Recurrent Genital Herpes Simplex Infections Research Articles

Recurrent Genital Herpes Simplex Infection

Genital herpes simplex virus (HSV) infection can be viewed, in the main, as a trivial disorder causing patients minor physical discomfort and some alteration in the pattern of their normal sexual activity. Notwithstanding the fact that genital HSV may have oncogenic properties and may be life-threatening to a fetus at term or to the immune suppressed, the simple clinical fact remains that the disease is a benign, self-limiting infection for most healthy individuals. This, of course, is<i>not</i>how most patients actually view the affliction. Recurrent infection with genital HSV presents, instead, a number of special psychosocial problems to patients and therapeutic dilemmas to physicians that defy conventional approaches appropriate to other sexually transmitted diseases. Included in a list of issues considered peculiar, if not unique, to recurrent genital HSV infection are the following: (1) the failure of most For editorial comment see p 467. conventional medical treatments to influence

Treatment of recurrent genital herpes simplex infections with oral acyclovir: A controlled trial: Reichman RC, Badger GJ, Mertz GJ, et al. JAMA 251:2103–2107, 1984. Reprint requests: Dr. Richard C. Reichman, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY,1642

Treatment of recurrent genital herpes simplex infections with oral acyclovir: A controlled trial: Reichman RC, Badger GJ, Mertz GJ, et al. JAMA 251:2103–2107, 1984. Reprint requests: Dr. Richard C. Reichman, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY,1642

Recurrent genital herpes simplex virus infection in guinea pigs.

After recovery from initial genital herpes simplex virus (HSV) infections, female guinea pigs developed spontaneous recurrent infections characterized by discrete erythematous or vesicular herpetic lesions on the external genital skin. HSV type 2 (HSV2) caused significantly more recurrent infections in guinea pigs than did HSV type 1 (HSV1). HSV2-infected animals demonstrated a significant decline in frequency of recurrences over time. The viral nature of the recurrent lesions was confirmed by recovery of infectious HSV, detection of HSV antigen, and histologic examination. Latent HSV2 could be demonstrated in dorsal root ganglia and external genital skin after recovery from the primary infection. Recurrent genital HSV infection in the guinea pig shares many features with recurrent genital herpes in humans and provides a model for studying the relationship between latency and recurrences and for exploring methods for control of recurrent disease.

Molecular biology in viral diagnosis: restriction enzyme analysis of viruses from recurrent genital herpes infections.

Recurrent genital herpes simplex infections are important causes of sexually transmitted disease (STD). Sub-typing of herpes simplex viruses into type 1 and type 2 has long been possible but restriction enzyme analysis of the viral genome now provides a more versatile tool in the diagnosis and investigation of these virus infections. Isolates were obtained from the genital tract and the electrophoretic profiles of restriction enzyme digests were used for typing and for investigating strain epidemiological patterns in sexual partners. Analysis of deoxyribonucleic acid (DNA) of repeated isolates from discrete sites in individuals may be important in the study of latent infections.

Treatment of Recurrent Genital Herpes Simplex Infections with Oral Acyclovir. A Controlled Trial

Two hundred fifty patients were entered into a multicenter trial to evaluate the efficacy and toxicity of orally administered acyclovir for treatment of recurrent genital herpes. The study consisted of part A, in which patients entered the study within 48 hours of the onset of lesions, and part B, in which patients self-initiated therapy as soon as possible after the onset of a recurrent episode. In both parts, patients received either acyclovir (200 mg) or placebo, five times daily for five days. In both parts, the duration of virus shedding and the time to crusting and healing of lesions were shorter among acyclovir recipients than among placebo recipients. In part B, fewer acyclovir recipients formed new lesions during the study medication period than did placebo recipients. When parts A and B were compared directly, the duration of virus shedding and the times required for crusting and healing of lesions were significantly shorter among acyclovir recipients in part B than among acyclovir recipients in part A. No significant differences in the duration of itching and pain or in the times of subsequent recurrence were noted between acyclovir and placebo groups in either part A or part B. No significant toxic or adverse reactions were seen in acyclovir recipients. Oral acyclovir shortens the duration of virus shedding and the duration of lesions in patients with recurrent genital herpes. These effects are more pronounced when therapy is self-initiated by patients early in the course of a recurrent episode. ( JAMA 1984;251:2103-2107)

