Pseudotumoral herpes genitalis in a woman living with HIV: Diagnosis and treatment challenges.

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.

Seroprevalence and Vaginal Shedding of Herpes Simplex Virus Type 2 in Pregnant Adolescents and Young Women from Morelos, Mexico.

Adolescents and young people are particularly vulnerable to contracting STIs, including HSV-2; furthermore, vaginal shedding of HSV-2 during pregnancy can cause vertical transmission and neonatal herpes. To evaluate the seroprevalence of HSV-2 and vaginal HSV-2 shedding in adolescent and young pregnant women, a cross-sectional study was carried out in 496 pregnant women-adolescents and young women. Venous blood and vaginal exudate samples were taken. The seroprevalence of HSV-2 was determined by ELISA and Western blot. Vaginal HSV-2 shedding was assessed by qPCR of the HSV-2 UL30 gene. The seroprevalence of HSV-2 in the study population was 8.5% (95% CI 6-11), of which 38.1% had vaginal HSV-2 shedding (95% CI 22-53). Young women presented a higher seroprevalence of HSV-2 (12.1%) than adolescents (4.3%), OR = 3.4, 95% CI 1.59-7.23. Frequent alcohol consumption was significantly associated with HSV-2 seroprevalence, OR = 2.9, 95% CI 1.27-6.99. Vaginal HSV-2 shedding is highest in the third trimester of pregnancy, but this difference is not significant. The seroprevalence of HSV-2 in adolescents and young women is similar to that previously reported in other studies. However, the proportion of women with vaginal shedding of HSV-2 is higher during the third trimester of pregnancy, increasing the risk of vertical transmission.

Alta seroprevalencia de sífilis y herpes genital en migrantes en tránsito en Chiapas, México

[RESUMEN]. Objetivos. Determinar la prevalencia de anticuerpos contra Treponema pallidum y virus herpes simple tipo 2 (VHS-2), así como identificar los factores asociados a dichas infecciones entre migrantes en tránsito en Chiapas, México. Métodos. Estudio transversal realizado durante 2021-2022, en tres albergues para migrantes en Chiapas, México. Las personas contestaron un cuestionario y proporcionaron una muestra de sangre para la detección de anticuerpos contra Treponema pallidum y VHS-2. Se calculó la seroprevalencia y se evaluaron los factores asociados mediante pruebas de χ2 y razones de momios. Resultados. Participaron 462 migrantes, con edad promedio de 31,2 años, 56,9 % eran mujeres, 41,1 % provenían de Honduras. La seroprevalencia de VHS-2 fue 29,9 % mientras que la de sífilis fue 4,5 %, siendo mayor en hombres (8,0 %) que en mujeres (1,9 %). El 15,4 % de las embarazadas presentaban anticuerpos contra sífilis. Entre las variables asociadas a sífilis destacan el ser hombre, antecedente de lesiones genitales, así como tener parejas del mismo sexo y la seropositividad a VHS-2. Con relación al VHS-2, factores como ser mujer, edad, escolaridad, dormir en la calle, antecedente de prueba de VIH, debut sexual temprano, número de parejas sexuales y sífilis estuvieron asociados a la infección. Conclusiones. Se encontró una prevalencia elevada de sífilis y VHS-2 entre la población migrante evaluada. La sífilis se confirma como una infección reemergente, incluso en las mujeres. Los migrantes presenta vul- nerabilidades asociadas al comportamiento sexual, por lo que se deben enfocar medidas de prevención, diagnóstico y tratamiento para este grupo poblacional.

[ABSTRACT]. Objectives. To determine the prevalence of antibodies against Treponema pallidum and herpes simplex virus type 2 (HSV-2), and to identify the factors associated with these infections among migrants in transit in Chia- pas, Mexico. Methods. Cross-sectional study conducted during 2021–2022, in three migrant shelters in Chiapas, Mexico. Participants answered a questionnaire and provided a blood sample to detect antibodies against Treponema pallidum and HSV-2. The study calculated seroprevalence and assessed associated factors using Chi-square (χ2) tests and odds ratios. Results. A total of 462 migrants participated, with an average age of 31.2 years; 56.9% were women, and 41.1% came from Honduras. The seroprevalence of HSV-2 was 29.9%; for syphilis it was 4.5%, and it was higher in men (8.0%) than in women (1.9%). Among pregnant women, 15.4% had antibodies against syphi- lis. Notable variables associated with syphilis include being male, having a history of genital lesions, having same-sex partners, and seropositivity to HSV-2. Regarding HSV-2, factors associated with infection included being female, age, schooling, sleeping in the street, a history of HIV testing, early sexual debut, number of sexual partners, and syphilis. Conclusions. A high prevalence of syphilis and HSV-2 was found among the migrant population evaluated. Syphilis is confirmed as a re-emerging infection, even in women. Migrants have vulnerabilities associated with sexual behavior, so prevention, diagnosis, and treatment measures should be focused on this population group.

