Preventing HIV and HSV-2 through knowledge and attitudes: A replication study of a multi-component community-based intervention in Zimbabwe.

INTRODUCTION: Approximately two-thirds of HIV-infected individuals reside in sub-Saharan Africa. The region accounts for 68% of the new HIV infections occurring worldwide with almost one-half of these infections being among young adults aged 12-24 years. Cowan and colleagues conducted a community-based, multi-component HIV intervention aimed at youth in rural Zimbabwe. Despite some changes in knowledge and attitudes, the community-based intervention did not affect the prevalence of HIV or HSV-2. We selected this frequently cited study for replication since it incorporates individual-, community-, and structural- level intervention components that are often considered in global HIV/AIDS prevention programs. Additionally, the intervention could be easily scaled-up, which is especially important in the context of limited resources. Although this study indicated no intervention effects in reducing HIV, the authors acknowledged some key methodological challenges. Our replication analysis provided important insights regarding the impact of these challenges to the interpretation of the results of this study. METHODS: Our replication study focused on replicating Cowan's findings and assessing the robustness of Cowan's results to alternative analytical models based on their study design. We determined how out-migration occurring during Cowan's study may have affected the population characteristics, the intervention exposure level, and the study findings. While the original intervention targeted knowledge and attitudes as a mechanism to decrease HIV/HSV-2, the Cowan study evaluated the intervention effects on knowledge, attitudes, and prevalence of HIV or HSV-2 separately. To better identify the pathway describing the interrelationship among the intervention and knowledge, attitudes, and prevalence of HIV or HSV-2, we assessed whether increases in knowledge or attitudes were associated with decreased HIV or HSV-2 prevalence. RESULTS: We replicated the original findings with minor discrepancies during the pure replication. Our additional analyses revealed that the study population characteristics changed over time in ways that may have affected outcomes. These changes also affected the levels of intervention exposure, with 48.7% males and 75.5% females of the intervention group receiving low-level exposure. Both genders with higher level intervention exposure experienced higher increments in multiple knowledge, attitude, and sexual risk behavior outcomes. Unfortunately, these did not translate to a significant reduction in HIV or HSV-2 regardless of the level and combination of knowledge and attitude domains. However, males receiving high-level intervention exposure compared to control indicated significantly lower odds of having HIV or HSV-2 under a Bayesian modeling paradigm. CONCLUSIONS: Our findings suggest a more robust conclusion on the study intervention effects. Further study based on a design that more consistently maximizes the exposure level of the intervention is necessary and should ideally be an evaluated goal in similar studies. Evaluation of the intervention impact for key subgroups of the target population is important and would better advise the use and scale-up of the evaluated interventions in various contexts. Our observation of a consistent lack of relationship between knowledge/attitudes and HIV/HSV-2 suggests a need to explore and include relevant additional and or complementary interventions, e.g., promoting effective skills in reducing risky sexual behaviors and addressing cultural and structural bottlenecks that may reduce HIV/HSV-2 risk among youth.

[Microbicides for preventing sexually transmitted infections: Current status and strategies for preclinical evaluation of new candidates]. / Microbicidas para la prevención de infecciones de transmisión sexual: estado actual y estrategias para la evaluación preclínica de nuevos candidatos.

Microbicides are a new tool, still under investigation, which could help prevent infection by the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Increasing evidence shows that the complexity of sexual transmission of viral pathogens requires the identification of compounds able to block the early events during the cycle of viral infection. In this manuscript we provide a comprehensive review of the different microbicide strategies that have been studied or are currently being considered for STI prevention, particularly emphasizing those having the potential to block HIV infection. The manuscript also reviews the complex process that is required to conduct future clinical studies in humans and concludes with a brief discussion of the strategies that could be part of the immediate future in microbicide research.

Microbicidas para la prevención de infecciones de transmisión sexual: estado actual y estrategias para la evaluación preclínica de nuevos candidatos. / [Microbicides for preventing sexually transmitted infections: Current status and strategies for preclinical evaluation of new candidates].

