Screening For Herpes Simplex Virus Research Articles

Herpes simplex virus infection in pregnancy – An update

Herpes Simplex virus (HSV) infection is one of the most common sexually transmitted infections among women of the reproductive age. It is estimated to affect about 2−3% of pregnant women. Vertical transmission during pregnancy is rare occurring in less than 1% of cases but for those with active lesions or shedding the virus asymptomatically the risk of vertical transmission intrapartum is high. Neonates with HSV may develop severe consequences such as disseminated, central nervous system and skin, eye mouth/mucous disease or suffer mortality. A high index of suspicion, timely diagnosis and institution of appropriate treatment during acute and recurrent episodes will reduce the risk of vertical transmission and therefore neonatal consequences. Routine screening for HSV in pregnancy is not recommended. This review provides an overview of HSV in pregnancy, diagnosis and management especially around unique scenarios such as prelabour preterm rupture of fetal membranes and presentation with active disease in labour.

The role of Screening for Herpes Simplex Virus in Candidates of Renal Transplantation

Background: Herpes Simplex Virus (HSV) infection in immunocompromised hosts like kidney transplant patients causes more morbidity and mortality than the general population. Objectives: The aim of this study was to evaluate the role of screening for HSV in donors and recipients of kidney transplantation. Materials and Methods: From October 2012 to November 2013, this cross sectional study was conducted on donors and recipients who were referred to our kidney transplant center in Ahvaz city, Iran. A standardized questionnaire was used to collect social and demographic data. The patients and donors were screened for HSV IgG and IgM antibodies by direct fluorescent antibody (DFA).Other routine pretransplant laboratory studies were also performed. Results: Overall 37 people (22 donors, 20 males and 2 females with mean age of 30 ± 5 years; 15 recipients, eight males and seven females with mean age of 45 ± 6 years) were enrolled in this study. All of the recipients were on hemodialysis. The markers of HBV and HCV infection were negative in 100% of recipients and donors. Herpes Simplex Virus (HSV) IgG antibody was positive in 93.33% of recipients (n = 14) and 77.27% of donors (n = 17). Herpes Simplex Virus (HAV) IgM antibody was positive in 33.33% of recipients (n = 5) and 13.63% of donors (n = 3). Conclusions: Herpes Simplex Virus is a common infection in donor and recipient candidates for kidney transplantation in Khuzestan province of Iran, and it seems that we need to perform screening for this infection to avoid kidney donation from seropositive donors to seronegative recipients.

Current thinking on genital herpes

Genital herpes has a high global prevalence and burden of disease. This manuscript highlights recent advances in our understanding of genital herpes simplex virus (HSV) infections. Studies demonstrate a changing epidemiological landscape with an increasing proportion of genital herpes cases associated with HSV type 1. There is also growing evidence that the majority of infected individuals exhibit frequent, brief shedding episodes that are most often asymptomatic, which likely contribute to high HSV transmission rates. Given this finding as well as readily available serological assays, some have proposed that routine HSV screening be performed; however, this remains controversial and is not currently recommended. Host immune responses, particularly local CD4 and CD8 T cell activity, are crucial for HSV control and clearance following initial infection, during latency and after reactivation. Prior HSV immunity may also afford partial protection against HSV reinfection and disease. Although HSV vaccine trials have been disappointing to date and existing antiviral medications are limited, novel prophylactic and therapeutic modalities are currently in development. Although much remains unknown about genital herpes, improved knowledge of HSV epidemiology, pathogenesis and host immunity may help guide new strategies for disease prevention and control.

The roles of self‐efficacy and pretest counseling in type 2 herpes simplex virus screening in asymptomatic adults

To evaluate the role of counseling for patients undergoing screening for type 2 herpes simplex virus (HSV-2). Using pre- and post-screening questionnaires, we evaluated correlations between demographic factors, measures of self-efficacy and follow-through with the screening test, and willingness to take antiviral medication and share results with sexual partners. Subjects (N= 115) were recruited as part of usual care at a private, urban family practice. A total of 111 subjects completed pre-screening questionnaires, and 38 completed post-screening questionnaires. The overwhelming majority of participants were (a) willing to undergo screening; (b) take suppressive antiviral medication if necessary; (c) share their results with sexual partners; and (d) consider safer sexual practices as a consequence of screening. Older patients were less willing to consider daily antiviral medication. Men who have sex with men (MSM) had lower perceived susceptibility to HSV-2 but were more likely to undergo and report screening. Future research should include predictive models for determining the most appropriate patients to screen for HSV-2 and best practices for those who test positive. Shared decision making between patients and advanced practice nurses regarding the risks and benefits of screening for HSV-2 should be a component visits that include sexually transmitted disease screening. Particular attention should be paid to those at higher risk for contracting the virus, including patients with HIV and MSM.

