Sexually transmitted infections in pregnancy and adverse pregnancy outcomes: A retrospective cohort study.

OBJECTIVE: There is a high prevalence and incidence rate of asymptomatic sexually transmitted infections (STIs) during pregnancy in adolescent girls and young women in Africa. The association between STIs and pregnancy outcomes in a hyperepidemic HIV setting has not been well described. METHODS: Pregnant women, HIV-1 negative and <28 weeks' gestation at three primary health clinics in KwaZulu-Natal, South Africa were enrolled from February 2017 to March 2018. Vaginal swabs collected at the first and later antenatal visits were stored and retrospectively tested for HSV-2, Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae at the end of the study. The association between STIs detected at first and later antenatal visits and pregnancy outcome was assessed using multivariable logistic regression models adjusted for maternal age and treatment received for symptomatic STIs. RESULTS: Testing positive Mycoplasma genitalium at the first antenatal visit was significantly associated with low birth weight (odds ratio [OR] 5.22; 95% confidence interval [CI]: 1.10-15.98). Testing positive for T. vaginalis at the repeat visit was significantly associated with preterm births (OR 2.37; 95% CI: 1.11-5.03), low birth weight (OR 2.56; 1.16-5.63) and a composite adverse pregnancy outcome (OR 2.11; 95% CI: 1.09-4.08). Testing positive for HSV-2 at the repeat visit was also likely associated with experiencing a preterm birth or any adverse pregnancy outcome (OR 3.39; 95% CI: 0.86-13.3) (P = 0.096). CONCLUSIONS: Among predominantly asymptomatic STIs, M. genitalium detected at baseline visit was significantly associated with low birth weight, while T. vaginalis detected at the repeat visit in later pregnancy was significantly associated with preterm birth. Further research is warranted to study the impact of etiological testing of STIs at more than one antenatal visit and empirical treatment on pregnancy outcomes.

Sepsis and multi-organ failure due to genital herpes in a healthy person.

Herpes simplex virus type 2 (HSV-2) is highly prevalent in several regions of the world and is the main pathogen causing genital herpes, which is transmitted almost exclusively through sexual contact. Systemically disseminated infections caused by HSV-2 are rare and most often seen in newborns, pregnant women, or immunocompromised populations. The virus can invade multiple organs and cause damage. In this paper, we present an extremely rare case of an immunocompetent 36-year-old male who came to our hospital with a high fever with abdominal pain and died of sepsis and multiple organ dysfunction syndrome within a short period. After the exclusion of common pathogens such as bacterial and fungal infections during hospitalization, metagenomic next generation sequencing of the patient's peripheral blood and ascites gave us the answer, and very high nucleic acid sequence counts of HSV-2 were detected in both his peripheral blood and ascites, confirming HSV-2 as the causative virus. In addition, this paper provides a brief review of the relevant literature.

Novel variants of human herpesvirus 2 from Brazilian HIV-1 coinfected subjects

BACKGROUND Human herpesvirus 2 (HHV-2) have DNA genome with a limited genetic variability and have been classified into two clades. OBJECTIVES To identify and characterise six HHV-2 isolates derived from Brazilian women. METHODS HHV-2 isolates were performed polymerase chain reaction (PCR) and sequencing of 2250 pb of the glycoprotein B (gB) coding regions. FINDINGS Four HHV-2 isolates were classified into clade B, while the remaining two, derived from HIV-1 co-infected women, showed a notable genetic divergence (> 1%). MAIN CONCLUSION The results reveal novel HHV-2 variants. The impact of these novel variants on HHV-2 pathogenesis and HIV/HHV-2 coinfection need to be investigated.

Herpes genital crônico: relato de caso e revisão da literatura / Chronic genital herpes: case report and literature review

Úlceras genitais são manifestações clínicas de etiologias diversas, o que pode dificultar o diagnóstico. Este relato de caso trata­se de mulher de 64 anos, com histórico de úlcera genital dolorosa há 4 meses, progressiva apesar do uso prévio de antiviral. Apresentava lesão ulcerada com comprometimento perianal. Histopatológico revelou neovascularização, edema e infiltrado inflamatório. Realizou tratamento com aciclovir endovenoso por 14 dias, com melhora parcial. O herpes simples crônico manifesta­se como verruga ou úlcera de pelo menos um mês, geralmente em imunossuprimidas. A resistência a agentes antivirais é uma complicação encontrada, mas a resposta ao tratamento costuma ser mais lenta do que nas infecções comuns.