Microbicides are a new tool, still under investigation, which could help prevent infection by the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Increasing evidence shows that the complexity of sexual transmission of viral pathogens requires the identification of compounds able to block the early events during the cycle of viral infection. In this manuscript we provide a comprehensive review of the different microbicide strategies that have been studied or are currently being considered for STI prevention, particularly emphasizing those having the potential to block HIV infection. The manuscript also reviews the complex process that is required to conduct future clinical studies in humans and concludes with a brief discussion of the strategies that could be part of the immediate future in microbicide research.

Infantile vesicular rash.

Neonatal rashes are common but can cause significant anxiety and concern to parents and health professionals. Most often these rashes are benign and parents need to be reassured. It is important to be aware of the uncommon but potentially serious rashe seen in the neonatal period such as neonatal herpes, inconentia pigmentii. Neonatal herpes is one of the most serious perinatal infections and is commonly caused by infected maternal genital secretions at the time of birth. The outcome of an untreated herpes infection can be devastating as high incidence of mortality is recorded in disseminated herpes and herpes encephalitis infections. Midwifery staff can help in the detection of asymptomatic herpes cases in pregnant women by taking a detailed history of previous herpes infections, as viral shredding is known to occur in such cases. Presented here is a case of neonatal herpes skin, eye and mucosa syndrome which, at times, can cause a diagnostic challenge and delay as was seen in this case..

[Update on the treatment of genital herpes]. / Actualización en el tratamiento del herpes genital.

Genital herpes is a chronic infection characterized by periodic reactivation. It can produce symptomatic disease in the host although asymptomatic viral excretion can also occur. It is currently the main cause of genital ulceration and an important public health problem that has substantial clinical, psychological, and economic repercussions. This review analyzes the currently available therapeutic options and regimens, which are based mainly on systemic use of antiviral agents such as aciclovir, valacyclovir, and famciclovir. In addition, special emphasis is placed on the prevention and management of this infection in specific situations, such as pregnant, pediatric, and immunocompromised patients.

Actualización en el tratamiento del herpes genital / Update on the Treatment of Genital Herpes

El herpes genital es una infección crónica que se caracteriza por una reactivación periódica, con capacidad tanto de producir una enfermedad sintomática en el huésped como de excreción viral asintomática. Hoy en día constituye la primera causa de ulceración genital y representa un importante problema de salud pública, con considerables repercusiones clínicas, psicológicas y económicas. Se revisan y actualizan las distintas opciones y pautas terapéuticas disponibles en la actualidad, basadas fundamentalmente en el empleo por vía sistémica de los fármacos antivirales aciclovir, valaciclovir y famciclovir. Por otro lado, se pone especial énfasis en la prevención y el manejo de esta infección en situaciones particulares, como en embarazadas, en niños, o en pacientes inmunodeprimidos (AU)

Genital herpes is a chronic infection characterized by periodic reactivation. It can produce symptomatic disease in the host although asymptomatic viral excretion can also occur. It is currently the main cause of genital ulceration and an important public health problem that has substantial clinical, psychological, and economic repercussions. This review analyzes the currently available therapeutic options and regimens, which are based mainly on systemic use of antiviral agents such as aciclovir, valacyclovir, and famciclovir. In addition, special emphasis is placed on the prevention and management of this infection in specific situations, such as pregnant, pediatric, and immunocompromised patients (AU)

Tests of Buffergel for contraception and prevention of sexually transmitted diseases in animal models.

BACKGROUND: BufferGel is a novel spermicidal and microbicidal gel formulated to maintain the natural protective acidity of the vagina by acidifying semen, which otherwise alkalinizes the vagina. GOAL: To test the efficacy of BufferGel for preventing sexually transmitted infections and pregnancy in animal models. STUDY DESIGN: Animals were challenged with pathogens or sperm after pretreatment with both test and control agents, or after no pretreatment, then evaluated for infection or pregnancy using standard methods. RESULTS: BufferGel provided significant contraceptive efficacy in the rabbit, and significant protection against vaginal and rectal transmission of herpes simplex virus type 2 (HSV-2) in the mouse, vaginal transmission of Chlamydia trachomatis in the mouse, and skin transmission of cottontail rabbit papillomavirus in the rabbit. It did not protect against vaginal transmission of Neisseria gonorrhoeae in the mouse. CONCLUSIONS: The protective efficacy of BufferGel in five of the six animal models suggests that this microbicide warrants clinical evaluation for both contraception and disease prevention.

