RESUMEN
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.
Asunto(s)
Complicaciones Infecciosas del Embarazo , Resultado del Embarazo , Nacimiento Prematuro , Enfermedades de Transmisión Sexual , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Complicaciones Infecciosas del Embarazo/epidemiología , Sudáfrica/epidemiología , Adulto , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/diagnóstico , Adulto Joven , Nacimiento Prematuro/epidemiología , Adolescente , Recién Nacido de Bajo Peso , Recién Nacido , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/diagnóstico , Mycoplasma genitalium/aislamiento & purificación , Herpes Genital/epidemiología , Herpes Genital/complicaciones , Prevalencia , Modelos Logísticos , Trichomonas vaginalis/aislamiento & purificación , Herpesvirus Humano 2/aislamiento & purificación , Atención Prenatal , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/diagnósticoRESUMEN
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.
Asunto(s)
Herpes Genital , Herpesvirus Humano 2 , Insuficiencia Multiorgánica , Sepsis , Humanos , Masculino , Herpes Genital/diagnóstico , Herpes Genital/complicaciones , Herpes Genital/virología , Adulto , Herpesvirus Humano 2/aislamiento & purificación , Insuficiencia Multiorgánica/virología , Sepsis/virología , Resultado FatalRESUMEN
BACKGROUND: For women living with HIV (WLHIV), co-infection with herpes simplex virus type 2 (HSV-2) causes severe genital ulcers and presents additional challenges for their HIV care. To inform preventive strategies, we aimed to determine the incidence and risk factors of HSV-2 positivity in a prospective cohort of South African women. METHODS: The CAPRISA 002 study enrolled women at acute HIV infection between 2004 and 2020. HSV-2 testing was conducted by multiplex polymerase chain reaction (PCR) assay on collected vaginal swabs up to twice annually during follow-up. We calculated incidence as the number of new cases per 100 person-years (PYs) and used Cox-proportional-hazard regression to identify factors associated with time-to-HSV-2 PCR positivity. RESULTS: At enrolment, the median age of 171 women was 24 years, interquartile range (IQR 21-28), and the estimated median days since HIV infection was 42 (IQR 22-65). Of participants tested at enrolment, HSV-2 antibody prevalence was 81.4% (105/129), and 10.6% (12/113) were positive by PCR. Among 147 women with a prior negative HSV-2 PCR diagnosis, we observed 47 new HSV-2 PCR positive cases over 424.4 PYs of follow-up, yielding an incidence rate of 11.1 cases per-100-PYs. HSV-2 PCR positivity incidence was higher among younger women (<25 years: adjusted Hazard Ratio [aHR] = 5.91, 95%CI 3.02-11.6), those with bacterial vaginosis (BV) (Nugent score 7-10: aHR = 2.17, 95%CI 1.15-4.10) and lower CD4 counts (<500 cells/µl: aHR = 2.04, 95%CI 1.08-3.87). CONCLUSION: After acute HIV infection in women, the incidence of HSV-2 PCR positivity was associated with younger age, BV diagnosis and lower CD4 count.