Genital ulcers are clinical manifestations of diverse etiologies, which can make diagnosis difficult. This case report is about a 64­year­old woman with a history of progressive genital ulcer pain for 4 months, despite prior antiviral use. The ulcerated lesion showed perianal involvement. Histopathology revealed neovascularization, edema and inflammatory infiltrate. Despite the use of intravenous acyclovir for 14 days, the improvement was partial. Chronic herpes simplex reveals wart or ulcer of at least one month, usually in immunosuppressed patients. A resistance to antiviral agents is a complication factor, but the treatment response to common infections is usually slower.

Seroepidemiological study of herpes simplex virus type 2 in patients with the acquired immunodeficiency syndrome in the city of Niterói, Rio de Janeiro, Brazil

This study was designed to determine the seroprevalence of herpes simplex virus type 2 (HSV-2) and to evaluate its association with age, sex as well as other demographic and behavioural factors in 150 human immunodeficiency virus (HIV) positive adults patients attending the general medical outpatient ward for routine care of Niterói, state of Rio de Janeiro, Brazil. Serum samples were screened for HSV-2 antibodies using an indirect ELISA. Eighty-three patients were men (mean age: 38.8) and 67 were women (mean age: 35.4). The estimated prevalence of HSV-2 was 52 percent (95 percent CI: 44-60 percent) and it was higher among men (53 percent) than among women (50.7 percent). Overall, the age of first sexual intercourse and past history of genital herpes were associated with HSV-2 seropositivity. Analysis by gender disclosed significant association of number of lifetime sex partners only among men. Although HSV-2 antibodies were frequent in the study group, genital herpes was reported by 21.8 percent of the HSV-2 positive subjects, indicating low awareness of the HSV-2 infection. These results may have public health importance for Brazil as the high rate of HSV-2 infection may act as a cofactor of HIV transmission.

Enfermedades de transmisión sexual y VIH / Sexually transmitted diseases and HIV

La epidemia de VIH ha modificado dramáticamente el campo de las enfermedades de transmisión sexual. La infección por VIH es única dentro de las enfermedades de transmisión sexual, porque puede modificar la presentación clínica y las características de otras enfermedades de transmisión sexual. A su vez, otras enfermedades de transmisión sexual pueden afectar la transmisión de VIH. Este artículo revisa las principales enfermedades de transmisión sexual que afectan a los pacientes VIH, su epidemiología y recomendaciones para la detección, seguimiento y tratamiento.

Herpes simplex type 2 pneumonia

Extensive reviews of pulmonary infections in AIDS have reported few herpetic infections. Generally these infections are due to Herpes simplex type 1. Pneumonia due to herpes type 2 is extremely rare. We describe a 40 year-old HIV positive woman who complained of fever, cough and dyspnea for seven years. She had signs of heart failure and the appearance of her genital vesicles was highly suggestive of genital herpes. Echocardiography showed marked pulmonary hypertension, right ventricular hypertrophy and tricuspid insufficiency. After a few days of hospitalization she was treated with Aciclovir and later with Ganciclovir. An open pulmonary biopsy revealed an interstitial inflammation, localized in the alveolar walls. Some pulmonary arteries had widened walls and focal hyaline degeneration. Immunohistochemistry indicated that the nuclei had herpes simplex virus type 2 in many endothelial cells (including vessels with widened walls), macrophages in the alveolar septa and pneumocytes. There was clinical improvement after treatment for herpes. We concluded that as a consequence of herpes infection, endothelial involvement and interstitial inflammation supervene, with thickening of vascular walls and partial obliteration of the vessel lumen. A direct consequence of these changes in pulmonary vasculature was pulmonary hypertension followed by heart failure.

