An epidemiologic study of herpes simplex virus type 1 and 2 infection in Japan based on type-specific serological assays

Seroprevalence of Infections with TORCH Agents in Romania: A Systematic Review

Maternal-fetal infectious pathology-notably the TORCH panel (Toxoplasma gondii, rubella, Cytomegalovirus, and herpes simplex viruses)-critically impacts maternal and neonatal health. This review collates data on the seroprevalence of IgG and IgM antibodies against TORCH agents in Romanian women, aiming to discern regional and population differences and identify risk factors. Twenty studies were included in the review, revealing variable seroprevalence rates across the country. Regions such as Moldavia and Banat showed higher anti-T. gondii IgG seroprevalence rates than Bihor, with notable declines in Banat. Rural, older, and multiparous women showed elevated T. gondii IgG rates. Anti-rubella vaccine introduction significantly reduced the prevalence of anti-rubella IgG antibodies, but recent vaccination coverage decreases raise concerns. CMV and HSV seroprevalence varied geographically, with rural areas generally showing higher CMV rates and HSV influenced by factors like education level and number of sexual partners. Concurrent seroprevalence of multiple TORCH components in some cases underscores potential common risk factors. This study highlights the importance of continuous monitoring and preventive measures such as vaccinations and awareness campaigns to mitigate the health impact on the pregnant population.

The Epidemiology of Herpes Simplex Virus Type 1 in Asia: Systematic Review, Meta-analyses, and Meta-regressions

Background

Herpes simplex virus type 1 (HSV-1) epidemiology in Asia was characterized by assessing seroprevalence levels and extent to which HSV-1 is isolated from clinically diagnosed genital ulcer disease (GUD) and genital herpes.

Methods

HSV-1 reports in Asia were systematically reviewed and synthesized, following PRISMA guidelines. Random-effects meta-analyses estimated pooled mean seroprevalence and proportion of HSV-1 detection in GUD and genital herpes. Random-effects meta-regressions identified predictors of seroprevalence and sources of between-study heterogeneity.

Results

Forty-nine relevant publications were identified. Fifty-four overall seroprevalence measures (182 stratified measures), and 8 and 24 proportions of HSV-1 detection in GUD and in genital herpes, respectively, were extracted. The pooled mean seroprevalence was 50.0% (n = 26; 95% confidence interval [CI], 41.3%–58.7%) for children and 76.5% (n = 151; 73.3%–79.6%) for adults. By age group, the pooled mean was lowest at 55.5% (n = 37; 95% CI, 47.5%–63.4%) in individuals aged <20 years, followed by 67.9% (n = 48; 62.4%–73.3%) in those aged 20–39 and 87.5% (n = 44; 83.4%–91.1%) in those aged ≥40 years. In meta-regression, age was the major predictor of seroprevalence. The mean proportion of HSV-1 detection was 5.6% (n = 8; 95% CI, 0.8%–13.6%) in GUD and 18.8% (n = 24; 12.0%–26.7%) in genital herpes.

Conclusions

HSV-1 epidemiology is transitioning in Asia. HSV-1 is probably playing a significant role as a sexually transmitted infection, explaining one-fifth of genital herpes cases. There is a need for expanded seroprevalence monitoring and GUD/genital herpes etiological surveillance.

Association of the Emergence of Acyclovir-Resistant Herpes Simplex Virus Type 1 With Prognosis in Hematopoietic Stem Cell Transplantation Patients

Background

Antiviral-resistant herpes simplex virus type 1 (HSV-1) has been recognized as an emerging clinical problem among patients undergoing hematopoietic stem cell transplantation (HSCT).

Methods

A prospective observational study was conducted at a hematological center over a 2-year period. Oropharyngeal swab samples were serially collected each week from 1 week before and up to 100 days after HSCT and were tested for virus isolation. The HSV-1 isolates were tested for sensitivity to acyclovir (ACV). The prognosis of patients with ACV-resistant (ACVr) HSV-1 and the genetic background of the ACVr HSV-1 isolates were assessed.

Results

Herpes simplex virus type 1 was isolated in 39 of 268 (15%) HSCT patients within 100 days after transplantation. Acyclovir-resistant HSV-1 emerged in 11 of these 39 patients (28%). The 100-day death rates of HSCT patients without HSV-1 shedding, those with only ACV-sensitive HSV-1 shedding, and those with ACVr HSV-1 shedding were 31%, 39%, and 64%, respectively. Patients with HSV-1, including ACVr HSV-1, shedding showed a significantly higher mortality rate. Relapsed malignancies were a significant risk factor for the emergence of ACVr HSV-1. Acyclovir resistance was attributable to viral thymidine kinase and DNA polymerase mutations in 6 and 5 patients, respectively.

Conclusions

Herpes simplex virus type 1, including ACVr HSV-1, shedding was associated with poorer outcome in HSCT patients, even if HSV disease did not always occur. Patients with relapsed malignancies were at especially high risk for the emergence of ACVr HSV-1.

Protection from lethal herpes simplex virus type 1 infection by vaccination with a UL41-deficient recombinant strain

The UL41 gene of herpes simplex virus type 1 (HSV-1) encodes a virion host shut off protein which is involved in immune evasion.　The growth and virulence of HSV-1 is markedly reduced by the deletion of UL41.　In this report, the UL41-deleted recombinant HSV-1 strain VR∆41 was evaluated as a prophylactic live attenuated vaccine against lethal HSV-1 infection in a mouse model.　Intraperitoneal (i.p.) inoculation with the VR∆41 strain clearly inhibited lethal wild-type HSV-1 (VR-3 strain) infection after both i.p. and intracerebral (i.c.) inoculations.　Vaccination with the VR∆41 strain was safer than VR-3 vaccination and was able to protect against a wild-type challenge to the same degree as VR-3 vaccination.　In contrast, i.p. inoculation with ultraviolet-irradiated VR-3 induced resistance against i.p. infection, but not against i.c.

INFECTION

Although replication of the VR∆41 strain in mice was greatly reduced compared to that of the VR-3 strain, VR∆41 strain maintained the ability to spread to the central nervous system (CNS) from a peripheral inoculation site. These results indicated that the VR∆41 strain evoked a potent immune reaction through viral protein expression within CNS without the induction of lethal encephalitis.　The entry of antigens into the CNS was essential for the establishment of protective immunity against the lethal HSV encephalitis.　We concluded that only a live attenuated vaccine is able to afford a prophylactic effect against CNS infection with HSV.　In order to fulfill this requirement, UL41-deleted viruses provide a strong candidate for use as a recombinant live vaccine.

Human Herpesviruses as Copathogens of HIV Infection, Their Role in HIV Transmission, and Disease Progression

Of eight human herpesviruses (HHVs), often, only herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) find mention in medical literature as both of these viruses are commonly associated with genital lesions and oral ulcers, commonly known as cold sores. However, role of human herpesviruses as copathogens and in aggravation and in the transmission of other human diseases, especially the Acquired immunodeficiency syndrome (HIV/AIDS) has only very recently been recognized. Therefore, screening and treating subclinical HHV infections may offer slowing of HIV infection, disease progression, and its transmission. Beside HSV-1 and HSV-2, HHV-3 a causative agent of herpes zoster remained one of the first manifestations of HIV disease before the era of highly active antiretroviral therapy (HAART). HHV-5 also known as human Cytomegalovirus infection remains a significant risk factor for HIV-associated mortality and morbidity even in HAART era. It is proposed that Cytomegalovirus viremia could be a better predictor of HIV disease progression than CD4+ T-lymphocyte count. The role of HHV-4 or Epstein-Burr virus and HHV-6, HHV-7, and HHV-8 is still being investigated in HIV disease progression. This review provides insight into the current understanding about these 8 HHVs, their co-pathogenesis, and role in HIV/AIDS disease progression. The review also covers recent literature in favor and against administering anti-HHV treatment along with HAART for slower AIDS progression and interrupted sexual transmission.

