genital herpes
Genital herpes serotesting: a study of the epidemiology and patients' knowledge and attitude among STD clinic attenders in Coventry, UK.

Narouz N, Allan PS, Wade AH, Wagstaffe S.

Department of Genitourinary Medicine, Coventry and Warwickshire Hospital, Coventry, UK. noshinarouz msn.com

OBJECTIVES: To examine the seroprevalence and correlates of antibodies to herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), and to assess patients' knowledge and attitude towards genital herpes infection and its serotesting, before and after counselling. METHODS: A cross sectional study among genitourinary medicine (GUM) clinic attenders in Coventry, a UK metropolitan city. Participants were asked to complete a self administered questionnaire before and after counselling. Patients were counselled before testing and after receiving the result. A commercially available enzyme immunoassay (EIA) was used to identify HSV-1 and HSV-2 antibodies (Gull/Meridian EIA). RESULTS: 223 patients participated in the study (97% of eligible patients). Overall, prevalence of HSV-2 antibody was 43/216 (20%) (19/103, 18% for males and 24/113 (21%) for females, p=0.61) while prevalence of HSV-1 antibody was 129/215 (60%) (60% for both sexes, p=0.91). In the multivariate analysis HSV-2 seropositivity was higher among black people and those with a history of genital herpes. HSV-1 seropositivity was independently associated with less education, increased years of sexual activity (between 14-25 years), and history of cold sores. The majority of patients wanted this serotesting to be available in the clinic (204/222 (92%) before and 216/218 (99%) after counselling, p=0.0003) and 97% accepted the test when offered. Only three patients regretted having the test and four patients contacted the department within 6 months of receiving the results for more counselling. CONCLUSION: The vast majority of the study population not only wanted to be tested, but accepted the test when offered. HSV-2 infection is common and largely unrecognised among our study population. The psychological impact of introducing type specific HSV serological testing in a clinical setting seems to be minimal. Counselling could improve patients' awareness of the infection and the acceptability of the test and its results.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12576612&dopt=Abstract genital herpes



genital herpes
Determinants of disclosure of genital herpes to partners.

Green J, Ferrier S, Kocsis A, Shadrick J, Ukoumunne OC, Murphy S, Hetherton J.

Jefferiss Wing, St Mary's Hospital, London, UK.

OBJECTIVE: To identify factors which determine whether and when patients will disclose infection with genital herpes to sexual partners. METHODS: The sample was 26 women and 24 men attending a herpes clinic in a sexually transmitted disease clinic. Semistructured interviews yielded quantitative data and also qualitative data which were subjected to content analysis. RESULTS: Characteristics of partners were very important in determining whether disclosure occurred. Respondents were less likely to tell partners regarded as casual. Perception of the likely reaction of partners was important in deciding whether to tell. Many respondents assumed that they were not infectious if they were not currently having an attack or if they were taking antiviral medication. The decision whether to tell tended to be based on considerations of likely discovery and of honesty towards the partner rather than control of transmission. Of patient characteristics only self rated depressed mood was related to disclosure to the most recent partner. CONCLUSIONS: Perception of the partner and anticipated partner response is crucially important in determining whether and when disclosure of genital herpes infection occurs.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12576613&dopt=Abstract genital herpes



genital herpes
Genital herpes: general practitioners' knowledge and opinions.

Narouz N, Allan PS, Wade AH.

Department of Genitourinary Medicine, Coventry and Warkwickshire Hospital, UK.

OBJECTIVES: To evaluate GPs' knowledge about genital herpes, especially recent information and to assess their attitudes towards serotesting. METHODS: GPs working in Coventry and the surrounding area were asked to complete an anonymous questionnaire. RESULTS: 70% of GPs (183 out of 261) responded to the questionnaire. Overall, 56% of the questions were answered correctly. 73% of participants knew that source partners in most transmission events are unaware of their infection and 77% were aware that patients shed the virus and transmit it even in the absence of clinical signs. As many as 43% did not know that the majority of infected individuals are unaware of their infection and 44% only knew that most transmission occurs during periods of asymptomatic shedding. Only 53% were aware that the proportion of genital herpes caused by HSV-1 is not decreasing. The majority (78%) supported the availability of its serotesting. CONCLUSIONS: This study demonstrates the lack of knowledge, among studied GPs, in some areas about genital herpes, especially recent information and indicates the need for more education about the condition. Most GPs in the study support the availability of genital herpes serotesting, although more studies need to be done before the wide availability of this testing.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12238653&dopt=Abstract genital herpes



genital herpes
Genital shedding of herpes simplex virus among men.

Wald A, Zeh J, Selke S, Warren T, Ashley R, Corey L.