Asunto(s)
Infecciones por VIH , Herpes Genital , Herpes Simple , Vaginosis Bacteriana , Humanos , Femenino , Adulto Joven , Adulto , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Herpesvirus Humano 2/genética , VIH , Sudáfrica/epidemiología , Incidencia , Estudios Prospectivos , Vaginosis Bacteriana/epidemiología , Herpes Genital/epidemiología , Herpes Genital/complicaciones , Herpes Simple/complicacionesAsunto(s)
Síndrome de Inmunodeficiencia Adquirida , Dermatitis , Herpes Genital , Humanos , Valaciclovir/uso terapéutico , Imiquimod/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Antivirales/uso terapéutico , Aciclovir/uso terapéutico , Dermatitis/tratamiento farmacológico , Herpes Genital/complicaciones , Herpes Genital/tratamiento farmacológico , Método Doble CiegoAsunto(s)
Coinfección , Infecciones por VIH , Herpes Genital , Herpes Simple , Mpox , Humanos , Herpesvirus Humano 2 , Infecciones por VIH/complicaciones , Herpes Genital/complicaciones , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Herpes Simple/complicaciones , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológicoRESUMEN
BACKGROUND: Genital ulcer diseases (GUDs) are a common syndrome associated with sexually transmitted infections. Genital ulcer diseases increase the risk of HIV transmission, necessitating appropriate diagnosis and treatment. We provide an updated GUD etiology assessment in Malawi to guide diagnostic development and treatment algorithms. METHODS: We enrolled patients 18 years or older presenting with GUD at a sexually transmitted infection clinic in Lilongwe, Malawi, between May and October 2021. We purposively sampled by HIV status. Swabs of ulcers were tested for Treponema pallidum, herpes simplex virus (HSV)-1 and HSV-2, Haemophilus ducreyi, and Chlamydia trachomatis using polymerase chain reaction. Blood was collected for syphilis and HSV-2 serologies and acute HIV testing. Participants were treated per Malawi guidelines. Ulcer resolution (size reduced by >50%) was evaluated 14 days later. RESULTS: Fifty participants enrolled (30 without HIV, 2 with acute HIV infection, 18 with HIV seropositivity; 32 men, 18 women). Forty-six (92%) had an etiology identified. Syphilis was more common among those without HIV (22 of 30 [73%]) than participants with HIV (PWH; 8 of 20 [40%]; P = 0.04). Herpes simplex virus was more common among PWH (11 of 20 [55%]) than participants without (2 of 30 [7%]; P = 0.0002). One-fifth (9 of 50 [18%]) had H. ducreyi. Among those who returned for follow-up (n = 45), 9 (20%) had unresolved ulcers; persistent GUD was slightly more common in PWH (6 of 19 [32%]) than participants without (3 of 26 [12%]; P = 0.14). CONCLUSIONS: We observed a dramatic increase in syphilis ulcer proportion in a population whose GUDs were previously HSV predominant. Observed differences in etiology and resolution by HIV status could play an important role in the ongoing transmission and treatment evaluation of GUD.
Asunto(s)
Enfermedades de los Genitales Masculinos , Infecciones por VIH , Herpes Genital , Herpesvirus Humano 1 , Enfermedades de Transmisión Sexual , Sífilis , Masculino , Humanos , Femenino , Úlcera/epidemiología , Úlcera/etiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Sífilis/complicaciones , Sífilis/epidemiología , Sífilis/diagnóstico , Malaui/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Herpesvirus Humano 2 , Genitales , Herpes Genital/complicaciones , Herpes Genital/epidemiología , Enfermedades de los Genitales Masculinos/etiologíaRESUMEN
The myriad presentations of ulcerative sexually transmitted infections, other than genital herpes and syphilis, challenge even the most astute clinician given the considerable overlap in clinical presentation and lack of widely available diagnostic resources, such as nucleic acid testing, to confirm the diagnosis. Even so, case prevalence is relatively low, and incidence of chancroid and granuloma inguinale are declining. These diseases still cause substantial morbidity and increased chance for HIV acquisition, and with the recent advent of mpox as a cause, it remains imperative to identify and treat accurately.
