HSV Screening Research Articles

PRETRANSPLANT SEROPREVALENCE OF EPSTEIN-BARR VIRUS AND HERPES SIMPLEX VIRUS INFECTION AMONG THAI KIDNEY TRANSPLANT RECIPIENTS

Introduction: Epstein-Barr virus (EBV) and herpes simplex virus infection are common in general population. Nevertheless, transplant candidates with EBV and/or HSV seronegative who received kidney from donor with seropositive had increased risk for primary infection. Primary EBV infection can cause post-transplant lymphoproliferative disease while primary HSV infection can lead to disseminated infection. Current guideline recommended pre-transplant screening with EBV IgG and HSV IgG, however cost of such routine testing is relatively high in our country. Data regarding of seroprevalence of EBV and HSV in Thai kidney transplant (KT) patients is lacking. Methods: A retrospective cohort study in all patients who had underwent KT in Siriraj Hospital between 1st January 2014 and 31st December 2019 was conducted. EBV IgG and HSV IgG in kidney transplant recipients were tested when the patients were admitted for KT. The patients without EBV and HSV IgG results were excluded. Seroprevalence of HSV and EBV and risk factors for seronegative were analyzed. Results: Of 445 patients, all patients had EBV IgG results while 418 patients (93.9%) had HSV IgG results. EBV seronegative was revealed in 5 patients (1.1%). Mean age of patients with EBV seronegative was significantly less than seropositive patients (22.4 ± 15.5 vs 42.1 ± 12.7 years; p = 0.001). Age of EBV seronegative patients were 12, 13, 15, 23 and 49 years, respectively. HSV seronegative was found in 121 patients (27.2%) with median age of 39 (12 – 62) years. Patients without previous HSV exposure were significantly younger than seropositive ones (39.0 ± 11.7 vs 45.4 ± 10.4; p < 0.001). Conclusion: Almost Thai KT patients had previous EBV exposure, thus pretransplant EBV screening is not necessary especially in adult KT recipients. Negative HSV IgG was found in three fourth of KT patients. HSV screening might be beneficial for post KT prophylaxis.

No. 207-Genital Herpes: Gynaecological Aspects.

The purpose of this guideline is to provide recommendations to gynaecology health care providers on optimal management of genital herpes. More effective prevention of complications and transmission of genital herpes. Medline was searched for articles published in French and English related to genital herpes and gynaecology. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed.

An Unusual Case of CMV Gastritis in a Healthy Adult

Case Report: A 24-year-old obese female presented with a 2-week history of abdominal pain, nausea, vomiting, and dark stools. Her past medical history was significant for menorrhagia and iron deficiency anemia. Her abdomen was soft, moderately tender with normal bowel sounds. Superficial lymph nodes, including cervical, axillary, and inguinal were not palpable. Lab results revealed hemoglobin of 7.8 g/dL, MCV of 75.8 fL, WBC of 5.38 k/uL with lymphocytes at 61%, and monocytes at 7%. CT of the abdomen revealed an enlarged spleen. Monospot test was negative. Screening for HSV, syphilis, parvovirus, ova, and parasites was unremarkable. Serology for HIV 1 and 2 was negative. Her CD4 count was 615 cells/uL, CD8 count was 727 cell/uL, and the CD4:CD8 ratio was 0.85. Serology for EBV was positive for IgG and IgM antibodies against viral capsid antigens and IgG antibodies against nuclear antigen and early antigen. An EGD was done, which revealed a normal esophagus, moderate gastritis with edematous gastric folds, many non-bleeding superficial gastric ulcers spread on the entire stomach, with the largest measuring 3 mm, and a normal duodenum (Figure 1). The biopsy of the lesion revealed scattered cells with characteristic CMV inclusion bodies, and immune-histochemical staining was positive for CMV and negative for H.pylori (Figures 2A, 2B). Culture of the gastric biopsy also yielded CMV. She was treated with ganciclovir and omeprazole. Follow-up 4 weeks later revealed complete resolution of her symptoms.Figure 1Figure 2Discussion: Primary CMV infection in normal hosts is aymptomatic, but can lead to a mononucleosislike syndrome and, rarely, severe organ specific complications. This case shows the occurrence of classical CMV gastritis lesions in a normal healthy and young host, and emphasizes the need to include CMV in the differential when multiple, shallow gastric ulcers are found on upper endoscopy, even in immunocompetent hosts.