[RESUMO]. Objetivos. Determinar a prevalência de anticorpos contra Treponema pallidum e vírus herpes simples tipo 2 (HSV-2) e identificar os fatores associados a essas infecções entre migrantes em trânsito por Chiapas, México. Métodos. Estudo transversal realizado nos anos de 2021 e 2022 em três abrigos de migrantes em Chiapas, México. Os participantes preencheram um questionário e forneceram uma amostra de sangue para a dete- cção de anticorpos contra Treponema pallidum e HSV-2. Calculou-se a soroprevalência e avaliaram-se os fatores associados usando testes de χ2 e razões de chances. Resultados. O estudou incluiu 462 migrantes com idade média de 31,2 anos, dos quais 56,9% eram mulhe- res e 41,1% vinham de Honduras. A soroprevalência do HSV-2 foi de 29,9%. A soroprevalência de sífilis, por sua vez, foi de 4,5%, sendo mais alta nos homens (8,0%) do que nas mulheres (1,9%). Os anticorpos contra a sífilis estavam presentes em 15,4% das mulheres grávidas. As principais variáveis associadas à sífilis foram sexo masculino e história de lesões genitais, além de parceiros do mesmo sexo e soropositividade para HSV- 2. Com relação ao HSV-2, fatores como sexo feminino, idade, escolaridade, dormir na rua, história de teste de HIV, iniciação sexual precoce, número de parceiros sexuais e sífilis estavam associados a infecção. Conclusões. A população migrante avaliada apresenta alta prevalência de sífilis e HSV-2. Confirmou-se que a sífilis é uma infecção reemergente, inclusive em mulheres. Os migrantes apresentam vulnerabilidades associadas ao comportamento sexual; portanto, é preciso concentrar medidas de prevenção, diagnóstico e tratamento nesse grupo populacional.

Chronic mucocutaneous anogenital herpes: series of ten cases and literature review.

Anogenital herpes is one of the most prevalent sexually transmitted infections worldwide. It has several clinical manifestations, from cases of primary herpes infection to recurrent forms, among them chronic mucocutaneous herpes. This presentation is rare, characterized by a duration of more than four weeks, usually associated with immunosuppression and resistance to classic anti-herpetic treatment. The present study presents a series of ten cases of chronic mucocutaneous herpes with a discussion about its clinical, laboratory, and therapeutic aspects.

Aspectos epidemiológicos de las infecciones de transmisión sexual en mujeres de la provincia de Santiago de Cuba / Epidemiologic aspects of sexually transmitted infections in women from the province of Santiago de Cuba

Introducción: Las infecciones de transmisión sexual constituyen un relevante problema de salud a nivel mundial; particularmente afectan la salud sexual de las mujeres ocasionando dolencias y efectos muy negativos, como la infertilidad, los embarazos ectópicos y el cáncer cervicouterino. Objetivo: Describir las características epidemiológicas de las infecciones de transmisión sexual relevantes en mujeres de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo en la provincia de Santiago de Cuba de la población femenina que presentó infecciones de transmisión sexual durante el período 2007-2017, detallando cada afección según año, municipio, edad, entre otras variables de interés. Asimismo, se analizaron la frecuencia, las tasas de incidencia, las tendencias y las variaciones temporales. Resultados: Las entidades clínicas predominantes fueron el síndrome de dolor pélvico y la secreción vaginal, en tanto, las menos frecuentes resultaron ser el herpes genital y la blenorragia. En el análisis por cada tipo de infección se observó una mayor afectación en féminas de edades jóvenes. Conclusiones: Las infecciones de transmisión sexual constituyen un serio problema de salud en mujeres de la provincia de Santiago de Cuba, que deviene causa importante de embarazos ectópicos y esterilidad. Sin embargo, se debe mejorar la vigilancia epidemiológica de estas enfermedades, pues existe un marcado subregistro de algunas y, por ende, una inadecuada atención, sobre todo en el sexo femenino.