Asunto(s)
Chancroide , Herpes Genital , Enfermedades de Transmisión Sexual , Sífilis , Humanos , Úlcera/diagnóstico , Úlcera/epidemiología , Úlcera/etiología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/etiología , Sífilis/diagnóstico , Sífilis/epidemiología , Chancroide/diagnóstico , Chancroide/tratamiento farmacológico , Chancroide/epidemiología , Herpes Genital/diagnóstico , Herpes Genital/complicaciones , Herpes Genital/epidemiologíaRESUMEN
BACKGROUND: Evidence suggests HSV-2 infection increases HIV acquisition risk and HIV/HSV-2 coinfection increases transmission risk of both infections. We analysed the potential impact of HSV-2 vaccination in South Africa, a high HIV/HSV-2 prevalence setting. METHODS: We adapted a dynamic HIV transmission model for South Africa to incorporate HSV-2, including synergistic effects with HIV, to evaluate the impact of: (i) cohort vaccination of 9-year-olds with a prophylactic vaccine that reduces HSV-2 susceptibility; (ii) vaccination of symptomatically HSV-2-infected individuals with a therapeutic vaccine that reduces HSV shedding. FINDINGS: An 80% efficacious prophylactic vaccine offering lifetime protection with 80% uptake could reduce HSV-2 and HIV incidence by 84.1% (95% Credibility Interval: 81.2-86.0) and 65.4% (56.5-71.6) after 40 years, respectively. This reduces to 57.4% (53.6-60.7) and 42.1% (34.1-48.1) if efficacy is 50%, 56.1% (53.4-58.3) and 41.5% (34.2-46.9) if uptake is 40%, and 29.4% (26.0-31.9) and 24.4% (19.0-28.7) if protection lasts 10 years. An 80% efficacious therapeutic vaccine offering lifetime protection with 40% coverage among symptomatic individuals could reduce HSV-2 and HIV incidence by 29.6% (21.8-40.9) and 26.4% (18.5-23.2) after 40 years, respectively. This reduces to 18.8% (13.7-26.4) and 16.9% (11.7-25.3) if efficacy is 50%, 9.7% (7.0-14.0) and 8.6% (5.8-13.4) if coverage is 20%, and 5.4% (3.8-8.0) and 5.5% (3.7-8.6) if protection lasts 2 years. INTERPRETATION: Prophylactic and therapeutic vaccines offer promising approaches for reducing HSV-2 burden and could have important impact on HIV in South Africa and other high prevalence settings. FUNDING: WHO, NIAID.
Asunto(s)
Infecciones por VIH , Herpes Genital , Úlcera Péptica , Humanos , Herpesvirus Humano 2 , Herpes Genital/complicaciones , Herpes Genital/epidemiología , Herpes Genital/prevención & control , Úlcera , Sudáfrica/epidemiología , Incidencia , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Vacunación , GenitalesAsunto(s)
Infecciones por VIH , Herpes Genital , Herpes Simple , Humanos , VIH , Cidofovir , Herpes Genital/complicaciones , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Herpes Simple/complicaciones , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Genitales , Herpesvirus Humano 2RESUMEN
OBJECTIVES: To examine innate immunity predictors of HIV-1 acquisition as biomarkers of HSV-2 risk and biological basis for epidemiologically established HIV-1 predisposition in HSV-2 infected women. METHODS: We analysed longitudinal samples from HIV-1 negative visits of 1019 women before and after HSV-2 acquisition. We measured cervical and serum biomarkers of inflammation and immune activation previously linked to HIV-1 risk. Protein levels were Box-Cox transformed and ORs for HSV-2 acquisition were calculated based on top quartile or below/above median levels for all HSV-2 negative visits. Bivariate analysis determined the likelihood of HSV-2 acquisition by biomarker levels preceding infection. Linear mixed-effects models evaluated if biomarkers differed by HSV-2 status defined as negative, incident or established infections with an established infection cut-off starting at 6 months. RESULTS: In the cervical compartment, two biomarkers of HIV-1 risk (low SLPI and high BD-2) also predicted HSV-2 acquisition. In addition, HSV-2 acquisition was associated with IL-1ß, IL-6, IL-8, MIP-3α, ICAM-1 and VEGF when below median levels. Systemic immunity predictors of HSV-2 acquisition were high sCD14 and IL-6, with highest odds when concomitantly increased (OR=2.23, 1.49-3.35). Concomitant systemic and mucosal predictors of HSV-2 acquisition risk included (1) serum top quartile sCD14 with cervical low SLPI, VEGF and ICAM-1, or high BD-2; (2) serum high IL-6 with cervical low VEGF and ICAM-1, SLPI, IL-1ß and IL-6; and (3) serum low C reactive protein with cervical high BD-2 (the only combination also predictive of HIV-1 acquisition). Most cervical biomarkers were decreased after HSV-2 acquisition compared with the HSV-2 negative visits, with incident infections associated with a larger number of suppressed cervical biomarkers and lower serum IL-6 levels compared with established infections. CONCLUSIONS: A combination of systemic immunoinflammatory and cervical immunosuppressed states predicts HSV-2 acquisition. A persistently suppressed innate immunity during incident HSV-2 infection may add to the increased HIV-1 susceptibility.