Prevalence and risk factors for herpes simplex infection among patients at high risk for HIV infection in Brazil

Herpes simplex infection is responsible for substantial morbidity in patients with HIV infection. Data from less-developed countries analyzing risk factors within this population are largely unavailable. Investigate the incidence and seroprevalence of HSV-1 and HSV-2 infection in populations at high and low risk for HIV infection. A prospective cohort study was performed in a population at high risk for STDs composed of 170 HIV seronegative male homosexuals and bisexuals (group A). The population at low risk for STDs was composed of 155 volunteer male blood donors (group B). All blood samples were screened using a type specific ELISA to HSV-1 and HSV-2 glycoprotein G (gG). The prevalence of HSV-1 and HSV-2 infection among all the 325 patients was 83.5% and 63.4%, respectively. Annual incidence of HSV-1 and 2 among group A were 0.053% and 0.08%, respectively. Among group B, the incidence for HSV-1 was 0.04% and for HSV-2 was 0.02%. Educational parameters (P<0.001), irregular use of condoms (P<0.001), and percentage of previous receptive anal intercourse (P<0,012) were significantly associated with seropositivity to HSV-2. About 8.4% of the HSV-1 seronegative subjects presented recurrence episodes of herpes labialis as well as 7.6% of the HSV-2 seronegative patients had genital herpes in the past. The high seroprevalence detected suggests that routine screening for HSV should be performed in populations at high risk for STDs, especially in HIV-infected patients. Educational campaigns, with particular focus on the transmission of HSV, and the regular use of condoms are important measures to reduce the HSV dissemination among patients with less advanced educations and at high risk for STDs.

Psychosocial Impact of a Positive HSV‐2 Diagnosis on Adults with Unrecognized HSV‐2 Infection

To evaluate the current research on the psychosocial impact of a positive herpes simplex virus type 2 (HSV-2) diagnosis on asymptomatic adults. A structured review of PubMed, CINAHL, and MEDLINE resulted in 8 articles published between 2000 and 2008. Articles were included if they investigated psychosocial reactions to HSV serological testing, including asymptomatic individuals, and used measurement instruments with adequate psychometric properties. The studies included participants of various backgrounds, including individuals with a new HSV-2 diagnosis concurrently receiving human immunodeficiency virus treatment, students within a university setting, and an HMO population. Current research indicates that a diagnosis of HSV-2 does not result in persistent psychosocial morbidity. However, studies that assessed for more nuanced reactions noted an impact on quality of life related to herpes. Further research is needed to confirm these findings among varied populations, to explore quality of life following HSV screening, and to identify the characteristics that may make particular individuals more susceptible to adverse psychological consequences.

HSV-1 Viremia as a Potential Cause of Febrile Neutropenia in an Immunocompromised Child

Although the standard of care in febrile neutropenic patients includes the initiation of empirical antibacterial and antifungal therapy, many patients do not respond and need further diagnostic work up and treatment. Here, we report on an immunosuppressed neutropenic patient with a prolonged episode of fever unresponsive to empirical antibacterial therapy. Herpes polymerase chain reaction revealed systemic reactivation of herpes simplex virus type 1 (HSV-1) infection and treatment with acyclovir was associated with the prompt resolution of signs and symptoms of infection. Screening for HSV in persistently febrile neutropenic patients may discover HSV reactivation that can be treated successfully by acyclovir administration.

Can E-Technology Through the Internet be Used as a New Tool to Address the Chlamydia trachomatis Epidemic by Home Sampling and Vaginal Swabs?

