Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit?

Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022-2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections.

Incidental diagnosis of mpox virus infection in patients undergoing sexually transmitted infection screening-findings from a study in France.

OBJECTIVES: This study aimed to investigate the prevalence of mpox virus (MPXV) infections in the general population consulting for routine sexually transmitted infections (STIs) in our Marseille public hospital. In fact, the recent worldwide MPXV outbreak mainly impacted men who have sex with men and the prevalence of MPXV infections in the general population remains poorly defined. METHODS: All samples addressed routinely to our microbiological laboratory for STIs between July 1 and October 15, 2022 were screened with MPXV-specific quantitative polymerase chain reaction. RESULTS: A total of 2688 samples from 1896 patients suspected of having STIs were tested and eight (0.4%) patients were incidentally diagnosed with MPXV infection, including six men and two women. MPXV was detected in rectal swabs (n = 2), urine (n = 2), vaginal swabs (n = 2), a urethral swab (n = 1), and a skin swab (n = 1). CONCLUSIONS: This study suggests that some MPXV infections are likely to be underdiagnosed because of their non-specific clinical presentation and/or insufficient clinical knowledge of the disease. Our data showed that systematic screening was particularly useful for detecting MPXV in patients without classic lesions or cases of asymptomatic carriage in patients reporting recent high-risk exposure and in patients presenting no obvious risk factor.

Detección molecular de agentes infecciosos de transmisión sexual en un grupo de hombres sintomáticos y su relación con la conducta sexual / Molecular detection of sexually transmitted agents in a symptomatic group of men and its relationship with sexual behavior

Background: Sexually transmitted infections (STIs) affect sexual and reproductive health of millions of men. Pathogens such as human papillomavirus (HPV), herpes simplex virus type 1 and 2 (HSV-1 y HSV-2), Chlamydia trachomatis,Mycoplasmagenitalium,Mycoplasma hominis and Ureaplasma urealyticum are associated with STIs. Aim: To detect pathogens associated with STIs in symptomatic men and its relationship with sexual behavior. Methodology: DNA was obtained from exfoliated cells of penis from 20 symptomatic men. Pathogens were detected using qPCR or PCR followed by reverse line blot. Sexual behavior was evaluated through a survey. Results: Two or more infectious agents were detected in 50% of samples. U. urealyticum was found in 25%, meanwhile C. trachomatis and M. hominis were detected in 15%. VHS-1, VHS-2 andM. genitalium were detected only in 5%. HPV was found in all samples. The most frequent HPV genotypes were VPH 16, 11, 70. There were no statistical link found between sexual behavior and the studied microorganisms Conclusion: Infectious agents associated with STIs were detected in symptomatic men. HPV was the most frequent pathogen and it was detected in multiple genotypes. It is necessary to increase the sample size to associate significantly the sexual behavior with the results.

Introducción: Las infecciones de transmisión sexual (ITS) afectan la salud sexual y reproductiva de millones de hombres. Patógenos como virus papiloma humano (VPH), virus herpes simplex (VHS-1 y VHS-2), Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis y Ureaplasma urealyticum están asociados a ITS. Objetivo: Detectar patógenos asociados a ITS en hombres sintomáticos y relacionarlos con su conducta sexual. Metodología: Se obtuvo ADN de exfoliado celular del pene de 20 hombres sintomáticos de ITS. Los patógenos fueron detectados por RPC cuantitativa o RPC seguida de reverse line blot. La conducta sexual se evaluó mediante una encuesta. Resultados: En 50% de las muestras se detectaron dos o más agentes infecciosos; U. urealyticum fue detectado en 25% de los casos, mientras que C. trachomatis y M. hominis en 15%. VHS-1, VHS-2 y M. genitalium sólo en 5%. VPH se encontró en todas las muestras y los genotipos más frecuentes fueron VPH 16, 11, 70. No se encontró relación estadística entre los microorganismos estudiados y la conducta sexual de los encuestados. Conclusión: Se detectaron agentes infecciosos asociados a ITS en hombres sintomáticos, siendo VPH el más frecuente y encontrándose en múltiples genotipos. Es necesario aumentar el tamaño de muestra para asociar significativamente la conducta sexual a los resultados.