Stability of glycoprotein gene sequences of herpes simplex virus type 2 from primary to recurrent human infection, and diversity of the sequences among patients attending an STD clinic

Background

Herpes simplex virus type 2 (HSV-2) is sexually transmitted, leading to blisters and ulcers in the genito-anal region. After primary infection the virus is present in a latent state in neurons in sensory ganglia. Reactivation and production of new viral particles can cause asymptomatic viral shedding or new lesions. Establishment of latency, maintenance and reactivation involve silencing of genes, continuous suppression of gene activities and finally gene activation and synthesis of viral DNA. The purpose of the present work was to study the genetic stability of the virus during these events.

Methods

HSV-2 was collected from 5 patients with true primary and recurrent infections, and the genes encoding glycoproteins B,G,E and I were sequenced.

Results

No nucleotide substitution was observed in any patient, indicating genetic stability. However, since the total number of nucleotides in these genes is only a small part of the total genome, we cannot rule out variation in other regions.

Conclusions

Although infections of cell cultures and animal models are useful for studies of herpes simplex virus, it is important to know how the virus behaves in the natural host. We observed that several glycoprotein gene sequences are stable from primary to recurrent infection. However, the virus isolates from the different patients were genetically different.

Herpes simplex virus meningitis in children in South East of caspian sea, iran

BACKGROUND

Herpes simplex virus (HSV) is a member of Herpesviridae and a leading cause of human viral diseases. Meningitis occurs as a complication of HSV-1 or HSV-2 primary infection.

OBJECTIVES

We aimed to evaluate HSV meningitis in children in Gorgan province, Iran.

PATIENTS AND METHODS

Forty-five cerebrospinal fluid samples were taken from children referred with meningitis symptoms. Samples with negative bacterial culture results were tested for viral, biochemical and cytological assays. DNA extraction and PCR were performed.

RESULTS

HSV-1 detected in 4 (8.8%) samples without any HSV-2 infections. Cases with positive results had fever and CSF pleocytosis. Vomiting, headache and higher count of WBC were observed in 3, 2 and 3 cases respectively. The cerebrospinal fluid (CSF) glucose and protein levels were normal and 3 cases showed positive C-reactive protein (CRP) results. Also erythrocyte sedimentation rate (ESR) was higher than normal in all positive cases.

CONCLUSIONS

Distribution of HSV types in children with meningitis in our area predominantly was type 1 compared with type 2, which has been reported more in other area.

Detection of herplex simplex virus-1 and -2 in cardiac myxomas

The etiology of sporadic cardiac myxomas remains elusive. The tendency for these lesions to recur following resection, their immunopathological characteristics, along with their histological and molecular profile, may implicate the presence of an infective agent in this type of tumor. In this study, we investigated the presence of herpes simplex virus (HSV) DNA in a cohort of cardiac myxomas in a tertiary referral centre. Twenty-nine formalin-fixed paraffin-embedded (FFPE) sporadic cardiac myxomas were obtained, 17 of which were shown to be informative. These were compared to 19 macroscopically and microscopically normal heart tissue specimens. The detection of HSV-1 and -2 genomic sequences was achieved with the use of a combined nested PCR-Restriction Fragment Length Polymorphism methodology. The presence of HSV-1 and/or -2 DNA was demonstrated in 6 of 17 (35%) informative sporadic cardiac myxomas, whereas no HSV DNA was detected in normal heart tissues (P < 0.01). The existence of HSV-1/2 DNA in sporadic cardiac myxomas, along with its absence from normal heart tissues, reinforces the possibility that HSV infection might be involved in the development of these lesions. Our findings raise the point of anti-HSV medication postsurgically with a potential benefit in reducing the rate of recurrences.

Carrier cell-based delivery of replication-competent HSV-1 mutants enhances antitumor effect for ovarian cancer. Cancer Gene Ther. 2011;18:77-86. [PMID: 20885447 PMCID: PMC3025316 DOI: 10.1038/cgt.2010.53]

Oncolytic viruses capable of tumor-selective replication and cytolysis have shown early promise as cancer therapeutics. We have developed replication-competent attenuated herpes simplex virus type 1 (HSV-1) mutants, named HF10 and Hh101, which have been evaluated for their oncolytic activities. However, the host immune system remains a significant obstacle to effective intraperitoneal administration of these viruses in the clinical setting. In this study, we investigated the use of these HSV-1 mutants as oncolytic agents against ovarian cancer and the use of human peritoneal mesothelial cells (MCs) as carrier cells for intraperitoneal therapy. MCs were efficiently infected with HSV-1 mutants, and MCs loaded with HSV-1 mutants caused cell killing adequately when cocultured with cancer cells in the presence or absence of HSV antibodies. In a mouse xenograft model of ovarian cancer, the injection of infected carrier cells led to a significant reduction of tumor volume and prolonged survival in comparison with the injection of virus alone. Our results indicate that replication-competent attenuated HSV-1 exerts a potent oncolytic effect on ovarian cancer, which may be further enhanced by the utilization of a carrier cell delivery system, based on amplification of viral load and possibly on avoidance of neutralizing antibodies.

Herpes simplex virus type-2 seropositivity among ever married women in South and north Vietnam: a population-based study

OBJECTIVE

To investigate herpes simplex virus type-2 (HSV-2) seropositivity and associated risk factors in Vietnamese women.

METHODS

Cross-sectional study with personal interviews and gynecological examinations among population-based samples of ever married women, aged 15 to 69 years, living in Ho Chi Minh City (HCMC) and Hanoi in 1997. Type-specific IgG antibodies against HSV-2 were detected using HerpeSelect ELISA (Focus Diagnostics). Adjusted prevalence ratios were estimated with log-binomial regression.

RESULTS

HSV-2 seroprevalence was higher in 1106 women from HCMC (30.8%, 95% CI: 28.1-33.4, age-standardized to 2000 world standard population) than in 1170 women from Hanoi (8.8%, 95% CI: 7.1-10.5). In HCMC, HSV-2 seroprevalence was higher for women who were not married, HPV DNA positive, current hormonal contraceptive users, or had a history of multiple sexual partners or spontaneous abortion. HCMC seroprevalence was inversely associated with educational attainment, age at first intercourse, and age at first pregnancy. In the multivariable model for HCMC, a trend of increasing HSV-2 seroprevalence with age was observed, and prevalence ratios were nearly identical to age-adjusted prevalence ratios for marital status, age at first pregnancy, and HPV DNA positivity.

CONCLUSIONS

HSV-2 was notably less prevalent in Hanoi than HCMC, where it was associated with traditional HSV-2 risk factors. These results are likely explained by socio-cultural, historical, economic, and demographic factors related to urban-rural and regional differences. Future population-based studies should include men and never-married women as a next step toward obtaining a more nearly complete picture of HSV-2 epidemiology in Vietnam.

Seroprevalence of herpes simplex virus 1 and 2 in a population-based cohort in Japan

Background

There have been few population-based studies of the seroprevalence and correlates of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in Japan.

Methods

We enrolled a total of 1244 adults, aged 18–59 years, from a population-based cohort in southern Japan, and tested their serum samples using an ELISA kit containing HSV type-specific antigens to glycoproteins G1 and G2.