Seroprevalencia del virus herpes simple 2 en mujeres con trabajos de parto que asistieron al Hospital Bertha Calderón Roque, en el período comprendido de noviembre-diciembre del 2000 / Seroprevalence of herpes virus simplex type 2 of woman in labor that attended to the Hospital Bertha Calderón Roque in the period incluyended from movember-december of 2000

Se realizó un estudio descriptivo de corte transversal, en el Hospital bertha Calderón Roque, a todas las pacientes que asistieron en trabajo de parto, durante el período de noviembre-diciembre 2000. El universo de estudio estaba constituído por 192 mujeres, las que se dividieron por grupo de edad donde el grupo de 15-19 años ocupó un 38.5 porciento, siguiéndole el grupo de 20-24 años. El estudio revela que el estado civil de acompañadas ocupa un lugar predominante con un 62 porciento, seguidas de mujeres casadas con un 25 porciento, con respecto a los antecedentes obstetricos el 41.4 porciento de mujeres eranprimigestas, seguidas de las bigestas con un 25.7 porciento en relación al número de abortos tenemos que el 89.6 porciento refieron haber no tenido ningún aborto,en relación al iniciación de su vida sexual refieren el 70 porciento de las pacientes haber iniciado entre los 15-19 años, seguido del grupo entre 10-14 años, que presentó el 15.1 porciento, lo que demuestra la precosidad con que los adolescentes inician sus relaciones sexuales, siendo esto un factor de riesgo para contraer un sinnúmero de enfermedades entre ellas la del herpes genital. La seroprevalencia del virus del Herpes Simple tipo 2 va en ascenso a mitad de las pacientes con historia de úlceras genitales hubo serología positiva, por lo que no siempre existe relación entre hisotria de infección genital y la presencia de anticuerpos HVS-2, por el número de parejas a lo largo de la vida, como comportamiento sexual de riesgo

Características y rol del herpes gluteo en población femenina / Characteristics and role of the gluteal herpes in a female population

Basado en el hecho que el herpes glúteo puede constituir la expresión clínica de la reactividad de un virus Herpes simplex latente a nivel de ganglio sacro, fue nuestro interés investigar en un grupo de mujeres portadoras de infección herpética glútea, las características de la infección, el tipo viral prodominantemente asociado a ella y su posible relación con el herpes genital. Se estudiaron 41 mujeres con herpes glúteo confirmado por laboratorio virológico. El 75,7% de esta población tenía además antecedentes de infección herpética en otra localización fundamentalmente genital. Se detectó un promedio de 7,2 episodios recurrentes al año, con un rango de 1 a 18 episodios anuales. De las cepas aisladas, el 78% fue tipificada como HSV-2 mediante el uso de anticuerpos monoclonales. Se resalta la importancia de considerar el antecedente de herpes glúteo como causal de clasificación de alto riesgo herpético

Deteccion inmunohistoquimica de antigenos del papiloma virus humano y del virus herpes simple tipo II en la neoplasia intraepitelial cervical y carcinoma invasor de cervix / Immunohistochemistry antigenic detection of human papilloviruses and herpex siplex virus in the intraepithelial cervical neoplasia and invader carcinoma of the cervix

Para conocer la presencia de los virus Herpes simple tipo 2 (V.H.S-2) y papiloma virus humano (P.V.H) en las lesiones premalignas y malignas del cervix uterino i.e. NIC I-III y CA invasor., se inicio un estudio retrospectivo de 125 biopsias en noviembre de 1986. Morfologicamente 24% de las biopsias contenian displasias y76% carcinoma insitu e invasor. A 90 especimenes histologicos se les investigo con la tecnica de Inmunoperoxiodasa la presencia de antigenos de los virus P.V.H. y V.H.S2 RESULTANDO POSITIVOS EL 21% Y EL 5.6% de los casos respectivamente ; no se detecto la presencia de los virus simultaneamente en el carcinoma invasor que en la neoplasia intraepitelial cervical I-II-III. A 76 pacientes se les realizo encuestas para investigar la correlacion de la infeccion viral con los factores de riesgo del cancer de cervix. Se encontro que el P.V.H. esta presente en mayoir proporcion en las pacientes con diagnostico anatomopatologico NIC-III y CA invasor, con 4 hijos o menos y que iniciaron vida sexual entre los 15 y 18 anos; este hallazgo indica la posibilidad de infeccion por el P.V.H. desde edades tempranas de la vida y persistencia del virus en forma latente en el epitelio escamocelular del cervix. Observamos que el habito de fumar es una caracteristica del 75% de las mujeres infectadas por el papiloma virus. En este estudio no se demostro una asociacion estadisticamente significativa entre los virus V.H.S-2 y P.V.H. con el CA de cervix. Sinembargo, nuestros resultados sugieren un papel del papiloma virus y el habito de fumar en el proceso..