Comparison Between Knowledge, Behavior and Risk Perception About the STD/AIDS in Medicine and Law Students from PUC-GO / Comparação entre Conhecimento, Comportamento e Percepção de Risco Acerca das DST/AIDS nos Estudantes de Medicina e Direito da PUC-GO

There has been a rise in the incidence of STIs/AIDS in the young Brazilian population; therefore, college students are a major focus for change of risky sexual behaviors. Objective: To analyze knowledge, sexual behavior, and risk perception of students in different years of the medical and law programs at the Pontifical Catholic University of Goiás (PUC-GO), Brazil, with regard to STIs/AIDS. Methods: Administration of anonymous questionnaires to students in their first, third, and last years of the medical and law programs at PUC-GO, using probability-proportional-to-size sampling and with margin of error set at 5%. Results: Medical students answered 201 questionnaires and law students 441 questionnaires. The comparison of both programs revealed that 40.3% of law students and 19.6% of medical students believe that HIV is transmitted through kissing and that 39.9% of law students and 29.3% of medical students believe that this virus is also transmitted through utensils. Consistent condom use was reported by 21.2% of medical students and 30.1% of law students. Medical students have greater risk perception of sexual behavior, and 83.8% claim they have been exposed to STIs; furthermore, 72.6% of law students believe they are at risk. Conclusion: There was an increase in medical students' knowledge about STIs/AIDS throughout the program. Nevertheless, medical students adopt riskier sexual behavior, which is caused by the lower frequency of condom use. Medical students have, however, increased risk perception regarding sexual behavior.

Vem ocorrendo um aumento da incidência de DST/AIDS na população jovem brasileira, assim, os universitários são um importante foco para mudança de comportamento sexual de risco. Objetivo: Analisar o conhecimento, o comportamento e a percepção sexual de risco acerca das DST/AIDS dos estudantes de diversos anos dos cursos de Medicina e Direito da Pontifícia Universidade Católica de Goiás (PUC-GO). Métodos: Aplicação de questionário anônimo a alunos do primeiro, terceiro e último anos dos cursos de Medicina e Direito da PUC-GO, considerando amostra probabilística proporcional e com margem de erro de 5%. Resultados: Foram respondidos 201 questionários pelos estudantes de Medicina e 441 pelos de Direito. Quando comparados os dois cursos, 40,3% dos estudantes de Direto e 19,6% da Medicina consideram que o HIV é transmitido pelo beijo e 39,9% do Direito e 29,3% da Medicina acreditam que esse vírus também seja transmitido por utensílios. O uso consistente do preservativo foi referido por 21,2% dos alunos de Medicina e 30,1% dos de Direito. Os estudantes de Medicina possuem maior percepção sexual de risco, com 83,8% considerando estarem sujeitos às DST; no Direito, 72,6% dos estudantes se consideram sob esse risco. Conclusão: Houve aumento do conhecimento acerca das DST/AIDS pelos acadêmicos de Medicina ao longo do curso. Apesar disso, os acadêmicos de Medicina adotam maior comportamento sexual de risco no que diz respeito à menor frequência de uso do preservativo. Os acadêmicos de Medicina apresentam, entretanto, maior percepção sexual de risco.

Determinantes da detecção de atipias celulares no programa de rastreamento do câncer do colo do útero no Rio de Janeiro, Brasil / Determinants of cellular atypia detection in the cervical screening program in Rio de Janeiro, Brazil

OBJETIVO: Identificar os principais determinantes da detecção de atipias celulares no programa de rastreamento do câncer do colo do útero no Estado do Rio de Janeiro, utilizando os dados do Sistema de Informação do Câncer do Colo do Útero (SISCOLO). MÉTODOS: Uma amostra aleatória de 65 535 exames citopatológicos realizados em 2007 foi obtida do SISCOLO. Essa amostra foi utilizada para construir um modelo de regressão logística que identificasse variáveis com impacto no processo de detecção de atipias celulares. Foi aplicada uma curva ROC para definir o ponto de corte mais adequado para classificar a presença ou a ausência de atipias. Uma análise de sensibilidade foi realizada para avaliar o impacto dos fatores relacionados à organização do serviço no modelo. RESULTADOS: As variáveis preditoras do modelo foram: "laboratório de referência", que reflete a escala de produção do laboratório; "presença de elementos celulares representativos da zona de transformação", que reflete a qualidade da coleta de amostras; "metaplasia escamosa imatura", "presença de outras alterações celulares benignas" e "ausência de microrganismos da microbiota vaginal". A cada acréscimo de 1 ano na idade da mulher, houve redução de 1,7% na chance de detecção de atipias. A curva ROC definiu o ponto de corte de 4,5%, que permitiu a maximização da sensibilidade (73,0%) e especificidade (66,8%) do modelo. A análise de sensibilidade indicou aumento da frequência de atipias de 46,4% quando simulou-se aumento na participação do laboratório de referência (42,9%) e na presença de elementos celulares representativos da zona de transformação (43,0%). CONCLUSÕES: O modelo revelou que a detecção de atipias celulares é fortemente influenciado por fatores organizacionais, como adequabilidade da lâmina e porte do laboratório de análise. Considerando que esses fatores são passíveis de alteração pelos gestores, o modelo pode ser uma importante ferramenta na melhoria dos programas de rastreamento.

