Primary Genital Herpes Research Articles

The Scarlet H

The Scarlet H

P1.014 Herpes Simplex Virus Type 2 UL23 Thymidine Kinase: Molecular Detection of Polymorphism and Mutations Associated with Acyclovir Resistance in South Africa

<h3>Background</h3> Acyclovir (ACV) is the first-line treatment for symptomatic primary and recurrent genital herpes in South Africa. Resistance to ACV is mainly due to mutations in the HSV-2 viral <i> UL23</i>gene that codes for thymidine kinase (TK), resulting in an inability for the drug to inhibit viral replication. The objectives of this study were to obtain genotypic data on the frequency of HSV-2 TK resistance mutations and natural polymorphism as well as to assess the prevalence of ACV-resistant HSV-2 among participants in the genital ulcer aetiological studies conducted between 2007 and 2011. <h3>Methods</h3> We amplified and fully sequenced the <i> UL23</i>gene of 254 HSV-2 positive specimens obtained from participants in genital ulcer aetiological studies conducted between 2007 and 2011 in Gauteng Province, South Africa. Additionally, intratypic differences between the HSV-2 were determined based on the number of reiterated sequences located in the non-coding regions of the <i> US1</i>and <i> US12</i>genes of HSV-2. <h3>Results</h3> We identified 63 single and/or double nucleotide mutations in the <i> UL23</i>genes analysed, that resulted in 30 silent mutations and 32 amino acid changes. 41% of these amino acid changes were due to natural polymorphism. In addition, we identified 19 unknown amino acid changes in 30 samples that have not been described before. All unknown mutations detected were outside the TK resistance “hotspots”, which are renowned sites for ACV resistance mutations to occur. No frameshift mutations or mutations causing stop codons were identified in the <i> UL23</i>genes of the samples analysed. <h3>Conclusions</h3> No evidence was found of known ACV resistance mutations in HSV-2 following the addition of ACV as first-line therapy for genital ulceration in South Africa. Genotyping of HSV-2, based on the length of reiterated sequences in the <i> US1</i>and <i> US12</i> genes of HSV-2, revealed a high degree of HSV-2 heterogeneity in this population.

P5.068 Role of Type Specific Herpes Simplex Virus Serology in Diagnosis of Primary and Recurrent Genital Herpes- a Study in the Indian Population

Background Type specific serologic tests for herpes simplex virus (HSV)-1&2 are used for sero-epidemiological studies. Its early application has also been shown to be of benefit in testing for primary & recurrent infections in diagnosis and patient management. The present study was conducted to evaluate the role of type specific HSV-1&2 antibody detection as a diagnostic modality in patients with clinically suspected genital herpes. Methods Sera obtained from 44 patients with clinically suspected genital herpes attending the STD clinic of our institution over last 7 months were tested for type specific HSV-1&2 IgG antibody by glycoprotein G based ELISA (HerpeSelect 1&2, Focus Diagnostics, USA). Direct Fluorescent Antibody testing (DFA) (BIO-RAD laboratories, USA) was used for identification and typing of HSV-1& 2 in genital ulcer specimens in all cases. Results There were 21 cases of primary & 23 cases of recurrent genital ulceration. DFA was positive in 68% samples (43% only HSV-2, 9% only HSV-1, 16% both HSV-1&2). On comparison with DFA, the sensitivity, specificity, positive and negative predictive value of HSV-2 IgG ELISA in primary herpetic ulcer was 8%, 75%, 33%, 33%, while it was 79%, 89%, 92%, 73% in recurrent genital ulceration. The sensitivity, specificity, positive predictive and negative predictive values of HSV-1 IgG ELISA in primary herpetic ulcer was 50%, 67%, 37.5%, 77%, while it was 80%, 39%, 27%, and 87.5% in recurrent genital ulceration. Conclusion Our results highlight the importance of HSV-2 IgG detection in strengthening the diagnosis of recurrent HSV-2 disease, while absence of HSV-2 IgG antibody helps in excluding genital herpes as a likely cause of recurrent genital ulceration. The identification of HSV-1 IgG antibody may not be useful for diagnosis in patients of genital ulcer disease highlighting the need for typing HSV-1 strains from the genital lesion.

O07.3 A Psychological Experiment to Examine the Global Impact of Stigma on Individuals Diagnosed with Type 1 Herpes Simplex Virus (HSV-1)

BackgroundHSV-1 causes at least 50% of primary genital herpes infections in Europe, Canada, Australia and the USA. In the UK, rates may be even higher, as the level 3 STI...

