Subject(s)
Antiviral Agents , Herpes Genitalis , Herpes Zoster , Herpesvirus 3, Human , Humans , Male , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapy , Herpes Genitalis/pathology , Herpes Genitalis/virology , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Herpes Zoster/pathology , Herpes Zoster/virology , Herpesvirus 3, Human/isolation & purification , Aged , Scrotum/pathology , Scrotum/virology , Penis/pathology , Penis/virologyABSTRACT
BACKGROUND: Cervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions. CASE PRESENTATION: A 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms. CONCLUSION: Herpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment.
Subject(s)
Herpes Genitalis , Herpesvirus 2, Human , Uterine Cervicitis , Humans , Female , Adult , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapy , Herpesvirus 2, Human/isolation & purification , Uterine Cervicitis/virology , Uterine Cervicitis/drug therapy , Uterine Cervicitis/diagnosis , Uterine Cervicitis/microbiology , Magnetic Resonance Imaging , Anti-Bacterial Agents/therapeutic use , Polymerase Chain ReactionABSTRACT
INTRODUCTION: Low-income and middle-income countries (LMICs) have a high burden of herpes simplex virus type 2 (HSV-2) infection, which has been strongly associated with HIV. In 2001, the WHO hosted a workshop to set research priorities for HSV-2 in LMICs. Periodic re-evaluation of research priorities is essential to ensure effective allocation of resources. This study describes the progress made between 2000 and 2020 in addressing the priorities identified in two of the five thematic areas that were the workshop's focus: HSV-2 epidemiology and diagnostics. The remaining areas are addressed in a companion paper. METHODS: A systematic search of MEDLINE, CINAHL, Global Health and Cochrane databases was carried out. Relevant primary and secondary research studies conducted in LMICs, written in English and published from 2000-2020 were included. Two independent researchers screened, identified papers and extracted preidentified variables from study texts. Data were organised into an Excel spreadsheet and analysed using IBM SPSS V.26. RESULTS: Overall, 4445 discrete papers were identified, of which 165 publications were eligible for inclusion. The highest general population HSV-2 prevalence was reported in South and West Africa. Prevalence was higher among women than men and increased with age. HSV-2 prevalence studies among key populations were few, and the majority were in East and South Asia. Cohort studies of HSV-2 incidence among younger populations (mean age=25 years) and HSV-2 infection prevalence in North Africa and the Middle East were few. The most researched topic in HSV-2 diagnostics addressed serological techniques and direct molecular biology. Studies of point-of-care testing were also few. CONCLUSION: HSV-2 research identified in LMICs has mainly addressed the epidemiology and diagnostics priorities identified by the 2001 WHO workshop. Unaddressed priorities include point-of-care testing, antiviral resistance and exploration of HSV-2 epidemiology in neglected geographical settings and population subgroups.
Subject(s)
Developing Countries , Herpes Genitalis , Herpesvirus 2, Human , Female , Humans , Male , Herpes Genitalis/epidemiology , Herpes Genitalis/diagnosis , Herpes Simplex/epidemiology , Herpes Simplex/diagnosis , Herpesvirus 2, Human/isolation & purification , Prevalence , World Health OrganizationABSTRACT
Genital herpes is a chronic, lifelong sexually transmitted viral infection, which can cause recurrent, self-limited genital ulcers. It is caused by herpes simplex virus (HSV) type 1 and type 2 viruses. Genital HSV infection is a very prevalent STI, which causes self-limited, recurrent genital ulcers. Treatment decreases duration of symptoms and signs and can be provided as episodic or suppressive therapy. Genital herpes can have a substantial impact during pregnancy and on sexual health in general. Counseling on natural history, transmission, treatment, and management of sexual partners is an integral part of management of genital herpes.
Subject(s)
Herpes Genitalis , Female , Pregnancy , Humans , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapy , Simplexvirus , Ulcer , Counseling , Primary Health CareABSTRACT
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.