Results

The seroprevalence of HSV-1 and HSV-2 was 55.4% and 7.4% in men and 63.3% and 9.3% in women, respectively. Overall, 4 percent of the participants (2.3% of men and 5.0% of women) were co-infected with HSV-1 and HSV-2. The seroprevalences of both HSV-1 and HSV-2 increased with age in both sexes, and were always higher among women than among men in each age bracket. The prevalence of HSV-2 infection among HSV-1 infected individuals was lower than that among uninfected individuals, both in men and women. Male current drinkers, and male and female current smokers, were more likely to be infected with HSV-1 and HSV-2, as compared to never drinkers and never smokers, respectively.

Conclusion

It is hoped that the estimates produced in this study will help in understanding the burden of these infections in Japan.

Prevalence and predictors of herpes simplex virus type 2 infection among female sex workers in Yunnan Province, China

The objective of this study was to determine the seroprevalence of herpes simplex virus type 2 (HSV-2), and to evaluate the relationship between HSV-2 infection and sociodemographic factors and the sexual practices of female sex workers (FSWs) in Kaiyuan city, Yunnan Province, China. This cross-sectional study involved 737 FSWs and was carried out from March to May 2006 with confidential interviews and laboratory tests for HSV-2 and other sexually transmitted infections (STI). HSV-2 was the most common STI (68%), followed by Chlamydia trachomatis (26%), Trichomonas vaginalis (11%), Neisseria gonorrhoeae (8%) and syphilis (7%). Prevalence of HIV-1 was 10.3%. Adjusted odds ratios of HSV-2 seroprevalence were 2.6 (95% CI [confidence interval]: 1.30-5.38) for HIV-1 infection, 2.0 (95% CI: 1.33-3.16) for vaginal douching, 2.0 (95% CI: 0.45-0.86) for condom breaking or falling off during sexual intercourse with the client in the previous week, 1.8 (95% CI: 1.07-3.18) for > or =5 years of commercial sex work, 1.6 (95% CI: 1.08-2.33) for > or =5 clients in the previous week, 0.6 (95% CI: 0.45-0.86) for > or =9 years of education. This study identifies a very high prevalence of HSV-2 infections among FSWs in Yunnan Province, with only a few who reported a prior history of genital herpes. HSV-2 serological screening and suppressive therapy should be considered for study populations. Education on the importance of diagnosis, treatment and prevention may help control the spread of HSV-2 infection.

Genital herpes

Genital herpes is the main cause of genital ulcers worldwide; the prevalence of herpes simplex virus (HSV) type 2 infections in the general population ranges from 10% to 60%. Most genital herpes is caused by HSV-2, although HSV-1 accounts for about half of new cases in developed countries. The risk of HIV acquisition is three times higher in people with HSV-2. Neonatal herpes is an uncommon but serious complication of genital herpes. Most genital HSV-2 infections are unrecognised and undiagnosed; infected individuals, even with mild symptoms, shed HSV, and can infect sexual partners. Since clinical diagnosis is neither sensitive nor specific, virological and type-specific serological tests should be used routinely. Oral antiviral drugs for HSV infections are safe and effective and can be used both to treat episodes and to prevent recurrences. Antiviral treatment of the infected partners and condom use reduce the risk of sexual transmission of HSV-2.

Herpes simplex virus type 2 seroprevalence in Korea: rapid increase of HSV-2 seroprevalence in the 30s in the southern part

To determine the characteristics of seroprevalence of herpes simplex virus type 2 (HSV-2) infection among Korean people, a cross-sectional study was conducted on three groups in 2004. The three groups consisted of the general public who visited public health centers, commercial sex workers (CSWs), and human immunodeficiency virus (HIV)-infected persons. Among the general public, HSV-2 seroprevalence rates for age under the 20s, in the 20s, 30s, 40s and the above 22.6%, 32.7% and 32.3%, respectively, which showed rapid increase of the rate in the 30s (p<0.0001). In case of the above of 19 yr old, women (28.0%) was higher than men (21.7%) (p<0.0001). The rate of CSWs (81.6%) was about 10 times higher than that of general women. In case of HIV-infected men (47.6%), the figure was about 2-3 times higher than that of general men. The low rate in the teens and the 20s proved that it is essential to develop sexually transmitted infections (STIs) prevention programs of education and publicity for them as a precaution measure. This study is the first major study of its kind on HSV-2 and would provide basic data for prevention of STIs including information about target groups subject to vaccination program.

Prevalence of antibodies against herpes simplex virus types 1 and 2 in children and young people in an urban region in Tanzania

Herpes simplex virus type 1 (HSV-1) is transmitted by close contact, both sexual and nonsexual, and infections are acquired during childhood and adolescence. Herpes simplex virus type 2 (HSV-2), however, is thought to be transmitted mainly by sexual contact. Most HSV-2 infections are consequently expected to occur after the onset of sexual activity. Recent reports indicate an increasing prevalence of HSV-2 on the African continent, but most studies have been performed on adult cohorts. In the present study, we collected sera from Tanzanian children and young persons from 1 to 20 years old, with at least 100 individuals in each age group. Antibodies against HSV-1 and HSV-2 were detected by an in-house Western blot method which was shown to perform well in comparison with a commercial Western blot assay. Type-specific antibodies were also analyzed by two noncommercial enzyme-linked immunosorbent assay methods based upon the antigenicities of branched synthetic oligopeptides corresponding to epitopes in glycoprotein G of HSV-1 or HSV-2. The prevalence of HSV-1 antibodies increased gradually from 73% for the age group of 1 to 4 years to 92% for the age group of 17 to 20 years. The prevalence of HSV-2 antibodies was unexpectedly high, as 15% of the children were infected by the age of 8 years, with the incidence increasing gradually to 40% in the age group of 17 to 20 years. The reason for this unexpectedly high frequency is not clear but could suggest that nonsexual transmission of HSV-2 is more common than previously thought. There was no statistically significant association between seropositivities for HSV-2 and human immunodeficiency virus.

Minimal change in HSV-2 seroreactivity: a cross-sectional Swedish population study

The prevalence of antibodies to herpes simplex virus type 2 (HSV-2) was determined in sera collected from 2 Swedish cross-sectional populations during 1990/91 and 1996/97. A glycoprotein G2 (gG-2) peptide ELISA was used to analyse 2899 sera from adults. We found a prevalence of 13.0% in 18-70-y-olds in 1990/91 and 16.4% in 31-55-y-olds in 1996/97. Seropositivity to HSV-2 was somewhat higher in women than in men; 14.4% compared to 11.6% in 1990/91 and 18.9% compared to 13.6% in 1996/97. Overall there was a significant difference in female prevalence of HSV-2 compared to prevalence in males of the same age groups (p=0.013). Total antibody prevalence to HSV-1 of 88% in HSV-2 negative individuals above 18 y of age was found. HSV-2 positive individuals were found seropositive to HSV-1 in approximately 95% of the cases. 12% were negative for both HSV-1 and HSV-2 antibodies. In addition, there was no serological sign that the reported increase of HSV-1 as an early sexual disease had reduced the frequency of HSV-2 seropositivity in the sexually most active age groups. In conclusion, our investigation has shown no significant increase of HSV-2 seroprevalence in randomly selected Swedish subjects during the defined time period.

Prevalence of infection with herpes simplex virus types 1 and 2 in Australia: a nationwide population based survey

BACKGROUND

Studies demonstrating previous herpes simplex virus (HSV) type 2 infection as a risk factor for HIV transmission, and the development of a HSV vaccine candidate, have emphasised the need for worldwide population based studies of HSV seroprevalence. The only nationwide seroprevalence studies have been conducted in the United States.

METHODS

An Australia-wide, population based study of HSV-1 and HSV-2 seroprevalence was conducted, using serum and sociodemographic data collected between 1999-2000, for a representative study of risk factors for diabetes in over 11 000 adults. A stratified random sample of 4000 was tested for HSV-2 and 1000 for HSV-1, with sampling and weighting for various demographic factors.