The Internet provides patients, as well as clinicians with immediate, confidential access to information about sexually transmitted diseases (STDs).1,2 Young individuals are avid users of the Internet and usage has been considered to be a risk factor for STDs.3–7 Data indicate that there are 246,402,574 North American Internet users.8

Herpes simplex virus: incidence of neonatal herpes simplex virus, maternal screening, management during pregnancy, and HIV

Neonatal herpes simplex virus infection is often severe, if not fatal. What is our understanding of the epidemiology of this disease? How is it diagnosed? Would maternal screening for herpes simplex virus-2 (HSV-2) in pregnancy make a difference? Does maternal HSV alter transmission of HIV vertically or horizontally or both? These questions continue to be pursued and unfortunately, there are few clear answers. A nationally reportable incidence and case definition of neonatal herpes simplex virus is desirable but not yet in effect. Maternal screening for HSV during pregnancy is becoming prevalent but not supported by any national committee or recommendation. Several lines of research have demonstrated HSV expression facilitates HIV transmission. Recently, HSV suppression has been attempted to decrease horizontal transmission of HIV. Neonatal herpes simplex virus infection is a rare and serious neonatal illness. The true burden of disease is uncertain. Several recent retrospectively determined incidences identify a case rate of about one per eight thousand live births. HSV reactivation occurs more often than previously thought. Current prophylactic HSV strategies do not decrease horizontal or vertical transmission of HIV-1.

Genital Herpes: Gynaecological Aspects

ObjectiveThe purpose of this guideline is to provide recommendations to gynaecology health care providers on optimal management of genital herpes. OutcomesMore effective prevention of complications and transmission of genital herpes. EvidenceMedline was searched for articles published in French and English related to genital herpes and gynaecology. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. Recommendations1.Up to 70% of all genital HSV-2 infections are transmitted during asymptomatic shedding; therefore, the use of condoms is recommended to lessen the likelihood of disease transmission. (II-A)2.A laboratory-based diagnosis of genital herpes is essential for its effective management. (II-A)3.Suppressive treatment is suggested for patients who have•at least 6 recurrences per year•significant complications, but fewer than 6 recurrences per year•their quality of life significantly affected•social and sexual dysfunction•to lower the risk of transmission to a sexual partner or fetus/neonate. (II-B)4.The use of the anti-viral valacyclovir, coupled with condoms and safer sex counselling, is recommended for individuals with proven genital herpes. (I-B)5.Routine or targeted HSV screening is not indicated. (III-B) J Obstet Gynaecol Can 2008;30(4):347–353

217: Antenatal screening for HSV: The cost-effectiveness of various screening modalities

SCREENING MODALITIES SARAH LITTLE, ANJALI KAIMAL, AARON CAUGHEY, Brigham and Women’s Hospital, Boston, Massachusetts, University of California, San Francisco, San Francisco, California OBJECTIVE: To investigate which, if any, antenatal screening program for genital HSV is cost-effective. STUDY DESIGN: A decision analytic model was created in Data TreeAge Pro. Our primary outcome was cost per quality-adjusted life year (QALY) from a societal perspective. 13 screening regimens were compared. (1) Type-specific screening at 35 weeks gestational age with acyclovir suppression if screen positive. (2-12) Screening women and, if negative, their partners, using all combinations of various screening times [15 vs. 35 weeks], screening protocols [HSV-2 only vs. 1 and 2], and therapeutic interventions [counseling vs. counseling plus suppression for women vs. counseling plus suppression for women and their partners]. RESULTS: Table 1 displays the costs, QALYs, incremental cost per QALY and cases of neonatal HSV for no screening as compared to the three most cost-effective screening modalities. Only the limited screening program, where women alone are screened at 35 weeks of gestation for seropositivity to HSV-2 and offered suppressive therapy if screen positive, was robust in sensitivity analysis. CONCLUSION: A limited antenatal screening program may be cost-effective. Caution is advised, however, as even minor considerations for increased falsepositive lesion detection or disutility from a positive screen appear to drastically alter the cost-effectiveness of any HSV screening program.