Herpes simplex laryngitis following primary genital herpes

Primary genital herpes is associated with involvement of extragenital sites like thighs, buttocks, fingers and pharynx. This involvement occurs due to autoinoculation, orogenital exposure from the source and also seeding due to viremia in the initial period. Involvement of larynx in a case of primary genital herpes is extremely rare prompting us to report this case.

Seroepidemiology of herpes simplex virus type 1 and 2 in pregnant women in Switzerland: an obstetric clinic based study

Objective To assess the seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) IgG antibodies and the seroincidence of HSV-1 and HSV-2 infections in pregnant women attending the maternity clinic of the University Hospital Lausanne. Study design Blood samples from 1030 women were taken at the usual pregnancy visit in the first trimester to assess the prevalence rate of IgG antibodies against HSV-1 and HSV-2 using a type-specific assay. A second blood sample was taken 6–8 weeks postpartum from returning women who were seronegative for HSV-2 or HSV-1 to assess the incidence of seroconversion (primary infection). Results The seroprevalence rates were 79.4% (95% CI: 76.9–81.9) for HSV-1 and 21.2% (18.7–23.7) for HSV-2 in women 14–46 years old. Type-specific serostatus patterns were as follows: 17.3% HSV-1/-2: +/+, 62.1% HSV-1/-2: +/−, 3.9% HSV-1/-2: −/+, 16.7% HSV-1/-2: −/−. Two hundred and sixty five women (59 of the 212 seronegative for HSV-1 (27.8%) and 265 of the 812 seronegative for HSV-2 (32.6%)) returned to the outpatient clinic for the post-delivery check and a second blood sample was obtained. One HSV-1 seroconversion was detected (HSV-1 seroconversion rate 2.4%/100 patient × year (95% CI: 0.06–13.4)) in a patient who had symptoms compatible with primary genital herpes. No HSV-2 seroconversion was detected (HSV-2 seroconversion rate: 0/100 patient × year (97.5% one-sided CI: 0–2)). Conclusion Compared to a previous population-based study, our study results suggest a rise in the prevalence of HSV-2 among pregnant women in Switzerland. The low incidence of seroconversion detected during pregnancy is consistent with the very low reported incidence of neonatal herpes in Switzerland. Condensation This study in a public hospital in Western Switzerland suggests an increasing prevalence of HSV-2, but a low incidence of primary infections in women of childbearing age.

Index of Suspicion in the Nursery

A 2.94-kg male infant is born at 39 weeks to a 19-year-old G1P0 woman. The pregnancy was complicated by gestational diabetes. The woman had no significant past medical history, including sexually transmitted diseases, and no significant family history. Prenatal screening for group B Streptococcus, Chlamydia, gonorrhea, syphilis, and human immunodeficiency virus were negative. Delivery is complicated by prolonged rupture of membranes for 18 hours, maternal fever (temperature of 38.9°C), and failure to progress. The baby is delivered in good condition by cesarean section. Apgar scores are 8 at 1 minute and 9 at 5 minutes. Vital signs are within normal limits, and physical examination at birth shows no abnormal findings of note. The infant is admitted to the newborn nursery for observation. Blood culture is drawn and empiric antibiotics are started. Hematologic parameters are within normal limits and C-reactive protein measures 0.5 mg/dL. Antibiotics are continued for suspected chorioamnionitis. He is otherwise feeding well, euthermic, and looking well, and his blood culture remains negative. On postnatal day 7, the nurse notices two vesicular skin lesions: one on the right side of the forehead (Fig. 1) and the other on the vertex of the scalp (Fig. 2). Both comprise groups of clustered tiny vesicles that have minimal erythema at their bases. Vital signs and physical examination findings are within normal limits. The result of a simple test supports the diagnosis, and further laboratory investigations confirm the cause. Figure 1. Vesicular lesions on the right side of the forehead. Figure 2. Vesicular lesions on the vertex of the scalp. # Case: Blister in a Baby: Benign or Bothersome? {#article-title-2} ### Differential Diagnosis Vesiculobullous lesions in neonates should never be ignored because the cause could range from benign, self-limited conditions to serious fatal diseases. Early diagnosis and management are crucial …

Hyperaesthesia Following Genital Herpes: A Case Report

We report an adult female patient who presented with sacral radiculopathy as incapacitating dysthesias following primary genital herpes simplex, which later recurred. Despite use of systemic antiviral treatment, the painful syndrome in our patient persisted. The success in treatment was seen only after the addition of amitriptyline hydrochloride. The case is being presented here for its rare manifestation and novel use of amitriptyline hydrochloride.

