Herpes Labialis, Chlamydophila pneumoniae, Helicobacter pylori, and Cytomegalovirus Infections and Risk of Dementia: The Framingham Heart Study.

BACKGROUND: An association between chronic infectious diseases and development of dementia has been suspected for decades, based on the finding of pathogens in postmortem brain tissue and on serological evidence. However, questions remain regarding confounders, reverse causality, and how accurate, reproducible and generalizable those findings are. OBJECTIVE: Investigate whether exposure to Herpes simplex (manifested as herpes labialis), Chlamydophila pneumoniae (C. pneumoniae), Helicobacter pylori (H. pylori), and cytomegalovirus (CMV) modifies the risk of dementia in a populational cohort. METHODS: Questionnaires regarding incidence of herpes infections were administered to Original Framingham Study participants (n = 2,632). Serologies for C. pneumoniae, H. pylori, and CMV were obtained in Original (n = 2,351) and Offspring cohort (n = 3,687) participants. Participants are under continuous dementia surveillance. Brain MRI and neuropsychological batteries were administered to Offspring participants from 1999-2005. The association between each infection and incident dementia was tested with Cox models. Linear models were used to investigate associations between MRI or neuropsychological parameters and serologies. RESULTS: There was no association between infection serologies and dementia incidence, total brain volume, and white matter hyperintensities. Herpes labialis was associated with reduced 10-year dementia risk (HR 0.66, CI 0.46-0.97), but not for the duration of follow-up. H. pylori antibodies were associated with worse global cognition (ß -0.14, CI -0.22, -0.05). CONCLUSION: We found no association between measures of chronic infection and incident dementia, except for a reduction in 10-year dementia risk for patients with herpes labialis. This unexpected result requires confirmation and further characterization, concerning antiviral treatment effects and capture of episodes.

Psychologic factors in the development of facial dermatoses.

In medical literature, as well as in daily practice, some common facial dermatoses are considered to be influenced or triggered by emotional factors. The main damager is stress, but depression and anxiety may play a role, among other factors. Some patients may experience a vicious cycle: Their facial dermatosis is triggered or worsened by stress, and in turn, the exacerbation itself is a major stressogenic stimulus. It appears that clinical wisdom and experience preceded clinical investigation in this field. Although patients testify that their emotional state may sometimes influence their facial condition, only limited experimental data exist so far, and only a few facial dermatoses were investigated.

Understanding recurrent herpes labialis management and impact on patients' quality of life: the HERPESCOPE study.

Herpes labialis (HL) is a common and benign disease. However, frequent episodes can impair quality of life (QoL) and impact healthcare consumption. The aim of this survey was to understand patients' profiles, behavior, treatment and quality of life, using web-based questionnaires administered in the USA and in France. A total of 1002 and 1005 patients completed it, respectively. Self-diagnosis of HL is usually made at the very start of the prodromal phase. In the USA, 41% of patients seek medical advice at some point and they are often prescribed a topical antiviral drug (AVD) associated with an over-the-counter drug. Those who treat HL by themselves purchase mainly non-antiviral topical drugs. In France, the treatment is almost identical (topical AVD) whether patients seek medical advice (32%) or not. In both countries, patients with 6 or more annual episodes often go to the doctor and use systemic AVD. Continuous treatment is prescribed to 55% and 35% of patients with at least 4 annual episodes, in the USA and France respectively. Sick leaves are delivered to 33% and 14% of patients, respectively. QoL is significantly impaired in a majority of patients, all the more so when HL episodes are more frequent.

Reducing the stigma of herpes simplex virus infection: lessons from an online video contest.

BACKGROUND: Herpes simplex virus (HSV) is one of the most common sexually transmisible infections worldwide. HSV-associated stigma negatively impacts emotional and sexual health, suggesting a need for novel approaches to reducing stigma. The aims of this study were to describe the range of destigmatising strategies used by the public in brief online videos, and to describe videos that were successful or unsuccessful in creating a destigmatising message. METHODS: A thematic content analysis was performed on 103 publicly produced YouTube videos designed to destigmatise HSV infection for an Australian online contest. RESULTS: Five destigmatising strategies were identified: providing information, normalising through familiarity, promoting disclosure, negating a negative perception and expressing moral indignation. Most videos employed multiple strategies. Regarding the degree of destigmatisation achieved, videos were coded as unsuccessful, successful, mixed or neutral. Unsuccessful and successful videos often employed the same strategies, but differed in their ability to balance positive and negative messages about HSV and to manage affective content. Some videos were successful despite not providing information about HSV. Mixed videos were appreciated differently in different contexts, and the use of humour was especially problematic. Neutral videos tended to exclusively provide information while avoiding affective content. CONCLUSIONS: Efforts to reduce HSV-associated stigma may be unsuccessful and may even perpetuate stigma. Special attention must be paid to balance and to affective content, specifically humour, when attempting to convey a destigmatising message. Doing so may help reduce the role stigma plays as a barrier to appropriate care for patients with HSV infection.