RESULTS

Seroprevalence of HSV-2 in Australian adults was 12%. Prevalence in women (16%) was twice that in men (8%). Rural populations had a lower prevalence (9%) than metropolitan (13%), and Indigenous had a higher prevalence (18%) than the non-Indigenous populations (12%). The seroprevalence of HSV-1 was 76% with significant differences by age group, sex and Indigenous status.

CONCLUSION

These are the first nationwide data to compare with US studies. HSV-2 infection is less common in Australia than the United States, and this will allow planning for combating HIV transmission in high prevalence populations in northern Australia. In addition, the high HSV-1 seroprevalence will be important for future deployment of genital herpes vaccines.

Human immunodeficiency virus test-seeking motivation in blood donors, Sao Paulo, Brazil

BACKGROUND AND OBJECTIVE

Previous studies have shown that volunteer, community-recruited donors have a higher prevalence of human immunodeficiency virus (HIV) infection in São Paulo, Brazil, than replacement donors. One hypothesis which may explain this unexpected finding is that some individuals donate blood because they are seeking HIV testing. The objective of this study was to characterize test-seeking blood donors and to determine whether they are at higher risk for HIV infection compared with other donors.

MATERIALS AND METHODS

Subjects presenting for blood donation were asked to participate in a study assessing their motivations (including test seeking) to donate, as measured by perceiving donation as a means to obtain infectious disease test results. Participants completed the standard blood bank predonation screening questions plus our additional survey, and were tested for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell lymphocytotrophic virus (HTLV) I/II, syphilis and Chagas' disease. As a result of anticipated low statistical power to directly measure the association between test-seeking motivation and HIV infection, we tested for herpes simplex virus type 2 (HSV-2) as a marker of sexual risk for HIV. Our survey includes accepted donors as well as persons whose risk-behaviour histories would result in their exclusion from donation according to routine screening procedures.

RESULTS

Of 1,720 potential blood donors randomly selected and approached, 1,600 (93.0%) participated. Overall, 141 (8.8%) were classified as test seekers; 15.6% of these were HSV-2 positive. The proportion of test seekers was the same among community-recruited and replacement donors. Test seekers had a higher prevalence of HSV-2 [adjusted odds ratio (AOR) 1.66; 95% confidence interval (CI): 1.06-2.59] adjusting for age, gender and prior donation. The association was significant among community-recruited blood donors whose previous donation was more than 1 year ago (i.e. 'lapsed donors') (AOR 2.55; 95% CI: 1.20-5.44). Test seekers were not more likely to be rejected from blood donation as a result of health reasons, self-reported HIV risk-related behaviour, or by their own confidential unit exclusion. We found no difference in HSV-2 prevalence between persons accepted for donation (15.7%) and those rejected because of self-reported sexual risk (16.7%).

CONCLUSIONS

We did not detect a difference in the proportion of test seekers across different types of blood donors; however, we did detect an association between HSV-2 infection and test seeking, especially among community-recruited lapsed blood donors. Of note, questions on test-seeking behaviour detected donors with increased prevalence of HSV-2, but the self-reported sexual risk behaviours currently used for deferral criteria did not. Incentives to get tested at sites other than blood banks may decrease the residual risk of HIV in the blood supply.

Primary prevention of human papillomavirus-dependent neoplasia: No condom, no sex

Cervix cancer is one of several neoplastic disorders that arise following transfer of human papillomavirus (HPV) during unprotected sexual intercourse, and like most other sexually transmitted diseases (STDs), is largely preventable by consistent condom use. This primary prevention strategy has received little support, however, when compared with massive secondary prevention initiatives involving cervical screening. The reasons for this anomalous situation are complex, and include: (i) the asymptomatic nature of most primary HPV infections; (ii) widespread ignorance concerning the venereal aetiology of HPV-related cancers; (iii) the common but incorrect belief that condom use does not reduce HPV transmission; (iv) the perceived irrelevance of safe sex campaigns based on reducing transmission of human immunodeficiency virus (HIV) in high-HPV but low-HIV countries such as the Philippines; (v) the promotion of oral contraception by the medical and pharmaceutical sectors as the sexual prophylaxis of choice; and (vi) the assumption that HPV vaccines will solve the problem. Here it is proposed that the high prevalence of non-HIV STDs, including distressing disorders such as genital warts and herpes simplex, can be exploited with greater efficacy as a public health deterrent to unsafe sex and HPV transmission. Targeting a "mutually assured infection" campaign at vulnerable subgroups such as teenagers and oral contraceptive users could help reverse the global expansion of HPV-related cancers.

Macrophages and cytokines in the early defence against herpes simplex virus

Herpes simplex virus (HSV) type 1 and 2 are old viruses, with a history of evolution shared with humans. Thus, it is generally well-adapted viruses, infecting many of us without doing much harm, and with the capacity to hide in our neurons for life. In rare situations, however, the primary infection becomes generalized or involves the brain. Normally, the primary HSV infection is asymptomatic, and a crucial element in the early restriction of virus replication and thus avoidance of symptoms from the infection is the concerted action of different arms of the innate immune response. An early and light struggle inhibiting some HSV replication will spare the host from the real war against huge amounts of virus later in infection. As far as such a war will jeopardize the life of the host, it will be in both interests, including the virus, to settle the conflict amicably. Some important weapons of the unspecific defence and the early strikes and beginning battle during the first days of a HSV infection are discussed in this review. Generally, macrophages are orchestrating a multitude of anti-herpetic actions during the first hours of the attack. In a first wave of responses, cytokines, primarily type I interferons (IFN) and tumour necrosis factor are produced and exert a direct antiviral effect and activate the macrophages themselves. In the next wave, interleukin (IL)-12 together with the above and other cytokines induce production of IFN-gamma in mainly NK cells. Many positive feed-back mechanisms and synergistic interactions intensify these systems and give rise to heavy antiviral weapons such as reactive oxygen species and nitric oxide. This results in the generation of an alliance against the viral enemy. However, these heavy weapons have to be controlled to avoid too much harm to the host. By IL-4 and others, these reactions are hampered, but they are still allowed in foci of HSV replication, thus focusing the activity to only relevant sites. So, no hero does it alone. Rather, an alliance of cytokines, macrophages and other cells seems to play a central role. Implications of this for future treatment modalities are shortly considered.

A systematic review of the epidemiology and interaction of herpes simplex virus types 1 and 2

OBJECTIVES

To explore epidemiological evidence about the interaction of herpes simplex virus (HSV) 1 and HSV-2 infections.

METHODS

A systematic review was undertaken of published epidemiological studies describing the pattern of HSV-1 or HSV-2 by age, and the coincidence of the two viral infections.

RESULTS

In cross sectional studies the unadjusted odds of HSV-2 are greater in those with HSV-1 infection in study populations categorised as "low risk" (p = 0.06) and across European populations (p = 0.001). This was not evident in "high risk" populations or in the United States. This increased risk of HSV-2 in those with HSV-1 infection does not agree with the results of prospective studies where there is a non-significant trend towards a lower risk of HSV-2 infection associated with previous HSV-1 infection.

CONCLUSIONS

"Low risk" and European populations have a relatively low HSV-2 seroprevalence and infection is more concentrated in those with characteristics putting them at high risk for both HSV-1 and HSV-2. This confounding could mask any protective effect of HSV-1, which is hinted at, but not demonstrated, in prospective and adjusted studies.

National Seroprevalence and Trends in Herpes Simplex Virus Type 1 in the United States, 1976–1994

OBJECTIVES

The objectives of this study were to estimate national seroprevalence of herpes simplex virus type 1 (HSV-1), describe trends in seroprevalence, and examine correlates of infection.

