.89). Valacyclovir at 500 mg twice daily was effective in preventing or delaying recurrences of genital herpes compared with placebo (hazard ratio, 0.20; 95% CI, 0.13-0.30; P<.001) and with valacyclovir at 1000 mg once daily (hazard ratio, 0.56; 95% CI, 0.40-0.80; P=.001), in 6-month and 48-week studies, respectively. The safety profile of valacyclovir was similar to that of acyclovir. Valacyclovir is well tolerated, safe, and effective for the treatment and suppression of recurrent genital herpes in human immunodeficiency virus-infected persons.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15494897&dopt=Abstract genital herpes



genital herpes
The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice.

Brocklehurst P, Carney O, Ross E, Mindel A.

Academic Department of Genitourinary Medicine, Middlesex Hospital, London, UK.

OBJECTIVE: To determine clinical practice amongst obstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection. METHODS: All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection. RESULTS: There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81%) routinely examined the genitals for evidence of a recurrence. When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (chi 2 = 30.38, P < 0.0001). Five hundred and ninety-six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was considered an acceptable indication for operative delivery by 745 obstetricians (62%). CONCLUSIONS: 1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7547735&dopt=Abstract genital herpes



genital herpes
Virologic characteristics of subclinical and symptomatic genital herpes infections.

Wald A, Zeh J, Selke S, Ashley RL, Corey L.

Department of Medicine, University of Washington, Seattle 98144, USA.

BACKGROUND. The frequency, pattern, and anatomical sites of subclinical shedding of herpes simplex virus (HSV) in the genital tract, along with factors that predict such shedding, have not been well characterized. METHODS. We studied prospectively the clinical and virologic course of genital herpes in 110 women. The women kept symptom diaries and provided daily samples from the vulva, cervix, and rectum for viral culture. RESULTS. During a median follow-up of 105 days, subclinical shedding of virus was identified in 36 of 65 women (55 percent) with HSV type 2 (HSV-2), in 16 of 31 women (52 percent) with HSV type 1 (HSV-1) and HSV-2, and in 4 of 14 women (29 percent) with only HSV-1. Among women with genital HSV-2 infection, subclinical shedding occurred on a mean of 2 percent of the days. The mean duration of viral shedding during subclinical episodes was 1.5 days, as compared with 1.8 days during symptomatic episodes. HSV was isolated from several sites in the genital tract and rectum in 17 percent of subclinical episodes and 22 percent of symptomatic episodes. Half the episodes of subclinical shedding of HSV occurred within seven days of a symptomatic recurrence. The risk of subclinical shedding increased with the frequency of symptomatic recurrences. Subclinical shedding was more frequent among women with more than 12 recurrences per year than among those with no symptomatic recurrences (odds ratio, 3.3; 95 percent confidence interval, 1.4 to 7.9); it was also more frequent among women who had recently acquired genital herpes (odds ratio for women with HSV acquired in the past year as compared with those who had had the infection for a year or more, 1.85; 95 percent confidence interval, 1.1 to 3.1). CONCLUSIONS. Among women with a history of genital herpes infection, subclinical shedding of HSV is common and accounts for nearly one third of the total days of reactivation of HSV infection in the genital tract. Women with frequent symptomatic recurrences also have frequent subclinical shedding and may be at high risk for transmitting HSV.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7643884&dopt=Abstract genital herpes



genital herpes
HIV, sexually transmitted diseases and gynaecologic disorders in women: increased risk for genital herpes and warts among HIV-infected prostitutes in Amsterdam.

Fennema JS, van Ameijden EJ, Coutinho RA, van den Hoek AA.

Department of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands.

OBJECTIVES: To determine the incidence of sexually transmitted diseases (STD; gonorrhoea, early syphilis, Chlamydia trachomatis infection, trichomoniasis and primary genital herpes) and gynaecologic disorders (vaginal candidiasis, anaerobic vaginosis, genital ulcerations of unknown cause, pelvic inflammatory disease, recurrent genital herpes, recurrent genital warts) in a cohort of HIV-infected and non-infected drug-using prostitutes in Amsterdam between 1986 and 1992. DESIGN: A subgroup of 212 female drug users with a history of prostitution, who made at least one visit to a special STD clinic for drug-using prostitutes was selected from an ongoing cohort study of drug users in Amsterdam. METHODS: Using Poisson regression, the relative risk (RR) for each outcome was calculated for HIV-positive women compared with HIV-negative women. To determine potential causal relations with immune suppression, associations between disease incidence and immunologic markers (CD4 cell count and anti-CD3 response) were assessed in HIV-positive women. RESULTS: Adjusted for number of clients and frequency of condom use, HIV-positive women were at strong and significantly increased risk for primary genital herpes (RR, 7.64), recurrent herpes (RR, 8.33) and recurrent genital warts (RR, 15.93); moderately (significantly) increased risks were found for gonorrhoea (RR, 1.43), trichomoniasis (RR, 1.39), vaginal candidiasis (RR, 2.11) and genital ulcers of unknown aetiology (RR, 2.60). Of these HIV-related outcomes, the risk for recurrent genital herpes and genital warts were strongly associated with decreased CD4 cell counts. CONCLUSIONS: HIV-infected women experience an excess morbidity of STD and gynaecologic disorders. The strongly increased risk for genital herpes and warts in HIV-seropositive women indicates a causal relation with HIV. This study emphasizes the need for accessible medical care for drug-using prostitutes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8527081&dopt=Abstract genital herpes



genital herpes
Measuring health-related quality of life in persons with genital herpes.