Silent Herpes Simplex virus infection in women with preterm premature rupture of membranes

Background: genital herpes simplex virus infection in pregnancy poses a major risk to the fetus and it has been associated with bad obstetric out come causing preterm labor, intrauterine growth retardation and spontaneous abortion. This study was conducted to determine if premature rupture of membranes before 37 weeks of gestational age are observed with subclinical shedding of herpes simplex virus (HSV).Patients and methods: Cervical swabs were taken from 75 women with a history of preterm premature rupture of membranes before 37 weeks of gestation, and 20 women with normalobstetrical history for the presence of HSV antigen using Enzyme linked Immuno Sorbent Assay (ELISA) method.Results: HSV antigen was detected in 37 swabs(49.3%) which revealed a significant association with preterm premature rupture membranes(PPROM) compared to control group(P<0.05).The majority of HSV infected women were asymptomatic 34(91.9%), and 23(56.1%) of the cases was associated with history of recurrent PPROM, compared to those women with history of single PPROM.Conclusion: The risk of maternal transmission of HSV to the fetus or newborn is a major health concern and the high rates of undiagnosed or asymptomatic HSV infections complicate the issue of prevention. With advent of serologic test that can reliably detect the virus in asymptomatic patient. Maternal HSV screening now is mandatory.

Projected cost-savings with herpes simplex virus screening in pregnancy: towards a new screening paradigm

ObjectivesHerpes simplex virus (HSV) infections in newborns are an uncommon but potentially devastating consequence of genital HSV infection in women. Current practice focuses on preventing perinatal transmission by women with...

Hemophagocytic syndrome caused by primary herpes simplex virus 1 infection: report of a first case

Hemophagocytic syndrome represents a severe hyperinflammatory condition by activated macrophages. Leading viral triggering agents are Epstein-Barr virus (EBV), cytomegalovirus (CMV), and adenovirus. We present a patient with Wegener's granulomatosis on azathioprine and prednisone medication, who developed a life-threatening hemophagocytic syndrome. Positive plasma polymerase chain reaction (PCR) with negative serology revealed a primary, disseminated infection with herpes simplex virus-1 as the triggering pathogen. After treatment with acyclovir, high-dose steroids, immunoglobulins, and etoposide, the patient recovered. Early diagnosis of potentially underlying infections of hemophagocytic syndrome influences the therapeutic approach. It is important to consider a variety of infectious agents, particularly in immunosuppressed individuals. The reported case emphasizes the importance of screening for herpes simplex virus 1.

Archipelago Keratitis: A Clinical Variant of Recurrent Herpetic Keratitis?

To describe archipelago keratitis, a presumed clinical variant of herpetic epithelial keratitis. Case series. A series of 6 patients with an unusual form of superficial keratitis. History, including age, gender, clinical evolution, and treatment; slit-lamp biomicroscopy findings; in vivo confocal microscopy findings; and corneal epithelial scrapings were analyzed. Clinical ocular examination, a diagnostic workup including corneal scraping for herpesvirus polymerase chain reaction, in vivo confocal microscopy, and therapeutic outcome. The authors describe a series of 6 patients with keratitis consisting of foci of epithelial erosions associated with subepithelial nummular inflammatory infiltrates and disposed in a radial, centripetal, archipelagolike pattern originating from the limbus. All the patients had a past history of herpetic epithelial keratitis, herpetic vesicles on the ipsilateral lid, or both. Polymerase chain reaction-based screening for herpes simplex virus 1 and 2 in corneal scrapings demonstrated positive results in 2 patients. In vivo corneal confocal microscopy revealed focal areas of hyperreflective epithelial cells and hyperreflective subepithelial dendritic structures overlying activated keratocytes. All the patients improved with oral valacyclovir treatment followed by topical steroid therapy. Archipelago keratitis may be a new clinical variant of herpetic keratitis, reflecting herpetic dissemination from the limbus to the center of the cornea.

Antenatal Herpes Serologic Screening

Calls for universal antenatal type-specific herpes simplex virus (HSV) screening to prevent neonatal herpes have recently increased and would affect the four million pregnant women and their partners annually in the United States. We undertook this review to assess the appropriateness of such screening, making relevant comparisons to established antenatal human immunodeficiency virus (HIV) and hepatitis B virus (HBV) screening programs. We conducted a full PubMed and bibliographic search for relevant literature in English available from 1966 through February 2006, using the terms "genital herpes," "neonatal herpes," "decision analysis" or "cost-effectiveness analysis," and "herpes and pregnancy" or "antenatal herpes screening." Comparison literature was obtained by replacing "herpes" with "HBV" or "HIV". We appraised antenatal type-specific HSV screening using well-established criteria for a good screening program, which we articulated as questions. Of 455 articles we selected those that addressed at least one of the questions and were pertinent to the U.S. population. We found that neonatal HSV is rare and its incidence is imprecisely defined. There is a lack of evidence supporting the effectiveness of interventions to prevent maternal acquisition of new infection in late pregnancy, which accounts for 60-80% of neonatal herpes. The consequences of universal screening are incompletely understood but include the potential for unnecessary cesarean deliveries and medical treatment, maternal psychosocial stress, and discord among partners. The available evidence indicates universal screening is not cost-effective. In contrast, antenatal HIV and HBV screening programs better satisfy accepted criteria for screening. On the basis of this appraisal, universal antenatal type-specific HSV screening to prevent neonatal herpes does not adequately satisfy criteria of a good screening program, and we recommend against its adoption.