Acceptance of Herpes Simplex Virus Type 2 Screening Among Sexually Transmitted Disease Clinic Clients

To the Editor: The recent article by Miyai and colleagues published in Sexually Transmitted Diseases1 adds important information to the discussion concerning routine screening of high-risk persons for asymptomatic herpes simplex virus type 2 (HSV-2) infection. Their study showed there was little psychosocial impact among a group of sexually transmitted disease (STD) clinic clients who requested HSV-2 screening and were found to be HSV-2-positive. One important caveat, as described in their discussion, is that these clients received “thorough pretest counseling… and among infected patients,… intensive posttest counseling and education,” services which would not likely be routinely available in a busy STD clinic. The availability of HSV-2 screening in STD clinics in the United States is unknown, but anecdotal evidence suggests that few STD clinics offer this service.2 Concerns about screening include the specificity (false-positivity) and cost of testing, cost of providing suppressive therapy, and importantly, the resources needed to provide effective counseling in a time-efficient manner.3 In San Diego county, we conducted an anonymous self-administered questionnaire survey of STD clinic clients to determine if clients wanted herpes screening knowing that, if positive, changes in sexual practice would be needed. We also asked clients if they would pay some amount toward the cost of this test. During the survey period (December 20, 2000–January 23, 2001), 920 clients (>90% response rate) completed the one-page questionnaire and 69% responded to an initial question that they would want testing if it was available (Table 1). On the reverse side of the questionnaire, we provided information about safe sexual behavior practices that would be recommended if they tested positive. We then asked again (posteducation question) if they wanted HSV-2 testing and 72% responded “yes” (small changes in both directions between the two questions). The desire for testing (posteducation question) varied little by gender or age, or by those who thought they possibly had genital herpes. However, clients who thought they had been possibly exposed to a sex partner with herpes were 20% more likely to want testing compared with those who did not think they had been exposed (84% [65 of 77] vs. 71% [576 of 809], rate ratio [RR] = 1.2, 95% confidence interval [CI], 1.1–1.3, P <0.02). More than 70% of the clients who wanted testing were willing to pay ≥$5.00 (≥$5 [71%], ≥$10 [42%], ≥$15 [29%], Table 1).TABLE 1: Sexually Transmitted Disease Clinic Clients’ Acceptance of Herpes Simplex Virus Type 2 (HSV-2) Screening, San Diego, California, 2001This survey adds to the small but growing body of data indicating that STD clinic clients want to be tested for HSV-2 infection.4,5 Studies have shown that HSV-2 prevalence may be ≥40% among STD clinic clients.6 Our study showed that learning about the need to adopt safe sexual practices if infected had little impact on the decision process. In addition, clients appeared willing to pay some amount for testing. The resources needed to provide effective counseling in an HSV screening program can be a formidable challenge. The list of educational and counseling points that need to be covered is long and complex7,8 and may require ≥2 counseling sessions.8 One evaluation in England reported that posttest counseling for all clients tested averaged 9.8 minutes (range, 1–20 minutes.) per client and posed a “considerable burden” on clinic operations.9 More empiric data from STD clinics where HSV-2 screening is offered are needed to determine the counseling resources, screening and treatment costs, and other impact on STD clinic services—information that can guide other STD clinic managers in deciding how to best offer this important screening service.

Routine HSV screening in pregnant women not economically viable

Routine HSV screening in pregnant women not economically viable

Routine HSV screening in pregnant women not economically viable

Routine HSV screening in pregnant women not economically viable

The potential role of suppressive therapy for sex partners in the prevention of neonatal herpes: a health economic analysis

Background: The development of suppressive therapy and type specific tests for herpes infections allow for screening to reduce the risk of neonatal herpes. Objectives: To assess the potential effectiveness, cost...