Treatment of Recurrent Genital Herpes Simplex Infections with Oral Acyclovir. A Controlled Trial

Treatment of Recurrent Genital Herpes Simplex Infections with Oral Acyclovir. A Controlled Trial

Asymptomatic shedding of herpes simplex virus from the cervix and lesion site during pregnancy. Correlation of antepartum shedding with shedding at delivery.

Asymptomatic shedding of herpes simplex virus (HSV) was detected in 0.83% of 955 cultures obtained from pregnant women with culture-proved recurrent genital HSV infections during pregnancy; seven (2.3%) of 299 women had asymptomatic shedding. In addition, one (2.3%) of 42 pregnant women with recurrent genital infection in the past but no attacks during pregnancy shed HSV when asymptomatic. Shedding occurred more frequently from the usual lesion site than from the cervix. The virus was not isolated at delivery from women with asymptomatic antepartum shedding. When an active lesion was present, concomitant shedding of HSV from the cervix occurred in seven (3.6%) of 193 pregnant women with vulvar lesions and in one (2.1%) of 47 women with lesions remote from the vulva. Ninety-two percent of the latter lesions were caused by type 2 HSV. In women who have had recurrent genital HSV infections in the past, asymptomatic shedding occurs in those with active attacks during pregnancy as well as in those asymptomatic throughout pregnancy; however, asymptomatic shedding during the antepartum period does not predict asymptomatic shedding at delivery.

Treatment of Recurrent Genital Herpes Simplex Infections With Oral Acyclovir

Two hundred fifty patients were entered into a multicenter trial to evaluate the efficacy and toxicity of orally administered acyclovir for treatment of recurrent genital herpes. The study consisted of part A, in which patients entered the study within 48 hours of the onset of lesions, and part B, in which patients self-initiated therapy as soon as possible after the onset of a recurrent episode. In both parts, patients received either acyclovir (200 mg) or placebo, five times daily for five days. In both parts, the duration of virus shedding and the time to crusting and healing of lesions were shorter among acyclovir recipients than among placebo recipients. In part B, fewer acyclovir recipients formed new lesions during the study medication period than did placebo recipients. When parts A and B were compared directly, the duration of virus shedding and the times required for crusting and healing of lesions were significantly shorter among acyclovir recipients in part B than among acyclovir recipients in part A. No significant differences in the duration of itching and pain or in the times of subsequent recurrence were noted between acyclovir and placebo groups in either part A or part B. No significant toxic or adverse reactions were seen in acyclovir recipients. Oral acyclovir shortens the duration of virus shedding and the duration of lesions in patients with recurrent genital herpes. These effects are more pronounced when therapy is self-initiated by patients early in the course of a recurrent episode.

Treatment of recurrent genital herpes simplex infections with oral acyclovir. A controlled trial

Treatment of recurrent genital herpes simplex infections with oral acyclovir. A controlled trial

Treatment of recurrent genital herpes simplex infections with oral acvclovir: Reichman RC, Badger GJ, Mertz GJ, et al. JAMA 1984; 251:2103–2107

Treatment of recurrent genital herpes simplex infections with oral acvclovir: Reichman RC, Badger GJ, Mertz GJ, et al. JAMA 1984; 251:2103–2107

The Course of Untreated Recurrent Genital Herpes Simplex Infection in 27 Women

GENITAL herpes simplex infection affects an unknown but ever increasing number of persons in the United States. Because of the lack of a national surveillance system, no reliable data are available...

A primate model for age and host response to genital herpetic infection: determinants of latency.