Subject(s)
Herpes Genitalis , Herpesvirus 2, Human , Multiple Organ Failure , Sepsis , Humans , Male , Herpes Genitalis/diagnosis , Herpes Genitalis/complications , Herpes Genitalis/virology , Adult , Herpesvirus 2, Human/isolation & purification , Multiple Organ Failure/virology , Sepsis/virology , Fatal OutcomeABSTRACT
BACKGROUND: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcers in industrialized countries. Herpes zoster (HZ) is an acute, cutaneous viral infection caused by the reactivation of the varicella-zoster virus (VZV). CASE SUMMARY: A 27-year-old male presented with painful vesicles over the trunk for the last 5 days with painful genital erosions for the last 2 days. His spouse also developed painful genital erosions with systemic complaints for the last 2 days. VZV Polymerase Chain reaction (PCR) from trunk vesicles and type-specific anti-HSV antibody from serum were positive from the index case. DISCUSSION: Here, we report an unusual case of co-reactivation of herpes zoster and genitalis in an immunocompetent male. We recommend the use of molecular testing to confirm the diagnosis of VZV or HSV infection in all cases of genital herpes-like lesions to exclude multi-segmental herpes zoster.
Subject(s)
Antiviral Agents , Herpes Genitalis , Herpes Zoster , Herpesvirus 3, Human , Humans , Male , Herpes Genitalis/diagnosis , Herpes Genitalis/virology , Adult , Herpes Zoster/diagnosis , Herpes Zoster/virology , Herpesvirus 3, Human/isolation & purification , Antiviral Agents/therapeutic use , Herpesvirus 2, Human/isolation & purification , Polymerase Chain Reaction , Virus Activation , Sexual Partners , Treatment Outcome , Antibodies, Viral/blood , Acyclovir/therapeutic useABSTRACT
BACKGROUND: Pregnant persons with a primary genital herpes simplex virus (HSV) infection can transfer HSV to the fetus or infant through the placenta or birth canal, which can cause significant infant morbidity or mortality. Primary nongenital infections with HSV-1 or HSV-2 in pregnant persons and the risk of infant infection are not well documented, leaving the clinician to make non-evidence-based decisions on evaluation and treatment in such presentations. CLINICAL FINDINGS: A term newborn was delivered vaginally by a pregnant person with a nongenital HSV-2 infection. The pregnant person's rash first appeared around 32 weeks' gestation, started on their lower back, and terminated on the outer left hip. The rash improved but was still present at time of delivery, and this rash was their first known HSV outbreak. PRIMARY DIAGNOSIS: Prenatal exposure to HSV-2. INTERVENTIONS: Diagnostics included the pregnant person's rash surface culture, immunoglobulin G and immunoglobulin M for HSV-1 and -2; infant surface, cerebral spinal fluid (CSF), and serum HSV-1 and HSV-2 polymerase chain reactions (PCRs), infant CSF studies, blood culture, liver function tests, and treatment with intravenous acyclovir. OUTCOMES: This infant remained clinically well during hospitalization and was discharged home at 5 days of life when CSF, surface, and serum PCRs resulted negative. PRACTICE RECOMMENDATIONS: Risk for infant HSV infection versus parent/infant separation and exposure to invasive procedures and medications should be considered when pregnant persons present with primary versus recurrent nongenital HSV infections. Research is needed for the evaluation and treatment of infants born to pregnant persons with primary nongenital HSV infections in pregnancy.
Subject(s)
Exanthema , Herpes Genitalis , Herpes Simplex , Herpesvirus 1, Human , Pregnancy Complications, Infectious , Pregnancy , Infant , Infant, Newborn , Female , Humans , Herpesvirus 2, Human , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Herpes Simplex/diagnosis , Herpes Simplex/drug therapy , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapyABSTRACT
Herpes simplex virus (HSV) is the leading cause of genital ulcers worldwide. In rare cases, mostly among immunocompromised hosts, HSV infections can present as hypertrophic pseudotumoral forms simulating malignancies or often mistaken as other viral infections, usually resistant to conventional antiviral therapy and often requiring alternative therapeutic approaches. A high level of clinical suspicion is needed. We present a case of woman living with HIV with pseudotumoral vulvar herpes refractory to oral acyclovir, successfully treated with systemic foscarnet and topical imiquimod.
