genital 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 genital herpes



genital 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 genital herpes



genital herpes
Seroprevalence and determinants of herpes simplex type 2 infection in an STD clinic in Milan, Italy.

Suligoi B, Calistri A, Cusini M, Palu G; Italian Herpes Management Forum.

Reparto AIDS e MST, Istituto Superiore di Sanita, Rome, Italy. suligoi iss.it

A number of studies have shown that the seroprevalence of herpes simplex virus type 2 (HSV-2) is higher among persons attending clinics for sexually transmitted diseases (STD) than among the general population. The HSV-2 seroprevalence among STD patients, however, varies greatly among studies, possibly reflecting differences in the baseline prevalence of the infection among different general populations or in the distribution of risk factors. A cross-sectional study was carried out to determine the seroprevalence of and the risk factors for HSV-2 infection among 776 HIV-negative persons attending an STD clinic in Milan, Italy. All samples were tested with a commercial HSV type-2 specific gG ELISA test. The HSV-2 seroprevalence was 29.5% (95% CI: 26.3-32.7%). The seroprevalence increased with age, yet it did not differ by gender. Among persons with a current STD, the seroprevalence was 44.3%. At the multivariate analysis, older age was independently associated with HSV-2 infection. A self-reported history of genital herpes was predictive of HSV-2 infection. The agreement between history of genital herpes and HSV-2 seroprevalence was poor, however, stressing that in clinical practice, caution should be used in interpreting the presence or absence of a history of genital herpes as an indicator of the presence or absence of HSV-2 infection. Our data show that HSV-2 seroprevalence among persons attending an STD clinic in Italy is high; thus serological screening for HSV-2 might be advisable for STD patients. Copyright 2002 Wiley-Liss, Inc.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12116025&dopt=Abstract genital herpes



genital 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 genital herpes



genital herpes
A comparison of PCR with virus isolation and direct antigen detection for diagnosis and typing of genital herpes.

Slomka MJ, Emery L, Munday PE, Moulsdale M, Brown DW.

Enteric and Respiratory Virus Laboratory, Central Public Health Laboratory, London, United Kingdom.

Patients attending the genitourinary medicine clinic at Watford General Hospital, UK, were examined for clinical signs of genital herpes infection. Genital swabs were taken from 194 patients (126 female, 68 male) who presented with genital ulceration or symptoms which were suggestive of genital herpes infection. Swabs from these patients were tested by three methods: (i) Detection of herpes simplex virus (HSV) antigen by direct HSV enzyme immunoassay (EIA), (ii) HSV isolation in Vero cell culture and (iii) HSV polymerase chain reaction (PCR). HSV was detected in 76 patients (39%) by EIA, in 93 (48%) by isolation in cell culture, and in 115 (59%) by PCR. Isolation by cell culture has been considered as the "gold standard" for the detection of HSV in genital lesions, but in this study HSV PCR was significantly more sensitive. Comparison of the three methods was as follows: Cell culture vs. PCR: Sensitivity 93/115 (80.9%), Specificity 79/79 (100%). HSV EIA vs. PCR: Sensitivity 75/115 (65.2%), Specificity 78/79 (98.7%). HSV EIA vs. Cell culture: Sensitivity 75/93 (80.7%), Specificity 100/101 (99%). EIA was less effective in detecting HSV among recurrent than among first episode infections, in comparison to culture or HSV PCR. This is the first comparison of HSV PCR with two other routine diagnostic methods for confirming genital herpes infection in a symptomatic population. The infecting HSV type was identified by restriction digestion of 108 HSV amplicons: HSV-1:37/108 (34%), HSV-2:71/108 (66%). In this population HSV-1 causes a significant proportion of genital herpes cases, and HSV-1 genital infection was detected in significantly more first episode infections (40.3%) than among recurrent infections (22.2%).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9598940&dopt=Abstract genital herpes



genital herpes
The ratio of cytokine levels in genital herpes during various phases of infection.

Shurshalina AV, Veryasov VN, Sukhikh GT.

Center of Obstetrics, Gynecology, and Perinatology, Russian Academy of Medical Sciences, Moscow.

The concentrations of cytokines (tumor necrosis factor-alpha and interleukin-10) in cervical scrapes and the percentage of CD4(+)lymphocytes producing interferon-gamma and interleukin-4 in the peripheral blood were measured in women of reproductive age with typical form of genital herpes. The results suggest that genital herpes is a chronic inflammatory process characterized by high levels of proinflammatory cytokines with predominance of T-helper type 1 over T-helper type 2 cytokines.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11687847&dopt=Abstract genital herpes



genital herpes
Prevalence of herpes simplex virus infection in patients suspected of genital herpes; and virus typing by type specific fluorescent monoclonal antibodies.

Puthavathana P, Kanyok R, Horthongkham N, Roongpisuthipong A.

Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

During the period between April 1994 and February 1996, a total of 154 female patients who attended the Clinic of Female Sexually Transmitted Diseases, Siriraj Hospital with clinical symptoms suspected of genital herpes were investigated for herpes simplex virus (HSV) infection by the virus isolation method in Vero cell cultures. Swabs from external genital lesions and the cervix from each patient were collected separately and used as the clinical specimens for isolation of HSV. The virus isolates were identified by indirect immunofluorescence (IIF) staining of the infected cell cultures using polyclonal HSV-2 specific antiserum which was reactive to common HSV antigens for both types of viruses. Typing of HSV was performed by direct IF using monoclonal antibody specific to HSV-1 or HSV-2. HSV was isolated from 78.6 per cent (121 of 154) of the cases studied; and among the infected cases, there were 47.9 per cent (58 of 121) in whom the infection involved both external genital lesions and cervixes, and 50.4 per cent (61) in whom the infection was limited to external genital lesions only. There were 2 cases (1.7%) in whom HSV was isolated from cervixes but not external genital lesions. Seventy-five HSV isolates were further subjected to typing. The present study showed that HSV-1 was accounted for 18.7 per cent (14 isolates), while HSV-2 took the remaining part of 81.3 per cent (61 isolates). The data demonstrated an increase in the prevalence of HSV-1 in genital herpes in our people.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9623019&dopt=Abstract genital herpes