OBJECTIVE: To identify the main determinants of cellular atypia detection in the cervical screening program in the state of Rio de Janeiro, Brazil, using data from the Cervical Cancer Information System SISCOLO. METHODS: A random sample of 65 535 Pap smears performed in 2007 was obtained from SISCOLO. This sample was used to produce a logistic regression model to identify variables that impact the process of detecting cellular atypia. A ROC curve was used to define the most suitable cutoff point to classify the presence or absence of atypia. A sensitivity analysis was performed to assess the impact on the model of factors related to the organization of the service model. RESULTS: The variables of impact were "reference laboratory," which reflects laboratory production scale; "presence of cellular elements representative of the transformation zone," which reflects the quality of the sampling; "immature squamous metaplasia," "presence of other benign cellular changes," and "absence of typical vaginal microorganisms." Each increase of 1 year in age was associated with a 1.7% reduction in the chance of detecting atypia. The ROC curve defined a cutoff of 4.5%, which allowed the maximization of the model's sensitivity (73.0%) and specificity (66.8%). Sensitivity analysis indicated an increase of 46.4% in the frequency of atypia following a simulated increase in the number of samples analyzed in the excellence (42.9%) and in the presence of cellular elements representative of the transformation zone (43.0%). CONCLUSIONS: The model revealed that the detection of atypical cells is strongly influenced by organizational factors such as adequate sample collection and laboratory size. Because these factors can be changed by adequate management practices, the proposed model may be an important tool to improve cervical screening programs.

Detección de virus linfotrópico de células T humano-I/II en pacientes con enfermedades de transmisión sexual de Santiago / Human T-lymphotropic virus I/II detection in Chilean patients from Sexually Transmitted Diseases clinics

Background: The human T-lymphotropic virus I (HTLV-I) causes spastic para-paresis and adult T-cell leukemia/lymphoma. It can be sexually transmitted and is highly prevalent in Central and South America. Aim: To study HTLV-I/IIprevalence in serum samples obtained from two Sexually Transmitted Diseases (STD) clinics. Material and Methods: Two hundred serum samples were randomly chosen from two reference STD centers of Santiago. The presence of specific HTLV I/II antibodies was detected by indirect immunofluorescence. Results: The analyzed samples came from participants aged 14 to 70 years. Forty nine percent were women and 76% were heterosexual. Only one of the 200 samples was positive (0.5%) and it came from a 70 year-old woman, housewife, with a stable single partner, a history of recurrent genital ulcers, VDRL (-) and positive serology for herpes simplex virus. Conclusions: The prevalence of HTLV-I found in this group is similar to that demonstrated in other populations in Chile, except for aboriginal populations, and similar to international STD studies. Our data is consistent with the low transmissibility by sexual contact.

Diagnóstico microbiológico de infecciones de transmisión Sexual: Parte II. ITS virales / Microbiologic diagnosis of sexually transmitted diseases: Part II. STD of viral origin

Sexually transmitted diseases are highly prevalent and a public health concern worldwide. Herpes simplex virus (HSV) and human papilloma virus (HPV) are described. The development of rapid, sensible and specific diagnostic assays has been difficult because of their pathogenic features. In the last years, molecular biology based techniques allowed a better and wider range of diagnosis, as in the HPV-cancer association. In this article, standardized diagnostic methodologies for HSV and HPV are reviewed.

Las Infecciones virales de transmisión sexual son altamente prevalentes y constituyen un problema de salud pública en el mundo. Entre los agentes que se contagian por esta vía, se describe acerca de virus herpes simplex (HSV) y virus papiloma humano (HPV). Las características patogénicas de estas infecciones han dificultado la implementación de técnicas diagnósticas rápidas, sensibles y específicas para el diagnóstico clínico habitual. En los últimos años las metodologías diagnósticas sustentadas en la biología molecular han permitido mej orar y ampliar el rango de diagnóstico posible para estos agentes infecciosos y relacionarlos con otras patologías, como es el caso de HPV y cáncer. En el presente artículo se revisan metodologías diagnósticas implementadas para el diagnóstico microbiológico de HSV y de HPV.

Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study

Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality in the state of Ceará, aged 12 to 49 years, were invited to participate. The women were asked about socio-demographic characteristics and genital symptoms, and thereafter examined gynaecologically. Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were: HPV 11.7 percent (95 percent confidence interval: 9.3-14.7), chlamydia 4.5 percent (3.0-6.6), trichomoniasis 4.1 percent (2.7-6.1), gonorrhoea 1.2 percent (0.5-2.6), syphilis 0.2 percent (0.0-1.1), and HIV 0 percent. The prevalence of BV and candidiasis was 20 percent (16.9-23.6) and 12.5 percent (10.0-15.5), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.

Vacunas terapéuticas recombinantes contra el cáncer del cuello uterino / Recombinante therapeutic vaccines against invasive cervical cancer

Durante el desarrollo de cáncer cervicouterino se inducen mecanismos para evadir el sistema inmune, como son la disminución de la expresión de moléculas de antígeno mayor de histocompatibilidad I y la secreción de citocinas por las células tumorales. Como consecuencia de ello, la estimulación de linfocitos T citotóxicos (LTC) y cooperadores (TC), de células asesinas naturales (AN) y macrófagos es muy deficiente. Para inducir una respuesta inmune efectiva contra el tumor, se requiere la estimulación simultánea de múltiples componentes del sistema inmune: por vía sistémica la estimulación de LTC y TC contra epítopos del virus del papiloma humano, y en nivel local. La inducción de la secreción de citocinas por el tumor, para aumentar el procesamiento y la presentación de blancos tumorales, así como la estimulación de los linfocitos, AN y macrófagos que infiltran el tumor

Infecção pelo papilomavírus humano durante a gravidez: o que há de novo? / Human papillomavirus infection during pregnancy: is there anything new?

Sabe-se que a infecção pelo papilomavírus humano (HPV) apresenta ampla distribuição na população, sendo considerada a doença sexualmente transmissível (DST) mais frequente mundialmente. Sua transmissão ocorre por exposição sexual em cerca de 98 porcento dos casos e seu pico de positividade é observado entre mulheres na idade reprodutiva, principalmente nos primeiros anos de atividade sexual. Taxas de prevalência em gestantes variam de 5,5 a 65 porcento, dependendo do meio semiótico utilizado e da população avaliada. Apesar da possibilidade de as modificações fisiológicas da gravidez interferirem na evolução da infecção pelo HPV, ainda é controverso se a gravidez provocaria maior vulnerabilidade a essa infecção. As condutas diagnóstica e terapêutica perante as formas clínica e subclínica da infecção apresentam diferenças entre gestantes e não gestantes. Uma das complicações mais temidas da transmissão materno-fetal do HPV é a papilomatose da laringe, doença extremamente grave, mas felizmente rara. A positividade para o HPV nos recém-nascidos parece ser transitória. A maioria deles elimina o vírus em curto espaço de tempo. Destaca-se que o pré-natal representa excelente oportunidade de contato entre a mulher e o sistema de saúde, principalmente em populações menos favorecidas, possibilitando o rastreamento de lesões pré-neoplásicas e das doenças sexualmente transmitidas, dentre elas a infecção pelo HPV.

It is know that human papillomavirus (HPV) infection has high distribution within the population, being considered the most frequent sexually transmitted disease (STD) worldwide. Its transmission occurs by sexual exposition in 98 percent of the cases and its highest positivity occurs in women's reproductive age, mainly during the first years of sexual activity. Prevalence rates at pregnancy varies from 5,5 to 65 percent, depending on the technique used and the studied population. Although pregnancy physiological modifications can interfere in HPV infection, there are controversies about pregnancy being a cause of more vulnerability to this infection. The diagnostic and therapeutic approaches to the clinical and subclinical forms of infection during pregnancy are different compared to those followed in non-pregnant women. One of the most feared complications of the maternal-fetal transmission is the respiratory papillomatosis, extremely serious, but fortunately rare. The HPV posivity seems to be transitory in the newborn infants. The majority of them eliminate the virus within a short period of time. It is worthwhile to mention that antenatal follow-up represents an opportunity of contact between the woman and the health system, specially in less assisted populations, making possible the screening of intraepithelial lesions and sexually transmitted diseases, among which is the HPV infection.