Asunto(s)
Infecciones por VIH , Seropositividad para VIH , Herpes Genital , Femenino , Humanos , Herpes Genital/epidemiología , Herpes Genital/complicaciones , Herpesvirus Humano 2 , Infecciones por VIH/complicaciones , Molécula 1 de Adhesión Intercelular/metabolismo , Interleucina-6 , Seroconversión , Factor A de Crecimiento Endotelial Vascular/metabolismo , Receptores de Lipopolisacáridos , Seropositividad para VIH/complicaciones , Inmunidad Innata , BiomarcadoresRESUMEN
BACKGROUND: Herpes simplex virus (HSV) has been the leading cause of genital ulcer syndrome (GUS) in South Africa for more than a decade, and acyclovir therapy is incorporated into syndromic management guidelines. We conducted surveillance at 3 sentinel sites to define the common sexually transmitted etiologies of GUS and to determine whether current syndromic management is appropriate. Secondary objectives of surveillance were to determine the seroprevalence of coinfections (HIV, syphilis, HSV-2) in persons presenting with GUS. METHODS: Consecutive, consenting adult men and women presenting with visible genital ulceration were enrolled between January 1, 2019, and December 31, 2020. Genital ulcer swab and blood specimens were collected and transported to a central sexually transmitted infection reference laboratory in Johannesburg. RESULTS: Among 190 participants with GUS, HSV-2 was the most frequently detected ulcer pathogen (49.0%; 95% confidence interval [CI], 41.9%-56.1%). The relative prevalence of the second most common ulcer-derived pathogen, Treponema pallidum, was 26.3% (95% CI, 20.5%-33.1%), with 90% of primary syphilis cases having a positive rapid plasma reagin (RPR) titer. Male sex was independently associated with primary syphilis compared with herpetic ulcers, after adjusting for the effect of casual sex partners and other exposures (adjusted odds ratio, 3.53; 95% CI, 1.35-9.21; P = 0.010). The overall HIV prevalence among participants was 41.3% (78 of 189; 95% CI, 34.2%-48.6%). CONCLUSIONS: Herpes simplex virus 2 remains the predominant cause of GUS, justifying the continued use of acyclovir in syndromic guidelines. Adequate supplies of benzathine penicillin G for syphilis treatment are essential at primary health care level, in addition to the provision of syphilis and HIV risk reduction services.
Asunto(s)
Infecciones por VIH , Herpes Genital , Herpes Simple , Enfermedades de Transmisión Sexual , Sífilis , Aciclovir/uso terapéutico , Adulto , Femenino , Genitales , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Herpes Genital/complicaciones , Herpes Genital/tratamiento farmacológico , Herpes Genital/epidemiología , Herpesvirus Humano 2 , Humanos , Masculino , Estudios Seroepidemiológicos , Enfermedades de Transmisión Sexual/complicaciones , Sudáfrica/epidemiología , Sífilis/complicaciones , Sífilis/tratamiento farmacológico , Sífilis/epidemiología , Úlcera/tratamiento farmacológico , Úlcera/epidemiología , Úlcera/etiologíaRESUMEN
BACKGROUND: Adolescents and young adults are responsible for most new genital herpes virus infections. Historically, primary genital herpes infections were thought to be caused by herpes simplex virus (HSV) type 2, however, recent studies suggest that up to 50% of incident episodes of genital herpes are caused by HSV type 1. CASE: In this case report we present an 18-year-old G1P0010 female who presented with a primary genital HSV type 1 outbreak that resulted in sepsis secondary to Streptococcus pyogenes bacteremia. SUMMARY AND CONCLUSION: Complications that might arise from HSV include encephalitis, Bell's palsy, aseptic meningitis, hepatitis, pneumonitis, sacral radiculitis, viremia, and superimposed bacterial infections. HSV infections are rarely associated with these complications; however, physicians should be aware of sepsis secondary to bacteremia as a possible complication of primary genital HSV infections when treating immunocompetent adolescents.