Subject(s)
HIV Infections , Herpes Genitalis , Female , Humans , Herpes Genitalis/diagnosis , Antiviral Agents/therapeutic use , Acyclovir/therapeutic use , Foscarnet/therapeutic use , HIV Infections/drug therapyABSTRACT
BACKGROUND: Sexually transmitted infections (STIs) associated with genital ulcer disease due to herpes simplex virus-2 (HSV-2) are a prominent cause of morbidity and mortality. Serologic screening for HSV-2 is recommended only for individuals with genital herpes symptom history. However, no validated symptom screening tool currently exists. METHODS: Currently asymptomatic adults presenting for routine care at STI clinics in Lima, Peru completed a survey of prior genital herpes symptoms and received HSV-2 serological testing with the Euroimmun Anti-HSV-2 (gG2) ELISA IgG (Lubeck, Germany). A sub-sample of indeterminate results were sent for Western blot confirmatory testing. We assessed associations between past symptoms and anti-HSV-2 positivity and corrected the HSV-2 prevalence by re-classifying indeterminates per Western Blot results. RESULTS: We enrolled 131 participants between July and October 2022. HSV-2 antibody test results found 21.4% positive, 41.2% indeterminate, and 37.4% negative. Excluding indeterminate results, 36.4% were positive. Of participants with no prior symptoms 31.2% tested positive, compared to 35.7% with one prior symptom, 50.0% with 2, and 50.0% with 3+ prior symptoms. Among the sub-sample of indeterminates, 92.6% were confirmed positive by Western Blot, bringing the total estimated proportion of participants with HSV-2 antibodies to 59.5%. Either based on the original classification of HSV-2 antibody status or after incorporation of confirmatory testing results, there was no significant association between symptom history and HSV-2 antibody positivity. CONCLUSIONS: With currently available tests, recommendations to screen individuals based on genital herpes symptom history may not be useful. More discriminatory symptom screening tools or HSV-2 antibody tests with better performance are needed.
Subject(s)
Herpes Genitalis , Herpesvirus 2, Human , Adult , Humans , Herpes Genitalis/diagnosis , Antibodies, Viral , Enzyme-Linked Immunosorbent Assay , GermanyABSTRACT
BACKGROUND: This case report describes the successful use of imiquimod to treat genital herpes in an immunocompetent individual with acyclovir-resistant HSV. CASE REPORT: A 32 year old male patient, presented with asymptomatic non-healing ulcers over the genital region for 2 years. The ulcers initially responded to acyclovir but became persistent after a few months. He also received multiple courses of antibiotics. On examination, the patient had bilateral inguinal lymphadenopathy and multiple painless ulcers over the coronal sulcus. Routine investigations were normal. The patient was treated with oral and intravenous acyclovir but showed no response. He was then started on topical imiquimod cream applied on alternate days. After one week, the patient presented with pain, redness, burning sensation, and fresh ulcer over the glans which were suspected to be imiquimod-induced irritant reaction or ulcer. Imiquimod was withheld for one week and then restarted at a twice-weekly schedule. After 1 month and 7 days of treatment with imiquimod at a twice-weekly schedule, there was healing of the ulcers. CONCLUSION: This case report illustrates the efficacy of imiquimod cream as a topical treatment for genital herpes simplex in an immunocompetent patient who had previously been unresponsive to treatment with acyclovir.
Subject(s)
Herpes Genitalis , Male , Humans , Adult , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapy , Imiquimod/therapeutic use , Ulcer/drug therapy , Acyclovir/therapeutic use , Administration, Intravenous , EmollientsSubject(s)
Coinfection , HIV Infections , Herpes Genitalis , Herpes Simplex , Mpox (monkeypox) , Humans , Herpesvirus 2, Human , HIV Infections/complications , Herpes Genitalis/complications , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapy , Herpes Simplex/complications , Herpes Simplex/diagnosis , Herpes Simplex/drug therapyABSTRACT
Background: The objective of this study was to characterize herpes simplex virus type 1 (HSV-1) epidemiology in Canada. Methods: HSV-1 publications as recent as December 6, 2021 were systematically reviewed, synthesized, and reported following PRISMA guidelines. Meta-analyses and meta-regressions were conducted. Results: HSV-1 measures were extracted from 22 studies and included 32 overall seroprevalence measures (79 stratified), 2 overall proportions of HSV-1 detection in clinically diagnosed genital ulcer disease (2 stratified), and 8 overall proportions of HSV-1 detection in laboratory-confirmed genital herpes (27 stratified). Pooled mean seroprevalence was 19.1% [95% confidence interval (CI): 12.6-26.4%] among healthy children and 51.4% (95% CI: 47.3-55.5%) among healthy adults. Pooled mean seroprevalence among healthy general populations increased with age, with the lowest being 35.7% (95% CI: 29.1-42.6%) among individuals <20 years of age, and the highest being 70.0% (95% CI: 54.8-83.2) among individuals ≥40 years. Seroprevalence increased by 1.02-fold (95% CI: 1.01-1.04) per year. Pooled mean proportion of HSV-1 detection in genital ulcer disease was 30.8% (95% CI: 12.6-52.8%). Pooled mean proportion of HSV-1 detection in genital herpes was 37.4% (95% CI: 29.5-45.6%) and was highest in women and in young persons. Proportion of HSV-1 detection in genital herpes increased by 1.04-fold (95% CI: 1.00-1.08) per year. Conclusions: HSV-1 epidemiology in Canada appears to be shifting toward less oral acquisition in childhood and more genital acquisition in adulthood, particularly among youth. Both HSV-1 seroprevalence and proportion of HSV-1 detection in genital herpes are increasing with time.