Wild D, Patrick D, Johnson E, Berzon R, Wald A.

Metris Research, Embankment, London, UK.

A disease-specific measure was needed for use in an international clinical trial to evaluate an investigational drug for genital herpes. A new measure was developed initially in the UK and translated and adapted for use in France, Italy, Germany, Denmark, Spain and the USA. This paper describes the translation and adaptation of the USA measure. It also describes the assessment of internal consistency, reproducibility, content validity, and construct validity (convergent and discriminant) of the measure. Two outcome measures of the final genital herpes-specific measure were developed: (1) a 21-item symptoms subscale; and (2) a 20-item HRQOL subscale. Each measure was scored and analyzed separately; the psychometric testing discussed in this paper refers to the HRQOL subscale only. The internal consistency of the HRQOL subscale is high (r = 0.93), as is the reproducibility measured with a two week interval (r = 0.85). Convergent validity is moderate to high. (Fleming Self-Regard subscale, r = 0.48; SF-36 Social Functioning dimension r = 0.59; SF-36 Mental Health dimension r = 0.50). The number of herpes outbreaks in the past year was a significant predictor of scores on the HRQOL subscale (0-1 outbreaks, mean = 82.1; 2+ outbreaks, mean = 72.1, p = 0.058) suggesting discriminant validity. The measure is currently in a phase III clinical trial including anti-viral therapy where the question of responsiveness can be addressed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8556013&dopt=Abstract genital herpes



genital herpes
The high prevalence of genital herpes among patients with genital ulcer disease in Uganda.

Kamya MR, Nsubuga P, Grant RM, Hellman N.

Department of Medicine, School of Medicine, Makerere University, Kampala, Uganda.

BACKGROUND: Genital ulcer disease is a risk factor for transmission of human immunodeficiency virus. One-hundred consecutive Ugandan patients (median age, 25 years) with genital ulcer disease were examined to determine the prevalence of genital herpes and its relationship to human immunodeficiency virus seropositivity. GOAL OF THIS STUDY: To improve management, prevention, and control of genital ulcer disease, thus reducing human immunodeficiency virus infections attributable to genital ulcer disease. STUDY DESIGN: This was a prevalence study of genital herpes in a consecutive sample of an urban sexually transmitted disease clinic population. RESULTS: Forty-nine percent (48/98) of the patients had genital herpes (36% by direct fluorescent antigen and 13% by history of recurrent vesicles). There was a trend toward larger lesions in patients who were human immunodeficiency virus seropositive. Twelve percent (11/89) of patients had syphilis, and 30% (30/100) remained sexually active, despite the presence of active genital ulcer disease. Sixty-five percent of 89 patients tested had antibodies to human immunodeficiency virus. CONCLUSIONS: Genital herpes is a common cause of genital ulcer disease in patients attending sexually transmitted disease clinics in Uganda, and herpes ulcers may be more extensive among those who are infected with human immunodeficiency virus.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8578407&dopt=Abstract genital herpes



genital herpes
Demonstration of either endogenous recurrence or exogenous reinfection by restriction endonuclease cleavage analysis of herpes simplex virus from patients with recrudescent genital herpes.

Sakaoka H, Aomori T, Gouro T, Kumamoto Y.

Department of Oral Bacteriology, Hokkaido University, Sapporo, Japan.

By using restriction endonuclease (RE) cleavage analysis, either endogenous recurrence or exogenous reinfection of herpes simplex virus (HSV) was clarified in 45 male and 20 female subjects with recrudescent genital herpes. All of the plural (two to ten) isolates from 63 (205 isolates) out of 65 subjects (97%) were HSV-2. Two isolates from only one of 65 subjects (1.5%) were HSV-1, and they showed the same RE profile. In addition, an HSV-1 and five HSV-2 isolates were obtained from the remaining one female patient (1.5%), indicating that an exogenous HSV-1 strain has been reinfected during HSV-2 recrudescences. HSV-2 isolates were furthermore classified into genotypes of HSV-2 using 16 different RE markers with five REs. Two hundred and ten HSV-2 isolates from 64 subjects were classified into 27 distinct genotypes, in which some predominant genotypes and seven new genotypes were found. Plural HSV-2 isolates obtained from 63 out of 64 subjects, including one subject from whom an HSV-1 and five HSV-2 strains were isolated, were classified into the same genotypes, indicating that they may be regarded as recrudescent genital herpes by the reactivation of the same endogenous strain. However, the RE profiles of two HSV-2 strains from the remaining one subject were different. Thus, it was finally found that only two out of 65 subjects (3%) were reinfected with exogenous strains. These results lead to the conclusion that almost all recrudescent genital herpes are due to the reactivation of an initially infected HSV-2 strain, and are occasionally due to reinfection with distinct HSV strains of either the same or a different type.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7595418&dopt=Abstract genital herpes