Asunto(s)
Bacteriemia , Herpes Genital , Herpesvirus Humano 1 , Sepsis , Adolescente , Bacteriemia/tratamiento farmacológico , Femenino , Genitales , Herpes Genital/complicaciones , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Humanos , Streptococcus pyogenes , Adulto JovenRESUMEN
Reproductive tract infections have long been hypothesized to be risk factors for development of uterine fibroids, but few studies have investigated the issue. In our 2016 cross-sectional analysis from the Study of Environment, Lifestyle and Fibroids (2010-2018), a large Detroit, Michigan, community-based cohort study of 23- to 35-year-old African-American women with ultrasound fibroid screening, we found no association between a very prevalent reproductive tract infection, herpes simplex virus type 2 (HSV-2), and fibroids. With prospective data from the cohort (ultrasounds performed every 20 months over 5 years), we examined HSV-2's associations with fibroid incidence (among 1,208 women who were fibroid-free at baseline) and growth (among women with fibroids at baseline or diagnosed during the study). Using Cox proportional hazards models, we computed adjusted hazard ratios and 95% confidence intervals for fibroid incidence comparing HSV-2-seropositive women with HSV-2-seronegative women. The influence of HSV-2 infection on growth was assessed on the basis of the difference in fibroid size between successive ultrasounds (1,323 growth measures) using a linear mixed model, estimating the percent difference in growth scaled to 18 months. HSV-2 seropositivity was not associated with fibroid incidence (adjusted hazard ratio = 0.88, 95% confidence interval: 0.69, 1.12) or growth (estimated growth difference = 3.1%, 95% confidence interval: -5.8, 13.0). Women can be reassured that HSV-2 infection is unlikely to increase their risk of fibroid-related health problems, given these longitudinal measures.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Herpes Genital/epidemiología , Herpesvirus Humano 2 , Leiomioma/epidemiología , Neoplasias Uterinas/epidemiología , Adulto , Estudios Transversales , Femenino , Herpes Genital/complicaciones , Herpes Genital/etnología , Humanos , Incidencia , Leiomioma/etnología , Leiomioma/virología , Michigan/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Estudios Seroepidemiológicos , Ultrasonografía , Neoplasias Uterinas/etnología , Neoplasias Uterinas/virología , Adulto JovenAsunto(s)
Hemorragia Gastrointestinal/virología , Hepatitis Viral Humana/virología , Herpes Genital/virología , Herpesvirus Humano 1/patogenicidad , Fallo Hepático Agudo/virología , Anciano , Biopsia , Resultado Fatal , Fiebre/etiología , Hemorragia Gastrointestinal/diagnóstico , Hepatitis Viral Humana/diagnóstico , Herpes Genital/complicaciones , Herpes Genital/diagnóstico , Humanos , Fallo Hepático Agudo/diagnóstico , Masculino , Insuficiencia Multiorgánica/etiologíaRESUMEN
Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, and extensive deforestation have created an ideal environment for a viral spread with unknown and multiple shedding routes. Many viruses can infect the male reproductive tract, with potential adverse consequences to male reproductive health, including infertility and cancer. Moreover, some genital tract viral infections can be sexually transmitted, potentially impacting the resulting offspring's health. We have summarized the evidence concerning the presence and adverse effects of the relevant viruses on the reproductive tract (mumps virus, human immunodeficiency virus, herpes virus, human papillomavirus, hepatitis B and C viruses, Ebola virus, Zika virus, influenza virus, and coronaviruses), their routes of infection, target organs and cells, prevalence and pattern of virus shedding in semen, as well as diagnosis/testing and treatment strategies. The pathophysiological understanding in the male genital tract is essential to assess its clinical impact on male reproductive health and guide future research.