Universal prenatal herpes screening is a bad idea in pregnancy

Three articles in leading US obstetric journals have called for universal herpes simplex virus screening during pregnancy.1–3 We believe that on the basis of the evidence such a strategy would provide little benefit and could be harmful to pregnant women and their babies.

The cost-effectiveness of routine antenatal screening for maternal herpes simplex virus–1 and –2 antibodies

The purpose of this study was to determine the cost-effectiveness of routine antenatal screening for herpes simplex virus 1 and 2 in women without a known history of genital herpes. Decision analysis was used to compare 3 treatment strategies to prevent neonatal herpes infection in women without a known history of genital herpes simplex virus: (1) the current standard of care (no herpes simplex virus screening), (2) antepartum herpes simplex virus-1 and -2 antibody screening of the pregnant woman and her male partner with appropriate counseling, and (3) antepartum herpes simplex virus-1 and -2 antibody screening with appropriate counseling and acyclovir prophylaxis at 36 weeks of gestation in seropositive women. Our model predicts that using current guidelines, 1 of 5469 women will have a herpes-infected neonate. Strategy 2 and 3 cost $5,812,819 and $4,130,297, respectively, for every significant neurologic sequela or death prevented. The cost-effectiveness of these strategies, expressed as cost per quality life-year gained, was $219,513 and $155,988 respectively. These results were robust in the sensitivity analysis. Routine herpes simplex virus screening in pregnancy is not cost-effective.

Return for Results After Herpes Simplex Virus Type 2 Screening

The objective of this study was to evaluate factors associated with return for results of type-specific herpes simplex virus (HSV) screening. Participants receiving type-specific HSV testing were asked to return for results 2 weeks after testing. Predictors of return included demographics, herpes-related knowledge and attitudes, and past sexual behaviors. A total of 820 sexually active subjects (age, 14-30 years; 41% male) received HSV screening and 578 (70%) returned for results. Higher probability of return for HSV testing results was significantly associated with older age (odds ratio [OR], 1.06), female gender (OR, 1.57), enrollment at sites other than the county sexually transmitted disease clinic (OR, 1.70-4.71), and heightened level of perceived HSV vulnerability (OR, 1.07). Lower probability of return was associated with having more than 1 recent sex partner (OR, 0.46). Lower rates of return of high-risk patients suggest the need to focus resources on receipt of test results.

Survey of acyclovir-resistant herpes simplex virus in the Netherlands: prevalence and characterization

Widespread and frequent use of acyclovir (ACV) for treatment, suppressive therapy and prophylaxis of herpes simplex virus (HSV) infections and its over the counter availability may be associated with emergence of HSV resistance. To determine the prevalence of ACV-resistant HSV isolates in different patient groups between 1999 and 2002 in the Netherlands. A total of 542 isolates, 410 HSV-1 and 132 HSV-2, from 496 patients were screened for reduced susceptibility to ACV. A newly developed ELVIRA HSV screening assay was used that allowed a high throughput screening. The genotypic analysis of the HSV thymidine kinase gene was performed to identify resistance-associated mutations. Thirteen isolates, 8 HSV-1 and 5 HSV-2, from 10 patients (2%) were found resistant to ACV. A single ACV-resistant strain was identified among isolates from 368 immunocompetent patients (0.27%; 95% confidence interval [CI], 0.007%-1.5%), whereas in nine isolates from 128 immunocompromised patients resistant HSV was identified (7%; 95% CI, 3.26%-12.93%). The highest frequency of ACV-resistant HSV was associated with bone marrow transplantation: four patients out of 28 (14.3%) shed resistant virus. In addition, resistant virus was obtained from two HIV-positive patients, one patient with a hematological malignancy and two patients on immunosuppressive drugs. Further testing showed that none of the isolates was resistant to foscarnet. Several new mutations were identified in the thymidine kinase gene of these resistant isolates, and their effect on ACV-resistance is discussed. Our study shows that the prevalence of ACV resistance is low in immunocompetent patients (0.27%), whereas ACV-resistant HSV infections occur relatively frequently in immunocompromised patients (7%; P < 0.0001). This emphasizes the need for drug susceptibility monitoring of HSV infections in immunocompromised patients with persisting infections despite antiviral therapy.