Incidence and Epidemiology of Streptococcus pseudoporcinus in the Genital Tract

Streptococcus pseudoporcinus, a beta-hemolytic microorganism first isolated from the female gastrourinary tract in 2006, cross-reacts with serogrouping kits for group B Streptococcus (GBS) and could be misidentified in the laboratory. The epidemiologic characteristics of this species have not been reported previously, but this organism is thought to be rare. Paired vaginal and rectal samples were collected from 663 nonpregnant women enrolled in a phase II clinical vaccine trial of a GBS type III capsular polysaccharide-protein conjugate vaccine, and isolates initially identified as S. pseudoporcinus were collected for further testing. A total of 120 isolates of S. pseudoporcinus were recovered from 36 unique individuals with 5.4% of 663 women having this organism recovered at least once during follow-up. All of these isolates cross-reacted with a commercially available GBS serogrouping kit. Women colonized with isolates confirmed as S. pseudoporcinus by genotypic and phenotypic methodologies were compared to women who were not colonized to determine whether there were any significant factors associated with acquisition of S. pseudoporcinus. Acquisition of S. pseudoporcinus vaginally and/or rectally was 36 per 846.0 women-years of follow-up for an annual incidence of 4 per 100 woman-years of follow-up. Acquisition of S. pseudoporcinus was independently associated with black women, being 30 to 40 years of age, recent Trichomonas vaginalis infection, primary or recurrent genital herpes, having bacterial vaginosis by Nugent criteria, and having had two or more male sexual partners since the last visit. This study suggests that S. pseudoporcinus is not rare, especially among black women, and could be misidentified as GBS.

Prevention of and Screening for Herpes Simplex Infection: A Survey of Quebec Physicians

ObjectiveTo determine which methods are most used by Quebec physicians performing deliveries with regard to the prevention of and screening for infections caused by the herpes simplex virus. MethodsA pretested bilingual questionnaire was mailed to all the general practitioners performing deliveries who belong to the Association des omnipraticiens en périnatalité du Québec, as well as to all obstetrician-gynaecologists belonging to the Association of Obstetricians and Gynecologists of Quebec, with two follow-up reminder communications. The participants’ anonymity was maintained. ResultsOf the 877 questionnaires sent, 539 (62%) were completed and returned; 451 participants (84% of the total) met the selection criteria. The majority (92%) of physicians performing deliveries asked pregnant women if they had a history of genital herpes. To prevent primary genital herpes, 73% of physicians recommended using condoms, 42.5% recommended abstinence when lesions are present, 33% recommended that the partner be given an antiviral treatment, and 3.3 % did not provide any specific advice. For a woman who presents with a confirmed history of genital herpes, vaginal delivery was preferred in (1) 87.5% of cases when the infection did not recur during pregnancy, (2) 94% of cases when the infection recurred before the third trimester, (3) 98% of cases when the infection recurred during the third trimester and an antiviral treatment was provided. In the case of a pregnant woman at term with herpetic lesions and with ruptured membranes, Caesarean section was preferred by 79% of obstetricians and 95% of general practitioners (P < 0.001). ConclusionThe screening and prevention methods preferred by most Quebec physicians performing deliveries match the recommendations of the current clinical practice guidelines.

Herpes Simplex

Herpes Simplex

Neonatal herpes simplex virus infection

Herpes simplex virus (HSV) infection in the neonate is a rare event with severe consequences for the child even if adequately treated with antiviral drugs. Mothers with primary genital herpes infections late in pregnancy or at delivery have a high risk of transferring the infection to the child, while the risk of transfer in mothers with recurrent genital infections is only a few percent. Neonatal herpes localized in skin-eye-mouth has no mortality and morbidity after antiviral treatment. In neonatal disseminated and central nervous system disease, early treatment is a predictor for better outcome. The morbidity in survivors is high; after herpes encephalitis, only one-third of children have normal development. While awaiting vaccines or reliable predictors for prevention of neonatal herpes, clinical awareness of primary maternal herpes during pregnancy and recommendations for prophylactic treatment are important tools. For pediatricians the differential diagnosis of a child aged two to four weeks with seizures, neonatal herpes encephalitis must be considered and either excluded or treated. Neurological follow-up and training programs to minimize the consequences of a disability are important clinical aspects.