GOAL

The goal of this study was to measure the burden of HSV-1 infection in the U.S. population.

STUDY

We tested serum samples for HSV-1 antibody and analyzed questionnaire data collected for the second and third National Health and Nutrition Surveys (NHANES II, 1976-80; NHANES III, 1988-94). Seroprevalence estimates were weighted to represent the total U.S. population.

RESULTS

At the time of NHANES III, two thirds (68%) of the U.S. population 12 years and older had HSV-1 antibody. Prevalence increased with age and varied by race/ethnicity; the majority of persons in all race/ethnic groups were HSV-1-seropositive by age 30. Overall, the national seroprevalence of HSV-1 decreased nonsignificantly by 2% in the years between NHANES II and III; decreases in HSV-1 seroprevalence in some population subgroups were balanced by increases in other groups.

CONCLUSIONS

There was no overall change in the seroprevalence of HSV-1 in the U.S. population between NHANES II and III.

Sexually transmitted herpes simplex viruses

Herpes simplex virus type 2 (HSV-2) is the dominant primary causative agent in genital ulcerative infections. Since infections with HSV-2 usually are acquired through sexual contacts, antibodies are rarely found before the age of onset of sexual activity. Although most genital infections are caused by HSV-2, a rising proportion has become attributable to primary type 1 herpes simplex virus (HSV-1) infection. Genital HSV-1 infections are usually both less severe clinically and less prone to recur. HSV-1 infection might render a certain protection against an HSV-2 infection and seems to mitigate the HSV-2 illness. It is not yet clear whether the advent of HSV-1 genitally will reduce the general occurrence of HSV-2. Increased efforts to protect against sexual transmission of the herpes viruses should have an effect on the transmission of other chronic diseases, such as the human immunodeficiency virus (HIV). In conclusion, it seems that increased sexual promiscuity and more advanced sexual techniques contribute to an unnecessary rise in prevalence of genital HSV infections, thus also affecting transmission of other genitally manifested diseases in targeted populations.

Seroepidemiology of Herpes Simplex Type 2 in Pregnant Women in Belgium

OBJECTIVE

The objective of this study was to study the prevalence of herpes simplex virus (HSV) type 2 in pregnant women in Belgium.

STUDY DESIGN

The serum of 1000 consecutive women was collected. HSV-1 and HSV-2 control sera were added to the study. HSV-2 antibodies were tested with the HerpeSelect 2 enzyme-linked immunosorbent assay (ELISA; Focus) based on the use of the recombinant gG-2 antigen.

RESULTS

The 21 HSV-2 control subjects were positive. Among the HSV-1 control subjects, 18 were negative and 4 were positive. Among the pregnant women, 80.3% were negative, 1.5% had equivocal results, and 18.2% were positive. No statistical difference was observed according to the origin (European or African) of the women.

CONCLUSIONS

The results obtained with the control sera indicate a high sensitivity of the Focus ELISA, as well as a capacity to discriminate between HSV-1/HSV-2 infection. The HSV-2 prevalence in the studied population raises the question of the possible benefit of a specific preventive program in pregnant women.

Relapse of neonatal herpes simplex virus infection

BACKGROUND

Neonatal herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity. Recurrence of skin vesicles is common.

OBJECTIVE

To determine the features of relapse and identify the factors related to relapse.

DESIGN

Thirty two surviving patients with neonatal herpes virus infections were enrolled. All patients received acyclovir treatment. Clinical and virological data were analysed and compared between relapsed and non-relapsed cases.

RESULTS

Thirteen (41%) had either local skin or central nervous system relapse between 4 and 63 days after completing the initial antiviral treatment. Nine patients exhibited local skin relapses, and four developed central nervous system relapses. In one skin and two central nervous system relapse cases, neurological impairment later developed. Type 2 virus infection was significantly related to relapse (odds ratio 10.4, 95% confidence interval 1.1 to 99.0). Patients with relapse had worse outcomes than those without relapse.

CONCLUSION

Neonates with HSV type 2 infections have a greater risk of relapse. Relapsed patients have poorer prognoses.

Divergence of reiterated sequences in a series of genital isolates of herpes simplex virus type 1 from individual patients

Both serotypes of herpes simplex virus (HSV), HSV-1 and HSV-2, are aetiological agents of genital herpes, although genital herpes caused by HSV-1 recurs less frequently. The HSV-1 genome contains a number of short, tandemly repeated sequences, and some reiterated sequences can serve as sensitive markers for the differentiation of HSV-1 strains. In the present study, variation in reiterations (assumed to be due to different copy numbers of tandemly repeated sequences) was examined in HSV-1 isolates from genital lesions from the same individual. Six sets (three primary-recurrence sets and three multiple-recurrence sets) of HSV-1 isolates were analysed: the primary-recurrence set consisted of two isolates (one isolated at a primary episode and the other at a recurrent episode) from the same individual; the multiple-recurrence set consisted of plural isolates from different episodes of recurrence in the same individual. Variations in length of the major DNA fragment, containing reiteration I (within the a sequence) and/or reiteration IV (within introns of genes US1 and US12), were detected between isolates of each multiple-recurrence set, but not of the primary-recurrence set. Thus, HSV-1 isolates of multiple-recurrence sets are assumed to have diverged more widely within each set than those of primary-recurrence sets, probably because of more rounds of virus DNA replication. This divergence of reiterations seems to indicate a forward step in the division of HSV-1 from a common ancestor into different lineages.

Ethnic variation in type of genital herpes simplex virus infection in a South London genitourinary medicine clinic

The aims of this study were to investigate the prevalence of herpes simplex virus (HSV) types 1 and 2 in the study population and correlate the results with clinical and demographic details. Consecutive HSV isolates from 334 clinic attendees were typed by immunofluorescence. Patient information was collected from the case notes. Overall, HSV-1 was isolated from 48 and HSV-2 from 287 samples, respectively. There was no significant difference in isolation rates according to gender. However, 33% of white patients' isolates typed as HSV-1, while only 6% of the isolates from the black population were HSV-1 (P < 0.001). Initial infections were seen in 81% of HSV-1 infections and 48% of HSV-2 infections, respectively. A wide discrepancy was observed in the prevalence of HSV-1 and HSV-2 infections between the ethnic groups in this population, which was not explained in terms of gender or age. This may reflect different exposure to HSV-1 in childhood or different sexual practices. The increased prevalence in genital HSV-1 reported in recent studies was not seen in this population. However, the differing proportions of primary and first episode infections may reflect a changing epidemiology.

Treatment of mucocutaneous presentations of herpes simplex virus infections

Infections by herpes simplex virus (HSV) types I and II are diverse and quite frequent. After primary infection, the virus establishes a life-long latency in the sensory ganglia and recrudescences may occur at an unpredictable rate. Recurrent labial and genital herpes infections represent the majority of clinical manifestations of HSV infections. Their management is currently well established using evidence-based medicine data. Primary labial herpes is generally not treated with antivirals in otherwise healthy children, although intravenous aciclovir may be offered in severe primary infections, particularly in the immunocompromised patient. The decision whether or not to treat recurrent labial herpes should be evaluated individually and depends on the frequency and severity of relapses, the impairment of the quality of life, and the cost of therapy. Patients with mild disease may benefit from topical therapy, and those with severe and frequent recurrences may be considered for intermittent or long-term oral antiviral therapy. Primary genital herpes is treated with oral or intravenous antivirals, depending on the severity of the infection and associated symptoms. Recurrent genital herpes can be managed with episodic short courses of oral antivirals in patients whose recurrences are moderate to severe and rare, and have a clear prodrome. Patients with >5 episodes/year, severe recurrences or unrecognisable prodromes may be best managed with long-term suppressive antiviral prophylaxis. HSV is also responsible for a variety of other clinical manifestations, including herpetic whitlow, neonatal infection, disseminated and atypical cutaneous infections, traumatic herpes, eczema herpeticum, and HSV-associated erythema multiforme. HSV infection may also represent a complication following cosmetic procedures of the oro-facial region, surgical and dental interventions, sun exposure and burns. Precise treatment guidelines for these HSV infections are not firmly established.

Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review

Information on age- and sex-specific prevalence of herpes simplex virus (HSV) types 2 and 1 infections is essential to optimize genital herpes control strategies, which increase in importance because accumulating data indicate that HSV-2 infection may increase acquisition and transmission of human immunodeficiency virus. This review summarizes data from peer-reviewed publications of type-specific HSV seroepidemiologic surveys. HSV-2 prevalence is, in general, highest in Africa and the Americas, lower in western and southern Europe than in northern Europe and North America, and lowest in Asia. HSV-2 and -1 prevalence, overall and by age, varies markedly by country, region within country, and population subgroup. Age-specific HSV-2 prevalence is usually higher in women than men and in populations with higher risk sexual behavior. HSV-2 prevalence has increased in the United States but national data from other countries are unavailable. HSV-1 infection is acquired during childhood and adolescence and is markedly more widespread than HSV-2 infection. Further studies are needed in many geographic areas.

Risk factors of herpes simplex type 1 (HSV-1) infection and lifestyle factors associated with HSV-1 manifestations

This study investigated risk factors for herpes simplex virus type 1 (HSV-1) infection in a population of university students in Germany and Spain. In addition, factors associated with the occurrence of oral lesions were studied. Serum samples were collected from 596 Spanish students from the Navarra Public University in Pamplona and 174 German students from the University of Bielefeld aged 17-41 years and tested by a HSV-1 type-specific immunoassay using monoclonal antibody-selected gG1 as antigen. Information on clinical manifestations and risk factors were obtained by a standardized questionnaire. The rate of HSV-1 infection was 55.3 and 27.4% of these infected students reported having had oral lesions within the last 12 months. Prevalence of HSV-1 infection did not differ between study sites, and did not vary according to gender or age. Students with coitus experience were more likely to be infected with HSV-1 (Odds ratio (OR), 1.88; 95%CI: 1.31-2.69), while other lifestyle factors were not associated with HSV-1 infection. Risk factors for the occurrence of oral lesions included HSV-1 seropositivity (OR: 6.90; 95%CI: 3.84-12.37) and a higher level of perceived stress, as measured by the Cohen scale of perceived stress (OR: 1.79; 95%CI: 1.15-2.78). Drinking alcohol was found to be a protective factor (OR: 0.59; 95%CI: 0.37-0.93). There was no difference in the clinical pattern and course of infection between the young adults in Germany and Spain. We conclude, that lifestyle factors appear to play an important role in the epidemiology and clinical manifestations of HSV-1.

Detection of HSV-2 in genital ulcers from STD patients in Dar es Salaam, Tanzania

BACKGROUND

Genital ulcer disease (GUD) is common in many developing countries. Several reports indicate that there is an association with HIV infection. Analysis by polymerase chain reaction (PCR) has demonstrated that the ulcers are frequently caused by herpes simplex type 2 (HSV-2), although HSV-1 is becoming increasingly important in many parts of the world. Comparable studies have not been performed in Tanzania.

OBJECTIVES

To determine the prevalence of HSV-2 and HSV-1 in genital ulcers in Dar es Salaam, Tanzania and determine their possible association with HIV infection.

STUDY DESIGN

Samples were collected from 70 consecutive patients with GUD attending a clinic for sexually transmitted diseases. Specimens from ulcers were analysed by PCR for the presence of HSV-2 and HSV-1, and sera were examined for antibodies against HSV-2 and HIV.

RESULTS AND DISCUSSION

HSV-2 DNA was detected in 64% of the specimens from ulcers while HSV-1 DNA was not found in any of them. Antibodies to HSV-2 and HIV were detected in 79.7 and 42% of the patients' sera, respectively. Although there was a significant positive association between HIV and HSV-2 seropositivity, HSV-2 DNA in genital ulcers was not more prevalent among HIV seropositive than among HIV seronegative individuals.

CONCLUSION

The prevalence of HSV-2 antibodies among Tanzanian patients with genital ulcers is very high, and HSV-2 is detected in most of the ulcers. There is an association between infections with HIV and HSV-2, but the relationship is not clear.

Prevalence and risk factors for herpes simplex virus type 2 infection among adolescents and adults in northern Cameroon

BACKGROUND

A number of surveys have reported a high prevalence of herpes simplex virus type 2 (HSV-2) infection in south central and east central Africa.

GOAL

To evaluate the distribution and modes of HSV-2 transmission in northern Cameroon.

STUDY DESIGN

A serosurvey was conducted among 194 adolescents and adults in a Cameroon hospital. Antibodies against HSV-2 were detected by a gG2-specific enzyme-linked immunoabsorbent assay.

RESULTS

The prevalence of HSV-2 antibodies was found to be 37.1%. In the multivariate analysis, female gender, no condom use, a positive syphilis serology, and HIV infection were significantly associated with HSV-2 infection.

CONCLUSIONS

The current findings show that the HSV-2 seroprevalence in northern Cameroon is high and similar to that found in other African countries. HSV-2 infection represents a marker for at-risk sexual behavior and may be a common cofactor for HIV transmission in this geographic area.

Differentiation of Herpes simplex virus types 1 and 2 in sera of patients with HSV central nervous system infections by type-specific enzyme-linked immunosorbent assay

OBJECTIVE

To differentiate by enzyme-linked immunosorbent assay (ELISA) using type-specific glycoprotein G herpes simplex virus (HSV) type 1 and type 2 in serum collected from patients with HSV central nervous system (CNS)infections.

METHODS

HSV 1 and 2 typing in convalescent sera of 17 patients with HSV acute encephalitis, myelitis, or meningitis was determined by the type-specific IgG ELISA kit (Gull Laboratory, Inc.). HSV CNS infections were diagnosed by polymerase chain reaction (PCR) or conventional serologic tests from acute to convalescent stages.

RESULTS

In 13 of 17 patients, HSV type 1 and HSV type 2 antibodies were positive; 11 patients with HSV type 1 and 2 patients with HSV type 2 were found. All 10 patients with encephalitis showed equivocal or positive results for HSVtype 1. In two of three cases of myelitis, HSV type 1 was demonstrated. Each case of myelitis and meningitis reacted to both types 1 and 2.

CONCLUSION

These data suggest that the kit is useful for type differentiation of HSV CNS infections from convalescent sera, and can play a supplementary role in HSV typing by PCR or previous serologic tests.

Seroprevalence of herpes simplex virus types 1 and 2 in HIV-infected and uninfected homosexual men in a primary care setting

BACKGROUND

Genital herpes is usually caused by herpes simplex virus type 2 (HSV-2), with infections often being unrecognised by patients and/or clinicians. HSV-2 infections may be a risk factor for the transmission of human immunodeficiency virus (HIV) infection. Reliable tests for type-specific HSV antibodies are now readily available.

OBJECTIVES

To determine the seroprevalence of HSV-1 and -2 in HIV-seronegative gay men in a primary care setting in Melbourne, Australia, and to compare it with the rate in HIV-infected gay men. To assess the utility in a clinical setting of a type-specific HSV enzyme linked immunosorbent assay (ELISA) as compared with western blot.