Seroprevalencias a diversos virus y características sociodemográficas en mujeres que buscan detectarse VIH / Seroprevalence of viruses and sociodemographic characteristics in women seeking detection of AIDS

Objetivos. Estimar la prevalencia de infección para sífilis, herpes simple-2, hepatitis B, y VIH, así como conocer las principales características sociodemográficas y de comportamiento sexual de mujeres de la ciudad de México que acudieron a realizarse la prueba del virus de la inmunodeficiencia humana (VIH). Metodología. Se usó un cuestionario autoaplicado en 454 mujeres, a las cuales se les tomó muestra sanguínea para la detección de marcadores para sífilis, anticuerpos tipo específico para virus de hepatitis B (VHB), y ELISA y Western blot para VIH. Resultados. Las seroprevalancia de anticuerpos contra el Treponema pallidum, VHS-2 VHB, y VIH fueron: 4.6 por ciento, 29.3 por ciento, 3.5 por ciento y 4.0 por ciento, respectivamante. El 46 por ciento de las entrevistadas tenía entre 20 y 29 años de edad; 70 por ciento refirió una escolaridad mínima de secundaria completa; 75 por ciento habían estado sexualmente activas en los últimos tres meses; 56 por ciento al menos una pareja masculina estable; 17 por ciento manifestó al menos una pareja sexual masculina ocasional. El 60 por ciento había tenido alguna relación sexual en los últimos tres meses; de ellas, sólo el 18 por ciento refirió haber utilizado el condón como medida preventiva. Casi el 30 por ciento de las mujeres VIH positivas tenían antecedentes de transfusión sanguínea; el 10.6 por ciento manifestó que alguna de sus parejas sexuales era portador del virus o estaba enfermo de SIDA. Conclusiones: Fue un grupo autoseleccionado cuyos riesgos para VIH/ETS (enfermedades transmisibles sexuales) se encontraron ligados a transfusión sanguínea, baja escolaridad y presencia de pareja sexual seropositiva a VIH. Estos resultados se espera contribuyan al fortalecimiento y el desarrollo de estrategias de control y prevención de infección por VIH/ETS que les permita a estas mujeres identificarse como un grupo en riesgo de adquirir VIH

Aspectos sociodemográficos, epidemiológicos, ginecológicos e obstétricos em mulheres infectadas pelo HTLV-1 no município de Salvador/Bahia / Sociodemographic, epidemiological, gynecological and obstetric in women infected with HTLV-1 in the city of Salvador

O vírus linfotrópico da célula T humana do tipo 1 (HTLV-1) foi o primeiro retrovírus associado à doença humana. As principais características epidemiológicas da infecção são: a)ser mais freqüentes em mulheres; b) aumentar com a idade; c) e ocorrer em determinadas regiões geográficas. Estima-se que 15 a 20 milhões de pessoas estejam infectadas por este vírus no mundo. No Brasil, a cidade de Salvador é considerada o epicentro da infecção, com uma prevalência de 1,7% na população geral e 2% em mulheres. Os dados da literatura são controversos em relação a anormalidades ginecológicas em portadoras do HTLV-1. O objetivo do presente trabalho é descrever e comparar as características sociodemográficas, epidemiológicas e ginecológicas em pacientes infectadas pelo HTLV-1 no Centro de Referência de HTLV da EBMSP/FIOCRUZ em Salvador- Bahia. Trata-se de um estudo transversal descritivo comparativo realizado no período de março a agosto de 2004 com 130 mulheres, sendo 64 portadoras de HTLV-1 e 66, soronegativas. Os testes sorológicos foram ELISA e Western blot. Foram coletados dados ginecológicos e obstétricos, epidemiológicos e sociodemográficos, utilizando questionário padronizado, e foram realizadas colposcopia, citologia oncótica, microflora vaginal e cultura de secreção vaginal. Os testes utilizados para análise estatística foram: ANOVA, Qui-quadrado de Person, exato de Fisher e Kruskall Wallis e regressão logística. Entre as 130 mulheres estudadas, 50,7% eram soronegativas para o HTLV-1 e 49,2% soropositivas, destas 57,8% assintomáticas e 42,1% eram e sintomáticas (mielopatia). Todas as mulheres participantes do estudo tinham um nível de escolaridade baixo e mais freqüente entre as mulheres sintomáticas em relação aos demais grupos. A média da idade foi...

Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and managemenT

Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.