Left out but not forgotten: Should closer attention be paid to coinfection with herpes simplex virus type 1 and HIV?

Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are among the most common coinfections seen in individuals infected with HIV-1. Most research on HSV-HIV coinfection has focused on HSV-2, and in particular, on its impact on HIV transmission. HSV-2 is associated with micro- and macroulcerations in genital mucosal surfaces, increased numbers of HIV target cells in genital mucosal tissue and increases in plasma HIV viral load of up to 0.5 log(10) copies/mL, such that HSV-2 infection increases the risk of both HIV acquisition and transmission. Because plasma HIV RNA levels are a major determinant of rates of CD4 cell decline, HSV-2 coinfection may also adversely affect the progression of HIV disease. Anti-HSV medications have in fact been associated with reciprocal decreases in HIV viral load in short-term studies. These findings have led to the development of several clinical trials of HSV-2 suppression as strategies for preventing HIV transmission and slowing the rate of HIV disease progression. HSV-1 coinfection has largely been ignored from this growing body of research, yet there are several reasons that this coinfection remains an important issue for study. First, the seroprevalence of HSV-1 is consistently higher than that of HSV-2 among both HIV-infected and HIV-uninfected populations, underscoring the relevance of HSV-1 coinfection to the majority of HIV-infected persons. Second, pre-existing HSV-1 antibodies in individuals may modulate the course of subsequently acquired HSV-2 infection; the implications of such changes on HSV-HIV coinfection remain unexplored. Third, HSV-1 and HSV-2 are closely related viruses that share 83% genetic homology. Their virological and pathobiological similarities suggest that their implications on HIV pathogenesis may be similar as well. Finally, HSV-1 is becoming increasingly relevant because the incidence of genital HSV-1 has risen. Although genital herpes is traditionally associated with HSV-2, recent studies have shown that the majority of serologically confirmed primary genital herpes in some settings is attributable to HSV-1. Because the genital tract is an important site of biological interaction between HSV and HIV, this epidemiological change may be clinically important.

Herpes Simplex Virus Viremia during Primary Genital Infection

Primary genital herpes simplex virus (HSV) infection is commonly associated with systemic symptoms. A systematic evaluation of HSV viremia during primary genital infection has not been performed previously. Plasma samples from adults with a first clinical episode of genital HSV infection were assayed for HSV DNA by polymerase chain reaction. One hundred sixty-four adults had confirmed primary genital HSV infection. Of these, 40 (24%) had HSV DNA detected in plasma. Thirty-seven (93%) of 40 were infected with HSV-2. Viremic participants were more likely to be women, compared with aviremic participants (83% vs. 61%; P=.01). Viremia was detected more frequently and at a higher number of copies per milliliter early in infection. We conclude that HSV viremia during primary genital HSV infection is common, especially among women.

Guidelines for the Management of Herpes Simplex Virus in Pregnancy

ObjectiveTo provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. OutcomesMore effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. EvidenceMedline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. ValuesRecommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. Recommendations1.Women’s history of genital herpes should be evaluated early in pregnancy. (III-A)2.Women with known recurrent genital herpes simplex virus (HSV) should be counselled about the risks of transmission of HSV to their neonates at delivery. (III-A)3.At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV. (II-2A)4.Women with known recurrent genital HSV infection should be offered acyclovir or valacyclovir suppression at 36weeks’ gestation to decrease the risk of clinical lesions and viral shedding at the time of delivery and therefore decrease the need for Caesarean section. (I-A)5.Women with primary genital herpes in the third trimester of pregnancy have a high risk of transmitting HSV to their neonates and should be counselled accordingly and should be offered a Caesarean section to decrease this risk. (II-3B)6.A pregnant woman who does not have a history of HSV but who has had a partner with genital HSV should have type-specific serology testing to determine her risk of acquiring genital HSV in pregnancy before pregnancy or as early in pregnancy as possible. Testing should be repeated at 32 to 34weeks’ gestation. (III-B) ValidationThese guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC. SponsorThe Society of Obstetricians and Gynaecologists of Canada

Is suspicion of genital herpes infection associated with avoiding sex? A clinic-based study