Introduction: Sexually transmitted infections constitute an outstanding health problem worldwide; they particularly affect the sexual health of women causing ailments and very negative effects as infertility, ectopic pregnancies and cervical uterine cancer. Objective: To describe the epidemiologic characteristics of the outstanding sexually transmitted infections in women from Santiago de Cuba. Methods: A descriptive and retrospective study was carried out in the province of Santiago de Cuba in the female population that presented sexually transmitted infections during 2007-2017, with details of each affection according to year, municipality, age, among other variables of interest. Also, frequency, rates of incidence, tendencies and temporary variations were analyzed. Results: The predominant clinical entities were the pelvic pain syndrome and vaginal secretion, as long as, the less frequent were genital herpes and blennorrhagia. In the analysis for each type of infection a higher affectation was observed in young females. Conclusions: Sexually transmitted infections constitute a serious health problem in women from the province of Santiago de Cuba that becomes important cause of ectopic pregnancies and sterility. However, the epidemiologic surveillance of these diseases should be improved, because there is a marked subrecord of some of them and, therefore, an inadequate care, mainly in the female sex.

HIV and Herpes Simplex Virus Type 2 Incidence Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data.

BACKGROUND: Adolescent motherhood is common in South Africa and occurs against a backdrop of high HIV risk. While childbearing during adolescence may result in social and economic strain that may negatively impact health, there has been limited study of whether adolescent motherhood increases the risk of HIV or herpes simplex virus type 2 (HSV-2) acquisition or engagement in high-risk sexual partnerships. SETTING: Data are from HIV Prevention Trials Network 068, a longitudinal conditional cash transfer study of adolescent girls and young women (age, 13-23) in rural South Africa. METHODS: We used survival analysis to estimate hazard ratios to determine if adolescent motherhood (live birth before 20 years) predicted incident HIV and incident HSV-2 and generalized estimating equations for behavioral risk ratios to determine if adolescent motherhood was associated with transactional sex and age-disparate partnerships. RESULTS: Of 2452 adolescent girls and young women who were HIV negative at baseline, 5% were adolescent mothers; 16% were adolescent mothers by the end of the study period. After controlling for covariates, adolescent motherhood predicted incident HSV-2 acquisition [ adjusted hazard ratios, 1.30; 95% confidence interval (CI): 1.01 to 1.95] but not HIV acquisition ( adjusted hazard ratios, 1.19; 95% CI, 0.76 to 1.86). Adolescent motherhood was also associated with being in an age-disparate partnership (adjusted risk ratio, 1.30; 95% CI: 1.07 to 1.58) but not transactional sex. CONCLUSION: Adolescent motherhood increased the risk of HSV-2 and engagement in age-disparate partnerships, both known risk factors for HIV infection. Sexually transmitted infection screening and/or tailored combination HIV prevention interventions that account for the context of adolescent motherhood are critical to maximize adolescent mothers' long-term health and to meet UNAIDS 95-95-95 targets by 2030.

Tumor-like herpes simplex infection in an HIV patient

Abstract A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.

Tumor-like herpes simplex infection in an HIV patient.

A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.

Herpesvirus encephalitis diagnosed by polymerase chain reaction at the National Institute of Neurology of Mexico.

The frequency of central nervous system infections due to herpesvirus have been studied in various populations; however, studies in Mexican mestizo patients are scant. This paper documents the frequency of herpesvirus encephalitis in Mexican mestizo patients from the National Institute of Neurology and Neurosurgery (NINN) of Mexico. To study the frequency of herpetic viral encephalitis at the NINN in the period from 2004 to 2009. We reviewed clinical records from patients with clinically suspected encephalitis; polymerase chain reaction assays were done for detection of herpesviruses in cerebrospinal fluid (CSF) samples. The total number of patients studied was 502; in 59 (12%), the diagnosis of herpetic encephalitis was confirmed by PCR-based testing of CSF. Of them, 21 (36%) were positive for herpes simplex virus type 1, 15 (25%) for Epstein-Barr virus, 10 (17%) for varicella zoster virus, 8 (14%) for cytomegalovirus, 3 (5%) for human herpesvirus 6, and 2 (3%) for herpes simplex virus 2. Our results show a varied frequency of viral encephalitis in mestizo patients due to herpesviruses in a tertiary neurological center and point out the importance of modern molecular technology to reach the etiological diagnosis in cases of encephalitis.

Viral infections and implications for male reproductive health.

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.

Pharmacological Inhibition of IRE-1 Alpha Activity in Herpes Simplex Virus Type 1 and Type 2-Infected Dendritic Cells Enhances T Cell Activation.

Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections are life-long and highly prevalent in the human population. These viruses persist in the host, eliciting either symptomatic or asymptomatic infections that may occur sporadically or in a recurrent manner through viral reactivations. Clinical manifestations due to symptomatic infection may be mild such as orofacial lesions, but may also translate into more severe diseases, such as ocular infections that may lead to blindness and life-threatening encephalitis. A key feature of herpes simplex viruses (HSVs) is that they have evolved molecular determinants that hamper numerous components of the host's antiviral innate and adaptive immune system. Importantly, HSVs infect and negatively modulate the function of dendritic cells (DCs), by inhibiting their T cell-activating capacity and eliciting their apoptosis after infection. Previously, we reported that HSV-2 activates the splicing of the mRNA of XBP1, which is related to the activity of the unfolded protein response (UPR) factor Inositol-Requiring Enzyme 1 alpha (IRE-1α). Here, we sought to evaluate if the activation of the IRE-1α pathway in DCs upon HSV infection may be related to impaired DC function after infection with HSV-1 or HSV-2. Interestingly, the pharmacological inhibition of the endonuclease activity of IRE-1α in HSV-1- and HSV-2-infected DCs significantly reduced apoptosis in these cells and enhanced their capacity to migrate to lymph nodes and activate virus-specific CD4+ and CD8+ T cells. These findings suggest that the activation of the IRE-1α-dependent UPR pathway in HSV-infected DCs may play a significant role in the negative effects that these viruses exert over these cells and that the modulation of this signaling pathway may be relevant for enhancing the function of DCs upon infection with HSVs.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: abordagem às pessoas com vida sexual ativa / Brazilian Protocol for Sexually Transmitted Infections 2020: approaching sexually active individuals / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: enfoque en las personas con vida sexual activa

Este artigo tem como objetivo apresentar conceitos e práticas clínicas recomendados para a abordagem da pessoa com vida sexual ativa. Esses conceitos são parte integrante das recomendações do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis (IST) publicado pelo Ministério da Saúde do Brasil em 2020. O artigo propõe uma abordagem abrangente da sexualidade para promoção da saúde e apresenta aspectos importantes do processo de comunicação, que deve ocorrer de forma clara, sem preconceitos ou juízos de valor, com foco na saúde sexual e reprodutiva. Destacam-se pontos relevantes acerca do exercício da sexualidade em fases específicas da vida, recomendando avaliação dos riscos e vulnerabilidades, bem como o rastreamento de IST e o uso de preservativos. Dessa maneira, é possível contribuir para que as pessoas possam exercer sua sexualidade de forma plena, responsável e segura.

This article aims to present concepts and clinical practices recommended to approach people with an active sex life. These concepts are an integral part of the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections (STI), published by the Ministry of Health of Brazil in 2020.The article proposes a comprehensive approach to sexuality for health promotion and presents important aspects of the communication process that must develop clearly, without prejudice and judgment, with a focus on sexual and reproductive health. It also highlights relevant points about the exercise of sexuality at specific stages of life, recommending assessment of risks and vulnerabilities, as well as screening for STI and condom use. In this way, it is possible to contribute so that people can exercise their sexuality fully, responsibly and safely.

Este artículo tiene como objetivo presentar los conceptos y las prácticas clínicas recomendados para un abordaje de la persona con una vida sexual activa. Estos conceptos son parte de las recomendaciones contenidas en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual (ITS), publicado por el Ministerio de Salud de Brasil en 2020. El artículo propone un abordaje amplio de la sexualidad para la promoción de la salud. Presenta aspectos importantes del proceso de comunicación, que debe ocurrir con claridad, sin prejuicios y juicios de valor, con un enfoque en la salud sexual y reproductiva. Destaca puntos relevantes sobre el ejercicio de la sexualidad en etapas específicas de la vida, recomendando evaluación de riesgos y vulnerabilidades, así como el rastreo de ITS y el uso de preservativos. De esta forma, es posible contribuir para que las personas puedan ejercer su sexualidad de manera plena, responsable y segura.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam úlcera genital / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause genital ulcers / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan úlcera genital

As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.

Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.

El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.

Vaccines to prevent genital herpes.