Asunto(s)
Salud Reproductiva/tendencias , Virosis/complicaciones , Hepatitis B/complicaciones , Hepatitis B/fisiopatología , Hepatitis C/complicaciones , Hepatitis C/fisiopatología , Herpes Genital/complicaciones , Herpes Genital/fisiopatología , Humanos , Masculino , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/fisiopatología , Virosis/fisiopatología , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/fisiopatologíaRESUMEN
Although acute retinal necrosis (ARN) and optic neuritis following herpes encephalitis are known causes of acute visual impairment associated with herpes simplex virus (HSV) infection, there have been no reports of parainfectious optic neuritis associated with genital HSV type 2 (HSV-2) infection. A young Japanese woman developed unilateral optic neuritis 7 days after the onset of genital HSV-2 infection. Ophthalmologic examination revealed no findings suggestive of ARN and both multiple sclerosis and neuromyelitis optica were ruled out by the brain images and serum antibody testing. An oral steroid therapy improved her symptoms. Here, we describe the first case of parainfectious optic neuritis associated with genital HSV-2 infection.
Asunto(s)
Herpes Genital/complicaciones , Herpes Genital/diagnóstico por imagen , Herpesvirus Humano 2/aislamiento & purificación , Neuritis Óptica/diagnóstico por imagen , Neuritis Óptica/etiología , Adulto , Antiinflamatorios/administración & dosificación , Femenino , Herpes Genital/tratamiento farmacológico , Humanos , Neuritis Óptica/tratamiento farmacológico , Prednisolona/administración & dosificaciónRESUMEN
Pubic hair grooming is common in many countries, but little is known about this practice in Africa. Grooming has been positively associated with self-reported sexually transmitted infections (STIs). This study aimed to investigate the prevalence and safety of pubic hair grooming in two South African settings. In KwaZulu-Natal province, 1218 women participating in the Evidence for Contraceptive Options and HIV Outcomes Trial completed an interviewer-administered questionnaire on pubic hair grooming practices, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and herpes simplex virus type 2 (HSV-2). Pubic hair removal was reported by 705 (58.2%) of women. Common areas for grooming were the pubis (n = 616, 99.4%), vagina/perineum (n = 529, 85.3%) and inner thigh (n = 255, 41.1%). Half (n= 361, 51.4%) removed some or all of their pubic hair at least monthly and 59 (8.4%) once a week or more often. Common side effects reported included itching (n = 439, 77.1%) and pimples and blisters (n = 249, 43.9%). A quarter (n = 173, 24.5%) of groomers had a positive result for either or both of CT and NG compared to a fifth (n = 98, 19.4%) of non-groomers (p-value < 0.033). There was no difference between the groups for HSV-2. After adjusting for age and having more than one sex partner, groomers were significantly more likely to have CT or NG than non-groomers (OR: 1.31; 95% CI: 1.19-1.45). Similarly, those who experienced hair removal-related complications had 1.26 times the odds of testing positive for CT or NG (95% CI: 1.03-1.54). The practice of pubic hair removal is common and reporting of side effects is high in this population. These injuries could put women at a higher risk of STIs.