Subject(s)
Herpes Genitalis , Herpes Simplex , Herpesvirus 1, Human , Peptic Ulcer , Adolescent , Adult , Child , Female , Humans , Young Adult , Canada/epidemiology , Herpes Genitalis/epidemiology , Herpes Genitalis/diagnosis , Herpes Simplex/epidemiology , Herpes Simplex/diagnosis , Seroepidemiologic Studies , UlcerABSTRACT
Genital herpes (GH) is a sexually transmitted infection causing recurrent, self-limited genital, buttock, and thigh ulcerations. Symptoms range from unrecognized or mild to severe with frequent recurrences. Herpes simplex viruses (HSV) type-1 or type-2 cause GH. HSV establishes latency in sacral ganglia and causes lifelong infection. Viral reactivation leads to genital ulceration or asymptomatic shedding which may lead to transmission. HSV infection during pregnancy can cause fulminant hepatitis and neonatal transmission. Severe and atypical manifestations are seen in immunocompromised people. Guanosine analogs treat symptoms and prevent recurrences, shedding, and transmission. Novel preventive and therapeutic strategies are in development.
Subject(s)
Herpes Genitalis , Herpes Simplex , Herpesvirus 1, Human , Pregnancy , Female , Infant, Newborn , Humans , Herpes Genitalis/drug therapy , Herpes Genitalis/diagnosis , Herpes Genitalis/prevention & control , Herpes Simplex/drug therapy , Recurrence , Herpesvirus 2, HumanABSTRACT
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.
Subject(s)
Chancroid , Herpes Genitalis , Sexually Transmitted Diseases , Syphilis , Humans , Ulcer/diagnosis , Ulcer/epidemiology , Ulcer/etiology , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/etiology , Syphilis/diagnosis , Syphilis/epidemiology , Chancroid/diagnosis , Chancroid/drug therapy , Chancroid/epidemiology , Herpes Genitalis/diagnosis , Herpes Genitalis/complications , Herpes Genitalis/epidemiologyABSTRACT
Importance: Genital herpes is a common sexually transmitted infection caused by 2 related viruses, herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). Infection is lifelong; currently, there is no cure for HSV infection. Antiviral medications may provide clinical benefits to symptomatic persons. Transmission of HSV from a pregnant person to their infant can occur, most commonly during delivery; when genital lesions or prodromal symptoms are present, cesarean delivery can reduce the risk of transmission. Neonatal herpes infection is uncommon yet can result in substantial morbidity and mortality. Objective: To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update on targeted key questions to systematically evaluate the evidence on accuracy, benefits, and harms of routine serologic screening for HSV-2 infection in asymptomatic adolescents, adults, and pregnant persons. Population: Adolescents and adults, including pregnant persons, without known history, signs, or symptoms of genital HSV infection. Evidence Assessment: The USPSTF concludes with moderate certainty that the harms outweigh the benefits for population-based screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. Recommendation: The USPSTF recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons. (D recommendation).
Subject(s)
Herpes Genitalis , Herpesvirus 1, Human , Herpesvirus 2, Human , Mass Screening , Pregnancy Complications, Infectious , Serologic Tests , Adolescent , Adult , Female , Humans , Infant, Newborn , Pregnancy , Herpes Genitalis/diagnosis , Herpes Genitalis/drug therapy , Mass Screening/adverse effects , Mass Screening/psychology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/prevention & control , Serologic Tests/adverse effects , Serologic Tests/methods , Serologic Tests/psychology , Herpes Simplex/diagnosisABSTRACT
This JAMA Patient Page summarizes the US Preventive Services Task Force's recent recommendations on screening for genital herpes infection.
Subject(s)
Herpes Genitalis , Mass Screening , Humans , Advisory Committees , Herpes Genitalis/diagnosisABSTRACT
This systematic review to support the 2023 US Preventive Services Task Force Recommendation Statement on serologic screening for genital herpes summarizes published evidence on the benefits and harms of screening and interventions for genital herpes in asymptomatic sexually active adolescents, adults, and pregnant persons with no clinical history of genital herpes.