STUDY DESIGN

We recruited a total of 300 HIV-seronegative homosexual men attending for HIV antibody testing, and HIV-infected men attending for CD4 lymphocyte count and viral load estimation. The subjects completed a questionnaire, and sera were sent for total IgG HSV testing and testing by Gull type-specific HSV ELISA assay. Selected serum samples were retested by western blotting and the results analysed.

RESULTS

In total, 168 HIV-antibody negative men and 132 HIV-antibody positive men were recruited. Of all subjects, 73.3% had HSV-1 antibodies. This proportion did not differ between HIV-seronegative and seropositive men (P=0.48). About twenty percent of HIV-seronegative men and 61% of HIV-seropositive men had antibodies to HSV-2 (P<0.0001); 75.6% of HIV-seronegative men with antibodies to HSV-2 gave no history of genital herpes, as did 66.7% of HIV-seropositive men. Overall, in using the type-specific ELISA (Gull) assay, false negative, false positive or equivocal results were obtained in 33/300 (11%) of samples tested compared with western blot.

CONCLUSIONS

High rates of HSV-2 infection were found in homosexual males, with the rate for HIV-seropositive men being over twice that for HIV uninfected men. Most subjects were not aware of their infection with HSV-2. HIV-infected individuals were also older and had higher numbers of sexual partners, but we were unable to unambiguously establish that these variables contributed to the difference in HSV-2 seroprevalence rates. The Gull type-specific assay for HSV antibodies has significant problems with sensitivity and specificity at a discrepancy rate of 11%. Caution is advised in using this type-specific commercial assay for clinical purposes.

Antenatal seroprevalence of herpes simplex virus type 2 (HSV-2) in Canadian women: HSV-2 prevalence increases throughout the reproductive years

BACKGROUND

This study sought to provide the first population estimates of herpes simplex type 2 (HSV-2) seroprevalence in Canada.

GOAL

To measure the antenatal seroprevalence of HSV-2 antibodies in reproductive age women.

STUDY DESIGN

An anonymous unlinked seroprevalence study used stored sera collected from pregnant women in British Columbia during 1999. Randomized sampling within age strata selected a total of 1215 subjects, ages 15 to 44 years. Serologic testing used the Gull Meridian Test. Overall prevalence was directly standardized to the 1999 Canadian female population.

RESULTS

The age-adjusted prevalence for HSV-2 was 17.3% (95% CI, 15.2-19.4). Prevalence ranged from 7.1% (ages, 15-19 years) to 28.1% (ages, 40-44 years), with the largest increases after the age of 24 years.

CONCLUSIONS

The HSV-2 seroprevalence among pregnant women in British Columbia is similar to that in the United States and other countries. Seroprevalence continues to rise through the later reproductive years. This observation may relate to continued transmission, an age cohort effect, or both.

High Prevalence of Antibodies to Herpes Simplex Virus Type 2 Among Middle-Aged Women in Mexico City, Mexico

BACKGROUND

Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted diseases worldwide. In Mexico there is a lack of population-based HSV-2 surveys.

GOALS

To determine population-based HSV-2 seroprevalence and risk factors among women in Mexico City.

STUDY DESIGN

A random sample of 730 women was identified among the residents of Mexico City. Women ages 25 to 85 years were selected from 3,694 households. Western blot serology testing was conducted on serum samples to determine HSV-2 type-specific serostatus. A structured questionnaire was administered, and multivariate analyses were performed to identify risk factors for HSV-2 seropositivity, which were stratified into two age categories: younger than 50 years of age and 50 years of age or older.

RESULTS

The HSV-2 seroprevalence among female participants was 29.8%, with a significant trend of increasing HSV-2 prevalence for each higher level of age (P < 0.001). Female participants had a median age of 46 years and were predominantly monogamous (82.6%). The overall population-based seroprevalence estimated in Mexico City among women was 35.8%. The independent risk factors for HSV-2 seropositivity included a history of two or more sexual partners (odds ratio [OR], 2.2; 95% CI, 1.4-3.4), two or more sexual partners before first pregnancy (OR, 2.3; 95% CI, 1.4-3.7), cohabitation with partner (OR, 2.5; 95% CI, 1.3-4.7), and current vaginal douching (OR, 1.7; 95% CI, 1.2-2.6).

CONCLUSIONS

Population-based HSV-2 seroprevalence is endemically high among middle-age women in Mexico City, and clearly is correlated with higher-risk sexual behavior. This elevated HSV-2 seroprevalence may reflect unrecognized HSV-2 transmission throughout life.

Prevalence and risk factors for herpes simplex virus type 2 infection among middle-age women in Brazil and the Philippines

BACKGROUND

Data comparing type-specific herpes simplex virus type 2 (HSV-2) seroprevalence and risk factors between comparable populations are largely unavailable, particularly from less-developed countries.

GOAL

To examine the seroprevalence of HSV-2 infection and the risk factors for this infection among women in São Paulo, Brazil, and Manila, the Philippines.

STUDY DESIGN

Altogether, 552 middle-aged women participating as control subjects in two cervical cancer studies were screened for type-specific HSV-2 antibodies.

RESULTS

Herpes simplex virus type 2 seroprevalence was higher in Brazil (42%) than in the Philippines (9.2%). The mean ages of Brazilian (n = 181) and Filipino (n = 371) women were 52.4 and 46.6 years, respectively. Brazilian participants had more lifetime sexual partners, less education, and more often a husband with other sexual partners than Filipino women. Herpes simplex virus type 2 was independently associated with younger age at first intercourse in both countries. More than one lifetime sexual partner, a husband with other sexual partners, urban/semi-urban residence, and no history of condom use were HSV-2 risk factors in Brazil, but not in the Philippines, where long-term hormonal contraceptive use was associated with increased risk.

CONCLUSIONS

The higher HSV-2 seroprevalence in Brazil than in the Philippines may be explained largely by differences in the sexual behavior of women and their husbands. Herpes simplex virus type 2 seroprevalence data may be used as a marker of past sexual behavior for the direct comparison of different population groups.

Herpes simplex virus epidemiology and ocular importance

PURPOSE

To review the changing epidemiology of herpes simplex disease and correlate it with the epidemiology of ocular herpes simplex disease.

METHOD

A review of pertinent reports in the world literature about the epidemiology of herpes simplex and specifically about ocular herpes simplex.

RESULTS

In developed countries, many individuals are reaching adolescence and adulthood without prior herpesvirus infection. Herpes simplex genital infection is increasing at a rapid rate in sexually active adolescents and adults, with about one in six adults now infected in the United States. Similar statistics are confirmatory worldwide in developed countries. Active herpes simplex infection is a risk factor for acquisition of human immunodeficiency virus. The Herpetic Eye Disease Study, as well as prior studies from Moorfields Eye Hospital and the Mayo Clinic in Rochester, Minnesota, provides us with the epidemiology of ocular herpes simplex. Recent studies suggest an older age of onset and perhaps overall more severe ocular disease as compared with the older literature.

CONCLUSIONS

Herpes simplex is a significant health concern at present with genital infections increasing in epidemic proportions. This is also reflected in a rise in the incidence of neonatal herpes. Herpes simplex virus type 1 (HSV-1) infection is being acquired for the first time in an older age group. A significant and increasing proportion of genital herpes is caused by HSV-1. Serologic studies are no longer as useful in distinguishing orofacial herpes from genital herpes. More acute retinal necrosis syndrome cases are associated with HSV-2. Speculation about the future of ocular herpes is made based on this changing epidemiology.