The present study tested the research hypothesis that sexually transmissible disease (STD) clinic patients suspecting genital herpes infection would be more likely than their 'non-suspecting' counterparts to abstain from sex to avoid transmission of a perceived STD. Recruitment (n = 351) occurred in a publicly-funded STD clinic located in a metropolitan area of the southern USA. Participants were tested for herpes simplex virus type 2 (HSV-2) using a rapid test manufactured by Biokit (Lexington, MA, USA) and they completed a self-administered questionnaire (using a 3-month recall period). Well over one-third (38.7%) of those indicating suspicion also indicated avoiding sex with steady partners because of concerns about STDs as compared with 28.0% among those not indicating suspicion (prevalence ratio = 1.38; 95% CI = 1.02-1.87, P = 0.036). The relationship between suspicion and avoiding sex with non-steady partners was not significant (P = 0.720). The relationship with steady partners only applied to people who were female (P = 0.013), single (P = 0.017), reported symptoms of genital herpes (P = 0.003), perceived that genital herpes would have a strong negative influence on their sex life (P = 0.0001), and who subsequently tested positive for HSV-2 (P = 0.012). Among STD clinic attendees, suspicion of genital herpes infection may translate into partner protective behaviour, but only for a minority of people and only with respect to sex with steady partners. Clinic-based and community-based education programs may benefit public health by teaching people (especially single women) how to effectively recognise symptoms of primary genital herpes infections. Reversing the often prevailing ethic of genital herpes as a 'community secret' will clearly be a challenge to these education programs.

Managing genital herpes infections in pregnancy.

Genital herpes is common and is becoming more so, with a seroprevalence of 25% in middle class primary care settings. Primary genital herpes in pregnancy most often is subclinical, but it also can cause severe illness. Further, active genital herpes at the time of vaginal delivery poses significant risk of neonatal infection, especially if the mother acquired the infection in the third trimester. It is important to prevent genital herpes acquisition in pregnancy and to diagnose recurrent genital herpes to prevent neonatal herpes.

Valacyclovir Prophylaxis to Prevent Recurrent Herpes at Delivery

To measure the efficacy of valacyclovir suppression in late pregnancy to reduce the incidence of recurrent genital herpes in labor and subsequent cesarean delivery. A total of 350 pregnant women with a history of genital herpes were assigned randomly to oral valacyclovir 500 mg twice a day or an identical placebo from 36 weeks of gestation until delivery. In labor, vulvovaginal herpes simplex virus (HSV) culture and polymerase chain reaction (PCR) specimens were collected. Vaginal delivery was permitted if no clinical recurrence or prodromal symptoms were present. Neonatal HSV cultures and laboratory tests were obtained, and infants were followed up for 1 month after delivery. Data were analyzed using chi2 and Student t tests. One hundred seventy women treated with valacyclovir and 168 women treated with placebo were evaluated. Eighty-two percent of the women had recurrent genital herpes; 12% had first episode, nonprimary genital herpes; and 6% had first episode, primary genital herpes. At delivery, 28 women (8%) had recurrent genital herpes requiring cesarean delivery: 4% in the valacyclovir group and 13% in the placebo group (P = .009). Herpes simplex virus was detected by culture in 2% of the valacyclovir group and 9% [corrected] of the placebo group (P =.02). No infants were diagnosed with neonatal HSV, and there were no significant differences in neonatal complications. There were no significant differences in maternal or obstetric complications in either group. Valacyclovir suppression after 36 weeks of gestation significantly reduces HSV shedding and recurrent genital herpes requiring cesarean delivery. I.

Importance of herpes simplex virus type-1 (HSV-1) in primary genital herpes

Herpes simplex virus type 1 (HSV-1) is increasingly reported in primary genital herpes. Its incidence was assessed among Rotterdam sexually transmitted diseases clinic attendees between 1996 and 2001, and demographic and sexual behaviour factors were evaluated. A retrospective record analysis was performed. All herpes diagnoses were based on cell culture techniques. A clinical scoring system was used to select "primary" cases. Demographic and sexual behaviour characteristics were analysed using logistic regression. The clinical scoring system showed 115 cases of primary genital herpes. HSV-1 (n = 60) was found in 52% and HSV-2 (n = 55) in 48% of cases. The multiple logistic regression model showed that HSV-1 was associated with "oro-genital contact" (p < 0.001) and "having a single partner in the last 2 months" (p = 0.054) and that HSV-2 was associated with "a higher number of sexual partners in the last 6 months" (p = 0.085). Our data confirm the growing importance of HSV-1 in primary genital herpes; oro-genital sex is the main risk factor.

Diagnosis of herpetic cervicitis and concurrent sexually transmitted infections in primary genital herpes

Diagnosis of herpetic cervicitis and concurrent sexually transmitted infections in primary genital herpes