Herpesvirus in localized juvenile periodontitis.

Herpesvirus genomic sequences can be detected in gingival crevicular fluid of adult periodontitis lesions. Herpesviruses are immunosuppressive and may facilitate establishment of subgingival pathogens. Electron microscopic studies have identified nuclear and cytoplasmic virus-like inclusions in gingival inflammatory cells from localized juvenile periodontitis (LJP). The present study aimed to determine if herpesviruses occur in LJP lesions and if human cytomegalovirus (HCMV) activation is associated with elevated levels of subgingival Actinobacillus actinomycetemcomitans, the putative bacterial pathogen of LJP. Eleven systemically healthy patients exhibiting LJP (10-23 yr) were studied. In each patient, subgingival samples were pooled from 3 periodontitis lesions around first molar and incisor teeth (5-11 mm periodontal pocket depth) and from 3 gingivitis/healthy sites around canines (2-3 mm periodontal pocket depth). Polymerase chain reaction (PCR) was used to detect herpesvirus DNA and HCMV cDNA of major capsid protein transcripts, indicative of viral activation. Selective culture and 16S rRNA PCR were used to identify A. actinomycetemcomitans. Of 11 deep periodontal samples, 8 showed HCMV, 7 showed Epstein-Barr virus type 1 (EBV-1), 1 showed EBV type 2, 6 showed herpes simplex virus (HSV) and 8 showed viral co-infection. Of 11 shallow periodontal samples, 2 showed HCMV, 2 showed EBV-1, 1 showed HSV and 2 showed viral co-infection. The difference in occurrence of HCMV and viral co-infection between deep and shallow periodontal sites was statistically significant (p =0.031). HCMV activation was detected in deep pockets of all 5 virally positive patients with early LJP (aged 10-14 years) but only in 1 of 3 virally positive LJP patients older than 14 years, and not in any shallow pocket tested. HCMV activation appeared related to absence of radiographic crestal alveolar lamina dura, a possible indication of periodontal disease progression. A. actinomycetemcomitans tended to be more prevalent in samples showing active than latent HCMV infection. The present findings are consistent with the notion that periodontal herpesvirus infection and possibly HCMV activation constitute important features of the etiopathogenesis of LJP.

Screening pregnant women for genital herpes.

In a prospective study to identify the viral type isolated from women undergoing screening for herpes simplex virus (HSV) during pregnancy using fluoroscine-labelled monoclonal antibodies to HSV-1 and HSV-2, HSV-2 was more likely to be isolated during the third trimester and was the only viral type isolated at term. As the severity of neonatal central nervous system disease is greater with HSV-2 than HSV-1 we recommended that all women with a history of genital herpes should be screened during pregnancy.

Genital herpes simplex virus (HSV) infections of mice: A model for evaluating cross susceptibility of drug resistant mutants

Background: Widespread and frequent use of acyclovir (ACV) for treatment, suppressive therapy and prophylaxis of herpes simplex virus (HSV) infections and its over the counter availability may be associated with emergence of HSV resistance. Objectives: To determine the prevalence of ACV-resistant HSV isolates in different patient groups between 1999 and 2002 in the Netherlands. Study design: A total of 542 isolates, 410 HSV-1 and 132 HSV-2, from 496 patients were screened for reduced susceptibility to ACV. A newly developed ELVIRA HSV screening assay was used that allowed a high throughput screening. The genotypic analysis of the HSV thymidine kinase gene was performed to identify resistance-associated mutations. Results: Thirteen isolates, 8 HSV-1 and 5 HSV-2, from 10 patients (2%) were found resistant to ACV. A single ACV-resistant strain was identified among isolates from 368 immunocompetent patients (0.27%; 95% confidence interval [CI], 0.007%–1.5%), whereas in nine isolates from 128 immunocompromised patients resistant HSV was identified (7%; 95% CI, 3.26%–12.93%). The highest frequency of ACV-resistant HSV was associated with bone marrow transplantation: four patients out of 28 (14.3%) shed resistant virus. In addition, resistant virus was obtained from two HIV-positive patients, one patient with a hematological malignancy and two patients on immunosuppressive drugs. Further testing showed that none of the isolates was resistant to foscarnet. Several new mutations were identified in the thymidine kinase gene of these resistant isolates, and their effect on ACV-resistance is discussed. Conclusions: Our study shows that the prevalence of ACV resistance is low in immunocompetent patients (0.27%), whereas ACV-resistant HSV infections occur relatively frequently in immunocompromised patients (7%; P<0.0001). This emphasizes the need for drug susceptibility monitoring of HSV infections in immunocompromised patients with persisting infections despite antiviral therapy.

Virological screening for herpes simplex virus during pregnancy.

Virological screening for herpes simplex virus during pregnancy.