Herpes study and resources.

AIDS: Herpes is caused by a virus that causes recurring bouts of cold sores or genital lesions. The differences between herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2) are explained. Herpes outbreaks can become harder to treat when the immune system is damaged by HIV. Acyclovir and famciclovir are safe and effective treatments, but preventing infection is especially important in HIV-infected individuals, as the amount of HIV in the blood increases during a herpes outbreak. World Wide Web addresses are provided for alternative herpes treatment information. A current trial is studying the effectiveness of acyclovir used with an antiviral gel, SP-303. Participants will be treated with acyclovir alone or with acyclovir and SP-303 gel. Call the Network for referral information.^ieng

The 'other' sexually transmitted diseases: a case for public health education.

Generally, people tend to associate the phrase 'sexually transmitted diseases' (STDs) with only gonorrhoea and syphilis. This paper highlights the prevalence of other diseases such as herpes simplex, trichomoniasis and candidiasis which are also sexually transmitted. It is shown that, although they are rarely discussed and reported, various estimates, particularly in the developed countries where statistics are available, indicate that their incidence rates are rapidly rising to epidemic proportions and, in certain instances, have surpassed the annual cases of syphilis and gonorrhoea. Their causative organisms, mode of spread, signs and symptoms, complications, prevention and control are presented. Although knowledge of the above are important, it is emphasised that it is much more desirable to focus on prevention through public health education. Health education strategies such as avoiding sexual exposure with infectees, personal hygiene, simulation, role-play and unemotional discussion in schools and the use of mass media in disseminating information to the public regarding prevention, control and how to seek for treatment are elaborated upon.

Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir.

OBJECTIVE: To assess the effect of the antiviral drug acyclovir on the frequency of subclinical shedding of herpes simplex virus (HSV) in the genital tract. DESIGN: A double-blind, placebo-controlled, crossover clinical trial. SETTING: A university-based virology research clinic. PATIENTS: 34 women with herpes simplex virus type 2 (HSV-2) antibody only and genital herpes of less than 2 years' duration. INTERVENTION: Participants were randomly assigned to receive either acyclovir, 400 mg twice daily for 70 days, followed by a 14-day washout period, and then placebo for 70 days, or the study medications in the reverse order. MEASUREMENTS: Women collected daily genital swabs of the vulvar, cervicovaginal, and perianal areas for HSV culture, maintained a diary of genital lesions, and were examined at the time of recurrences. RESULTS: In an intent-to-treat analysis of the initial treatment period, 15 of the 17 women who received placebo and 3 of the 17 women who received acyclovir had at least 1 day of subclinical shedding (P < 0.001). Among the participants who received placebo, subclinical shedding occurred on 64 of 928 (6.9%) days compared with 3 of 1057 (0.3%) days among the participants who received acyclovir (P < 0.001). The relative risk for subclinical shedding was 0.09 (95% CI, 0.03 to 0.35) for the women who received acyclovir compared with the women who received placebo. In a paired analysis of 26 women who completed both arms of the study, acyclovir therapy was associated with a decrease in the frequency of subclinical shedding; subclinical shedding occurred on 83 of 1439 (5.8%) days with placebo, and on 6 of 1611 (0.37%) days with acyclovir (P < 0.001)--a 94% reduction. The frequency of subclinical shedding was reduced at all anatomic sites and in all patients. CONCLUSIONS: Daily therapy with oral acyclovir suppresses subclinical shedding of HSV-2 in the genital tract, suggesting that studies to evaluate the use of acyclovir in preventing HSV-2 transmission are warranted.

Vagina dentata revisited: gender and asymptomatic shedding of genital herpes.

Medical research on genital herpes indicates that women shed herpes asymptomatically. This paper examines the medical understanding of asymptomatic shedding of herpes among women as partial knowledge, meaning biased and incomplete, based upon folk models of male and female sexual bodies and upon the structure of medical practice. The focus on women's sexual anatomy as dangerous to men and the lack of a medical specialty on male reproductive/sexual health results in blaming women for transmission of sexual diseases.