Genital herpes increases the risk of acquiring and transmitting Human Immunodeficiency Virus (HIV), is a source of anxiety for many about transmitting infection to intimate partners, and is life-threatening to newborns. A vaccine that prevents genital herpes infection is a high public health priority. An ideal vaccine will prevent both genital lesions and asymptomatic subclinical infection to reduce the risk of inadvertent transmission to partners, will be effective against genital herpes caused by herpes simplex virus types 1 and 2 (HSV-1, HSV-2), and will protect against neonatal herpes. Three phase 3 human trials were performed over the past 20 years that used HSV-2 glycoproteins essential for virus entry as immunogens. None achieved its primary endpoint, although each was partially successful in either delaying onset of infection or protecting a subset of female subjects that were HSV-1 and HSV-2 uninfected against HSV-1 genital infection. The success of future vaccine candidates may depend on improving the predictive value of animal models by requiring vaccines to achieve near-perfect protection in these models and by using the models to better define immune correlates of protection. Many vaccine candidates are under development, including DNA, modified mRNA, protein subunit, killed virus, and attenuated live virus vaccines. Lessons learned from prior vaccine studies and select candidate vaccines are discussed, including a trivalent nucleoside-modified mRNA vaccine that our laboratory is pursuing. We are optimistic that an effective vaccine for prevention of genital herpes will emerge in this decade.

Prevalence of active infection by herpes simplex virus type 2 in patients with high-risk human papillomavirus infection: A cross-sectional study.

The aim is to determine the prevalence of active infection by herpes simplex virus type 2 (HSV-2) among Mexican women with high-risk human papillomavirus (HR-HPV) cervical infection, recruited from public gynecology and colposcopy services. In a cross-sectional study, HSV-2 antibodies, HSV-2 DNA, and HR-HPV DNA were quantified. Significant differences in HSV-2 seroprevalence and HSV-2 active infection rates were found between negative and positive HR-HPV cases. HSV-2 seroprevalence was 28.15% and 16.1% (P = .0001), while HSV-2 active infection rates were 6.83% and 0.62% (P = .001) for positive and negative HR-HPV groups, respectively. The risk of HSV-2 seropositivity was 1.7 times greater for HR-HPV-positive cases (P = .02). Similarly, HR-HPV-positive cases were nine times more likely to have an HSV-2 active infection than HR-HPV-negative cases (P = .03). High HSV-2/h-HPV coinfection rates were observed among women recruited from public gynecology and colposcopy services. The main factors related to an HSV-2 active infection are a history of risky sexual behavior and HR-HPV infection. The prevalence of HSV-2 active infection among positive HR-HPV subjects indicate that these infections constitute an important group of STIs in Mexico.

Presentación atípica anogenital de virus herpes simple en un adulto VIH positivo, manejo exitoso con foscarnet: reporte de caso / Atypical anogenital herpes simple virus infection in an hiv patient, successfully treatment with foscarnet: a case report

Las lesiones anogenitales hipertróficas, pseudotumorales y similares a placas, son presentaciones atípicas del virus herpes simple (VHS). Estas lesiones desarrollan resistencia a los tratamientos y se presentan en inmunocomprometidos, especialmente aquellos con infección por el virus de inmunodeficiencia humana (VIH). Presentamos el caso de un paciente masculino de 38 años de edad, VIH/SIDA, con antecedente de carcinoma escamocelular infiltrante de canal anal, con lesiones múltiples hipertróficas anogenitales y exudativas, a quien se le confirma infección por VHS-1, sin respuesta a aciclovir ni valaciclovir a dosis óptimas, el cual resuelve con 21 días de foscarnet intravenoso. Nuestro caso muestra la importancia de considerar el uso de foscarnet en adultos con infección de VIH y del VHS, que no respondan a tratamiento de primera línea, en un país donde no hay esquemas establecidos de manejo para este tipo de presentaciones y donde existe la limitante de no haber disponibilidad en pruebas para resistencia a antivirales.

Pseudotumoral, hypertrophic, plaque-like anogenital ulcers are atypical features of herpes simplex infection. These ulcers develop treatment resistance and they appear in immunocompromised mainly those infected by human immunodeficiency virus. We present a 38 years-old man with AIDS and personal history of infiltrative squamous carcinoma of anal canal with multiple hypertrophic and exudative ulcers secondary to VHS-1 etiology without response to acyclovir neither valacyclovir at optimal doses but complete answer with 21 days of foscarnet treatment. Our case highlights the role of foscarnet in adults with HIV-HSV coinfection that don't respond to frst line treatment in a country that doesn't have clear treatment recommendations in these cases and with the limitations of absence of antiviral resistance test.

Vegetative chronic genital herpes with satisfactory response to imiquimod.

Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.