Thirty five female Cebus albifrons monkeys (16 adolescents and 19 adults) were infected vaginally with herpes simplex virus (HSV) type 2. Fifteen developed spontaneous recurrent genital HSV infections. All 35 were killed for study eight to 12 months after primary infection, and tissue from the vagina, cervix, uterus, ovary, paracervical autonomic plexus, and lumbosacral dorsal root ganglia of eight animals. Host age was the most important variable influencing viral latency; 69% of adolescents and 42% of adults had latent HSV type 2 infections. Animals that developed latent infections were significantly easier to infect, shed virus during the primary infection significantly longer, and had more severe primary disease than those who did not become latently infected.

The course of untreated recurrent genital herpes simplex infection in 27 women.

GENITAL herpes simplex infection affects an unknown but ever increasing number of persons in the United States. Because of the lack of a national surveillance system, no reliable data are available to determine either the magnitude or the growth rate of this problem. However, reports from three different parts of the country indicate that genital herpes is diagnosed more frequently than gonorrhea in women visiting private gynecologists.1 2 3 Women are particularly burdened with this infection: in addition to the morbidity associated with recurring episodes, they may incur an increased risk of cervical cancer, 4 and they may transmit a severe or fatal . . .

Perinatal Herpes Simplex Virus Infections

Because of the relative paucity of data on the epidemiology and management of perinatal herpes simplex virus (HSV) infections, the following recommendations represent the best current judgments of the Committees on Fetus and Newborn and Infectious Diseases of the American Academy of Pediatrics. HSV infection of the newborn is associated with a case fatality rate of 60% and at least half of the survivors have significant neurologic or ocular sequelae, or both. Approximately 75% of isolates from affected neonates are HSV-2 and 25% are HSV-1. Although preliminary data suggest that antiviral chemotherapy is effective in reducing mortality and morbidity resulting from neonatal HSV infections, measures designed to prevent infection of newborns are currently the most important means of controlling neonatal infections. A maternal source of infection can be found in about 90% of neonatal cases. Maternal HSV infection is usually caused by type 2 strains and involves the labia, cervix, and/or vagina. The majority of genital infections are asymptomatic and difficult to recognize on clinical examination, making identification of women whose infants are in jeopardy very difficult. EPIDEMIOLOGY Maternal Infection Primary HSV infection during pregnancy may be associated with spontaneous abortion, prematurity, and rarely with congenital anomalies. The risk of infection to the newborn appears to be the highest in primary genital infection of the pregnant woman, but is also high in recurrent infection. Women with a history of recurrent genital HSV infection, those with active disease during the current pregnancy, and those whose sexual partners have proven genital HSV infection should be monitored with virologic or cytologic studies, or both, at least twice during the last six weeks of pregnancy.

Clinical course and diagnosis of genital herpes simplex virus infection and evaluation of topical surfactant therapy

A prospective study of 37 men and 32 women with culture-proved genital herpes simplex virus (HSV) infection was undertaken to characterize the clinical manifestations of the disease and effects of topical therapy with Nonoxynol 9,∗ a nonionic surfactant active in vitro against HSV. The duration of pain, lesions, and virus shedding was significantly longer in initial than in recurrent genital HSV infection. Cervical HSV shedding occurred in 11 of 13 initial infections versus two of 19 recurrences (p < 0.001). Type 1 HSV caused seven of 29 initial and none of 40 recurrent infections (p < 0.01). Clinical recurrences within six weeks were detected more often in men than in women and were unrelated to the menstrual cycle. The influence of coitus on recurrences is unclear. Papanicolaou smears were transiently abnormal (Class II) in four (12.5 per cent) of 32 female patients. Evidence of herpesvirus was detected in cytologic smears from only 28 (41 per cent) of 69 culture-proved external lesions and three (23 per cent) of 13 culture-positive cervices. Serology was also of limited diagnostic value except in testing paired sera from initial infections. The topical therapy had no beneficial effect.