Valaciclovir: a review of its long term utility in the management of genital herpes simplex virus and cytomegalovirus infections

Valaciclovir is an aciclovir prodrug used to treat infections caused by herpes simplex virus (HSV) and varicella zoster virus, and for prophylaxis against cytomegalovirus (CMV). Oral valaciclovir provides significantly better oral bioavailability than oral aciclovir itself, contributing to the need for less frequent administration. Several studies have demonstrated the efficacy of long term (> 90 days) therapy with valaciclovir for the suppression of genital HSV disease in otherwise healthy individuals with HSV infection. In 1 randomised, double-blind trial, once daily valaciclovir (1000 mg, 500 mg and 250 mg) produced statistically significant suppression of disease recurrence, as did twice daily valaciclovir 250 mg and aciclovir 400 mg. Valaciclovir dosages of > or = 500 mg daily are recommended for suppression of genital herpes recurrences in immunocompetent individuals. This disease occurs frequently in patients with human immunodeficiency virus (HIV) infection and, in a single randomised double-blind trial, prophylactic valaciclovir (1000 mg once daily or 500 mg twice daily) and aciclovir (400 mg twice daily) were found to be of similar efficacy in the suppression of genital herpes. However, a higher than expected dropout rate indicated that more studies of valaciclovir in patients with HIV are required. In a randomised trial of patients undergoing renal transplant, valaciclovir 2 g 4 times daily for 90 days significantly reduced the incidence and delayed the onset of CMV disease: the incidence in valaciclovir-treated patients who were CMV-seronegative at baseline, and recieived a kidney from a CMV-seropositive donor, was 3% versus 45% for placebo after 90 days of treatment. Acute graft rejection was also reduced in the valaciclovir-treated group. A small study in heart transplant patients compared valaciclovir (2 g 4 times daily) with aciclovir (200 mg 4 times daily) and found a significant reduction in CMV antigenaemia favouring valacilovir at the end of the treatment period. Additional reductions in other indices of CMV in those given valaciclovir compared with aciclovir were also noted. In a preliminary study of prophylaxis for CMV disease in bone marrow transplant recipients valaciclovir (2 g 4 times daily) was superior to aciclovir (800 mg 4 times daily) in terms of time to CMV viraemia or viruria. Although valaciclovir (8 g/day for approximately 30 weeks) reduced the incidence and time to CMV disease compared with aciclovir (3.2 g/day) in patients with advanced HIV disease, valaciclovir was associated with more gastrointestinal complaints and an increased risk of death, leading to premature termination of the study. As yet, no trials comparing the efficacy of valaciclovir with famciclovir (the oral prodrug for penciclovir) in the suppression of recurrent episodes of genital herpes have been published, nor have direct comparisons been made, between valaciclovir with ganciclovir in patients with CMV disease. Valaciclovir is well tolerated at dosages used to suppress recurrent episodes of genital herpes (500 to 1000 mg/day) in immunocompetent and HIV seropositive individuals, with headache being reported most often. However, a potentially fatal thrombotic microangiopathy (TMA)-like syndrome has been reported in some immunocompromised patients receiving high-dose prophylactic valaciclovir therapy (8 g/day) for CMV disease for prolonged periods, and the risk of this syndrome appears to be higher in patients with advanced HIV disease. While the clinical benefits of valaciclovir in some immunocompromised patients may outweigh the risk of TMA, close monitoring for symptoms of TMA is indicated in all immunocompromised patients receiving high-dose valaciclovir.

CONCLUSION

Oral valaciclovir is an effective drug for the suppression of recurrent episodes of genital herpes in immunocompetent and immunocompromised individuals. (ABSTRACT TRUNCATED)

High prevalence of herpes simplex virus type 2 in acute retinal necrosis syndrome associated with herpes simplex virus in Japan

PURPOSE

To determine the type of herpes simplex virus in acute retinal necrosis syndrome associated with herpes simplex virus.

METHODS

Herpes simplex virus type 1, herpes simplex virus type 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus were examined by polymerase chain reaction in intraocular specimens from 16 patients with acute retinal necrosis syndrome. Anti-herpes simplex virus type 1 and anti-herpes simplex virus type 2 type-specific antibodies in serum from the patients were detected by enzyme immunoassay.

RESULTS

Of 16 patients with acute retinal necrosis syndrome, seven were polymerase chain reaction positive for herpes simplex virus type 2 and nine were positive for varicella-zoster virus. Anti-herpes simplex virus type 2 antibody was positive and anti-herpes simplex virus type 1 antibody was negative in the sera of the seven patients with herpes simplex virus type 2 DNA-positive acute retinal necrosis syndrome. In contrast, anti-herpes simplex virus type 2 antibody was absent in all nine varicella-zoster virus DNA-positive acute retinal necrosis syndrome patients.

CONCLUSION

Herpes simplex virus type 2 has been demonstrated to be the major causative agent in acute retinal necrosis syndrome associated with herpes simplex virus by molecular biological and serological methods. Negative preexisting anti-herpes simplex virus type 1 antibody may play an important role in acute retinal necrosis syndrome associated with herpes simplex virus type 2.

A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group

BACKGROUND AND METHODS

Herpes simplex virus (HSV) infections are endemic, but the clinical characteristics of newly acquired HSV type 1 (HSV-1) and HSV type 2 (HSV-2) infections in adults have not been rigorously defined. We monitored 2393 sexually active HSV-2-seronegative persons for clinical and serologic evidence of new HSV infection. Of the participants, 1508 were seropositive for HSV-1 and 885 were seronegative. Charts were reviewed in a blinded manner for classification of those with genitourinary or oropharyngeal symptoms. Charts were also reviewed for all 174 persons with HSV seroconversion.

RESULTS

The rates of new HSV-1 and HSV-2 infections were 1.6 and 5.1 cases per 100 person-years, respectively. Of the 155 new HSV-2 infections, 57 (37 percent) were symptomatic, 47 of which (82 percent) were correctly diagnosed at presentation. Among the 74 patients given a clinical diagnosis of genital HSV-2 during the study, 60 were given a correct diagnosis and 14 were given an incorrect diagnosis of genital herpes, for a ratio of true positive results to false positive results of 4:1. Among the 98 persons with asymptomatic HSV-2 seroconversion, 15 percent had genital lesions at some time during follow-up. Women were more likely than men to acquire HSV-2 (P<0.01) and to have symptomatic infection. Previous HSV-1 infection did not reduce the rate of HSV-2 infection, but it did increase the likelihood of asymptomatic seroconversion, as compared with symptomatic seroconversion, by a factor of 2.6 (P<0.001). Of the 19 new HSV-1 infections, 12 were symptomatic. The rates of symptomatic genital HSV-1 infection and oropharyngeal HSV-1 infection were the same (0.5 case per 100 person-years).

CONCLUSIONS

Nearly 40 percent of newly acquired HSV-2 infections and nearly two thirds of new HSV-1 infections are symptomatic. Among sexually active adults, new genital HSV-1 infections are as common as new oropharyngeal HSV-1 infections.

Changes in prevalence of herpes simplex virus type 1 and 2 antibodies from 1973 to 1993 in the rural districts of Japan

Using the gG-capture ELISA, changes in the seroprevalence of HSV-1 and HSV-2 from 1973 to 1993 were studied for 614 sera collected from general adults living in rural Japan. The HSV-1 seroprevalence for men and women decreased from 75.3 and 80.6% in 1973 to 54.4 and 59.6%, respectively, in 1993. The HSV-2 seroprevalence also decreased from 10.2 and 9.9% in 1973 to 1.8 and 1.2%, respectively, in 1993. Although the decrease in HSV-2 prevalence seemed to be correlated with the general decrease of sexually transmitted diseases in Japan since the 1950s, these findings should not be interpreted as typical, as HSV-2 infections are particularly known to distribute unevenly among populations, according to sexual activity and cohorts.