Update on Neonatal Herpes Simplex Epidemiology in the Netherlands: A Health Problem of Increasing Concern?

BACKGROUND: This article provides an update on the incidence of neonatal herpes, guideline adherence by health care professionals (HCP) and trends in genital herpes simplex virus (HSV) infection during pregnancy in the Netherlands. METHODS: Questionnaires were sent to all hospitals inquiring about numbers and characteristics of neonatal and maternal HSV infections, and guideline adherence between 2012 and 2015. Longitudinal trends were investigated from 1999 onward using survey data and Perinatal Registry of the Netherlands data (Perined). Trends were smoothed with Poisson regression splines. Risk indicators for neonatal and maternal HSV infections were examined with Poisson regression analyses. RESULTS: Neonatal herpes incidence was 4.8/100,000 live births based on survey data (2012-2015) and 3.4/100,000 based on Perined (2012-2014). Mortality rate was 23% (7/30). Neonatal herpes incidence increased slightly over time as did the prevalence of genital HSV infection among pregnant women. Non-Western ethnicity (Rate Ratio: 1.9; 95% confidence interval: 1.5-2.5) and age <20 years (Rate Ratio: 2.3; 95% confidence interval: 1.2-4.7) were associated with genital herpes during pregnancy. In Perined, none of the neonatal herpes cases had a mother diagnosed with an active genital herpes infection during pregnancy. Preventive measures to reduce vertical herpes transmission (such as cesarean section) were less commonly reported by HCP in 2012-2015 compared with 2006-2011. CONCLUSIONS: Neonatal herpes incidence in the Netherlands slowly increased over the last 15 years. An increased genital HSV prevalence during pregnancy or, to lower extent, the decreased guideline adherence by HCP may be responsible. A rise in asymptomatic maternal HSV shedding is also plausible, emphasizing the challenges in preventing neonatal herpes.

[A persistent 'insect bite']. / Een hardnekkige insectenbeet uit Costa Rica.

A 57-year-old woman had a persistent 'mosquito bite' after a stay in Costa Rica, which proved to be cutaneous myiasis due to Dermatobia hominis.

Vulvovaginal candidiasis: diagnostic and therapeutic approaches used by Dutch general practitioners.

OBJECTIVE: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. METHODS: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information was requested with regard to diagnostic examinations performed and preferred treatment when dealing with vulvovaginal candidiasis. RESULTS: 380 (32.87%) GPs returned the questionnaire, of which 189 GPs worked in single-person practices (n=189). The group of 380 GPs consisted of 269 (70.8%) males and 111 (29.2%) females. On average, GPs reported 105.6 consultations concerning vaginal candidiasis per practice per year. Only 61 (16.1%) Dutch GPs always or often performed microscopy when diagnosing candidiasis, while 143 (37.6%) GPs never used a microscope to confirm their diagnosis. Furthermore, only 30 (7.9%) GPs regularly took Candida cultures, whereas 154 GPs (40.5%) never took a vaginal swab to diagnose acute candidiasis. Treatment of choice was mostly miconazole (50%) or clotrimazole (24%). CONCLUSION: GPs often diagnose "vulvovaginal candidiasis" in their practices, but often do not perform the laboratory examinations required to confirm their putative diagnosis. This may lead to wrong diagnoses and maltreatment with antimycotics, without cure of the patients' vaginal complaints.

Isopentenyl pyrophosphate-reactive Vgamma9Vdelta 2 T helper 1-like cells are the major gammadelta T cell subset recovered from lesions of patients with genital herpes.

Herpes simplex virus (HSV)-specific T cells are essential to control and resolve genital herpes (GH). To investigate the potential involvement of gamma delta T cells in GH, T cells were recovered and expanded, by mitogenic stimulation, to T cell lines from the genital lesions of 17 patients with GH and 5 control subjects who had other diseases. Relatively high numbers of gamma delta T cells--predominantly, V gamma 9V delta 2 T cells--were detected only in the T cell lines of the patients with GH. Intralesional V gamma 9V delta 2 T cell clones did not recognize HSV-infected cells, but they showed reactivity to isopentenyl pyrophosphate and Daudi cells. The T cell clones secreted interferon- gamma, tumor necrosis factor- alpha, interleukin (IL)-8, macrophage inflammatory protein-1 alpha, and RANTES (regulated on activation, normally T cell expressed or secreted), but they secreted no or limited IL-4. The results of the present study suggest the infiltration and putative involvement of isopentenyl pyrophosphate-reactive V gamma 9V delta 2 T helper 1-like cells in individuals with GH.

Routine HIV screening of sexually transmitted disease clinic attenders has favourable cost-effectiveness ratio in low HIV prevalence settings.

HIV screening for attenders of clinics for sexually transmitted disease (STD) may identify individuals with high-risk sexual behaviour and avert HIV infections in partners. Extending our previous analysis in AIDS, we performed an economic evaluation of HIV screening of STD-clinic attenders in Rotterdam, the Netherlands. The results, at euro 2987 per life-year gained, display a favourable economic profile. Routine HIV screening in STD clinics should be considered as a highly cost-effective prevention measure even in countries with a low HIV prevalence.

A retrospective analysis of costs and patterns of treatment for external genital warts in The Netherlands.

BACKGROUND: External genital warts (EGWs) are one of the most common sexually transmitted infections, but little is known about the treatment patterns or resources used in the management of this condition. OBJECTIVE: The purpose of this retrospective analysis is to examine the patterns of treatment, resource utilization, and costs for EGWs in 3 dermatology clinics in the Netherlands. METHODS: A total of 530 completed episodes of care for EGWs were analyzed to identify patterns of treatment and resources used. Costs of care were calculated based on 4 cost components for each visit: labor costs, material costs, indirect costs, and extra costs. RESULTS: Across the 3 sites, men required an average of 5.78 clinic visits to achieve a completed episode of care; women required an average of 6.52 visits. The distribution of visits is highly skewed, however, with a median of 4.56 visits for men and 5.55 for women. More than 80% of patients were initially treated with monotherapy. Podophyllin and cryotherapy were the principal choices for initial therapy. The mean cost, in euros, of completing an episode of care was 221.34 euro for men and 292.29 euro for women. The cost per completed or successful episode of care was 395.92 euro for men and 485.05 euro for women. The distribution of costs was also skewed, with a relatively small group of patients accounting for a considerable proportion of overall costs. Although only 31.4% of male patients recorded > or = 6 visits for a completed episode of care, this group accounted for 57.3% of the total costs of treatment for male patients. Among female patients, 43.4% had > or = 6 visits, which accounted for 73.9% of the total costs of care for female patients. Costs also varied markedly by therapy sequence chosen. Patients who remained on their initial monotherapy or combination therapy had the lowest costs; the extent to which patients switched therapies substantially affected overall costs. For those patients initially treated with podophyllin, the mean total costs of treatment, taking into account the proportion who required a change in therapy, were 204.84 euro for men and 386.38 euro for women. For those initially treated with cryotherapy, the mean cost of treatment was 193.60 euro for men and 169.23 euro for women. CONCLUSION: Current treatment options for EGWs do not appear to minimize resource utilization or help achieve complete episodes of care at the lowest possile cost.