Asunto(s)
Infecciones por Chlamydia/complicaciones , Genitales Femeninos/lesiones , Genitales Masculinos/lesiones , Gonorrea/complicaciones , Remoción del Cabello/efectos adversos , Herpes Genital/complicaciones , Conducta Sexual/estadística & datos numéricos , Adulto , Animales , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis , Estudios Transversales , Femenino , Gonorrea/epidemiología , Gonorrea/microbiología , Herpes Genital/epidemiología , Herpesvirus Humano 2 , Humanos , Laceraciones/microbiología , Masculino , Neisseria gonorrhoeae , Prevalencia , Parejas Sexuales , Enfermedades Bacterianas de Transmisión Sexual/complicaciones , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Enfermedades Bacterianas de Transmisión Sexual/microbiología , Sudáfrica/epidemiologíaRESUMEN
Herpes Simplex Virus (HSV) is the leading cause of genital ulcers worldwide. In Human Immunodeficiency Virus (HIV) co-infected individuals, rare hypertrophic pseudo-tumoral forms have been described as simulating squamous cell carcinoma or other viral infections such as those caused by Varicella zoster, Molluscum contagiosum and HPV induced lesions. Here, we report a case of hypertrophic genital herpes in an HIV-infected patient effectively treated with surgery and topical 5% imiquimod after the recurrence of lesions. A 45-year-old woman, HIV-positive for 17 years and on regular antiretroviral therapy, presented with a painful 2cm vulvar sessile lesion, a 1cm ulcerated lesion on the clitoral hood, and a slightly elevated lesion in the middle third of the tongue. Excisional biopsy and surgical removal of lesion were performed for histopathological exam. Histopathology of genital lesions showed evidence of chronic lymphoplasmacytic inflammation, intense ulcerated plasmacytosis, and squamous cells displaying HSV cytopathogenic effect. After three months, the patient presented with a new ulcerated perineal lesion. Histopathology showed evidence of chronic ulcerative-vegetative herpetic dermatitis. Consequently, topical 5% imiquimod was administered with successful results. Relapsing character and atypical genital disease evolution with an exophytic pseudotumoral injury have been noted in patients co-infected with HIV and HSV, necessitating anatomopathological recognition for diagnostic confirmation and exclusion of malignancy. Local immunotherapy should be considered as treatment approach.
Asunto(s)
Antivirales/uso terapéutico , Coinfección , Infecciones por VIH/complicaciones , Herpes Genital/tratamiento farmacológico , Herpes Genital/patología , Imiquimod/uso terapéutico , Femenino , Herpes Genital/complicaciones , Herpes Genital/diagnóstico , Humanos , Hipertrofia , Persona de Mediana Edad , Úlcera/patología , Vulva/patologíaRESUMEN
Introduction: Herpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2), but may also be due to genital HSV type 1 (HSV-1), which has less frequent recurrent episodes than HSV-2. The global burden of GUD has never been quantified. Here we present the first global and regional estimates of GUD due to HSV-1 and HSV-2 among women and men aged 15-49 years old. Methods: We developed a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection, informed by a literature search for data on model parameters. We considered both diagnosed and undiagnosed symptomatic infection. This model was then applied to existing infection estimates and population sizes for 2016. A sensitivity analysis was carried out varying the assumptions made. Results: We estimated that 187 million people aged 15-49 years had at least one episode of HSV-related GUD globally in 2016: 5.0% of the world's population. Of these, 178 million (95% of those with HSV-related GUD) had HSV-2 compared with 9 million (5%) with HSV-1. GUD burden was highest in Africa, and approximately double in women compared with men. Altogether there were an estimated 8 billion person-days spent with HSV-related GUD globally in 2016, with 99% of days due to HSV-2. Taking into account parameter uncertainty, the percentage with at least one episode of HSV-related GUD ranged from 3.2% to 7.9% (120-296 million). However, the estimates were sensitive to the model assumptions. Conclusion: Our study represents a first attempt to quantify the global burden of HSV-related GUD, which is large. New interventions such as HSV vaccines, antivirals or microbicides have the potential to improve the quality of life of millions of people worldwide.