Department of Medicine, University of Washington, Seattle, Washington 98122, USA. annawald u.washington.edu

Epidemiologic studies suggest that most sexual transmission of genital herpes occurs when persons shed virus but lack lesions. This study assessed 79 men (63 with a history of genital herpes simplex virus [HSV] type 2 infection, 5 with a history of genital HSV-1 infection, and 11 with HSV-2 antibodies but no history of genital herpes) and obtained daily swabs for viral culture. HSV was isolated at least once from 60 (81%) HSV-2-seropositive men. The total viral shedding rate in HSV-2-seropositive men was 5%; the subclinical shedding rate was 2.2%. Of 11 HSV-2-seropositive men without a genital herpes history, 7 recognized typical recurrences and HSV was detected in 10. The shedding rate among men with genital HSV-2 was significantly higher than among men with genital HSV-1 infection (odds ratio, 4.4; 95% confidence interval, 1.2-15.3). The frequency of viral shedding in men with genital herpes appears comparable with that in women.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12353185&dopt=Abstract genital herpes



genital herpes
Public Health Strategies to Prevent Genital Herpes: Where Do We Stand?

Handsfield HH.

Harborview Medical Center, Box 359777, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. hhh u.washington.edu.

At least 25% of the United States population has overt or subclinical genital herpes simplex virus (HSV) infection, and herpes probably is the sexually transmitted disease of greatest concern to sexually active persons, aside from AIDS. In addition to its direct clinical and psychosexual complications, genital herpes is an important determinant of sexual transmission of HIV. Genital herpes is usually transmitted by persons with subclinical infection, whether entirely asymptomatic or with unrecognized symptoms. Although the composition and efficacy of a national genital herpes prevention program are in debate, clinicians should adopt a public health perspective in managing patients to help prevent transmission. Specific approaches include accurate diagnosis of genital ulcer disease by routine use of virologic tests for HSV; use of type-specific serologic tests to diagnose subclinical HSV infection in patients' sex partners and others at high risk; counseling patients to recognize symptoms and defer sex with uninfected partners when symptomatic; and serologic testing and counseling of pregnant women and their partners to prevent neonatal herpes. Antiviral chemotherapy may be effective in preventing herpes-related cesarean sections, and its efficacy in preventing sexual transmission of HSV is under study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11095834&dopt=Abstract genital herpes



genital herpes
Herpes simplex virus type 2 seroepidemiology in Spain: prevalence and seroconversion rate among sexually transmitted disease clinic attendees.

Varela JA, Garcia-Corbeira P, Aguanell MV, Boceta R, Ballesteros J, Aguilar L, Vazquez-Valdes F, Dal-re R.

Gijon STD Clinic, Spain.

BACKGROUND: Only limited data on the seroprevalence of herpes simplex virus type 2 (HSV-2) are available from European countries. Until recently, serologic tests for HSV-2 serotyping have been hampered by cross-reactivity to type-common antigens. The present study aims at providing data on the prevalence of HSV-2 infection in a group of STD clinic attendees using a reliable type-specific immunoassay. GOAL: To evaluate the seroprevalence of HSV-2 and the accumulated incidence of clinical genital herpes infection in a sample of Spanish sexually transmitted disease (STD) clinic attendees. STUDY DESIGN: The study consisted of two parts. First, a cross-sectional study of HSV-2 seroprevalence was conducted in patients with STDs. Second, a prospective cohort study was undertaken to evaluate the accumulated incidence of infection by HSV-2 and of clinical episodes of genital herpes in HSV-2-negative patients included in the first study during a follow-up period of 6 to 18 months. RESULTS: Of the 374 patients (129 men, 245 women) studied, 25% were seropositive for HSV-2 (12% of men, 30% of women). Antibodies to HSV-2 were related to female gender (odds ratio, 2.7; P < 0.001) and to the number of sexual partners (odds ratio, 4.1; P < 0.001). Fifty-two percent of patients (145 of 281 patients) who were initially seronegative returned to the clinic for a second serologic testing, of whom 1% (2 of 145 patients) had seroconverted. None of the patients developed genital herpes during the follow-up period. CONCLUSION: The relatively high seroprevalence (25%) and the low rate (4%) of HSV-2 previously reported in the general population in Spain suggest that the virus circulation may be restricted to certain risk groups. Therefore, future healthcare measures may target specific groups, such as patients with STDs.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11196047&dopt=Abstract genital herpes



genital herpes
[Factual approach to the treatment of genital herpes]

[Article in French]

Nikkels AF, Pierard GE.

Service de Dermatopathologie, Universite de Liege.

Genital herpes is a sexually transmitted disease. After the primary infection, the virus establishes a life-long latency in the sacral dorsal root ganglia. Recurrences may occur at an unpredictable rate. The clinical signs are not always easy to recognize and viral identification techniques may be helpful such as immunohistochemistry and in situ hybridization on Tzanck smears and muco-cutaneous biopsies. The treatment of genital herpes can follow one of three strategies using antiviral drugs, non-specific immunomodulators, and vaccination. The new oral antiviral drugs decrease the severity of clinical manifestations without, however, providing a definitive cure. In this article recent knowledge about the clinical aspects, differential diagnosis, diagnostic methods, treatment options and management is reviewed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10941309&dopt=Abstract genital herpes