A survey on the prevalence of orofacial herpes in France: the INSTANT Study.

Orofacial herpes is a common benign disease suspected to significantly impact the quality of life (QOL) of affected subjects. The objective of this population-based study was to evaluate the annual prevalence of orofacial herpes in France, its epidemiology, and its impact on QOL. Face-to-face home interviews were conducted among a random sample of 10,263 adults. A screening questionnaire identified subjects with a history of orofacial herpes (or cold sore) during the past 12 months; then, subjects with herpes completed another questionnaire to further describe their disorder and its management, and the SF-36 questionnaire to assess their QOL. The annual prevalence of orofacial herpes was 14.8% (95% confidence interval 14.03; 15.47); it was significantly higher in women than in men (P < .001) and decreased with age (P < .001). Among subjects with herpes, only 23% were aware of their disease. Tiredness and emotional stress were the main triggering events. There was no detectable difference between subjects with herpes and controls on SF-36 scores; however, when compared with subjects with 1 to 5 episodes per year, subjects with 6 or more episodes per year had significantly lower QOL scores.

[Herpes as viewed by the French: result of a survey conducted on 10,000 persons]. / L'herpès vu par les Français: résultat d'une enquête portant sur 10,000 personnes.

Herpes is a viral infection which increases, specifically genital herpes. The aim of this survey was to assess the perception of herpes in the general population and in patients with herpes in France using a self-administered questionnaire. A total of 10,000 persons answered the questionnaire among which 128 patients presented herpes. This study showed that only 5% of the French population knew that herpes was a viral infection, and 7% a sexually transmitted disease. Among patients with genital herpes only 34% indicated a sexual relationship and a mode of contamination. The interference with sexual and social life is important. Development of information and communication on herpes appears crucial.

Preliminary evidence for Herpes labialis recurrence following experimentally induced disgust.

BACKGROUND: After primary orofacial infection with the herpes simplex virus (type 1, HSV-1), up to 40% of HSV seropositive subjects suffer recurrent herpes infections which are characterized by painful erosions of the involved skin mainly around the lips (herpes labialis). Besides various other factors, there is growing evidence suggesting that psychosocial factors might trigger HSV. The present study was designed to investigate modulation of recurrent HSV infection by experimentally induced emotional distress. METHODS: Among patients with herpes labialis (n = 91), subjects who showed recurrent HSV infection (>5 acute infections/year) and who reported to suffer from HSV symptoms exclusively after confrontation with dirty dishes, i.e. dirty plates or dirty glasses were selected by standardized interview. Subjects (n = 20) were randomly assigned to two treatment groups. The experimental group (n = 10) was first exposed to 5 slides showing dirty glasses and subsequently to the glasses previously presented on the slides in vivo. The control group (n = 10) was exposed to neutral slides and neutral objects. In order to determine the proportion of leukocyte subpopulations and concentrations of tumor necrosis factor alpha (TNF-alpha), blood samples were collected 15 min before as well as 40 min and 48 h after stimulus presentation. Saliva cortisol was obtained 45, 20, 15 and 1 min before and 1, 10, 20 and 30 min after stimulus confrontation. RESULTS: Medical examination of the volunteers 48 h after the experiment indicated that four experimental subjects showed HSV-1 symptoms while not a single herpetic infection could be determined in the control subjects (p = 0.033). Moreover, significantly elevated concentrations of TNF-alpha were observed in the experimental, but not in the control group. No significant alterations of the number of leukocyte subpopulations were found 30 min or 48 h after stimulus presentation. Further, cortisol concentrations were found to be unchanged after the treatment. CONCLUSIONS: The present findings suggest that experimentally induced emotional stress such as disgust may be associated with reactivation of HSV.

Human doctoring: bringing authenticity to our care.

Increasingly, doctors are looking for ways to treat the whole patient--mind, body, and spirit, disease and illness. To accomplish this, doctors must establish authentic relationships with their patients--that is, relationships in which the life experiences and knowledge of both participants are acknowledged and respected. Physicians must be aware of everything they bring, both as persons and as professionals, to every clinical encounter. In this article, the authors discuss a hypothetical case of a teenaged girl suffering from recurrent coldsores and the possible ways her physician might handle her case. They analyze the differences among the three scenarios, using them to highlight ways physicians can work to achieve authentic and mutually beneficial relationships with the people in their care.

Immune, stress, and mood markers related to recurrent oral herpes outbreaks.

This was a prospective and longitudinal study designed to compare daily mood states and weekly changes in plasma levels of immune and neuroendocrine markers with recurrent herpes labialis lesion recurrences during a 3-month period among 9 subjects. Results from a paired t test showed that there was a significant decrease in plasma levels of natural killer cells and serum levels of epinephrine from the week before recurrent herpes labialis lesion occurrence (T1,9 = 2.70; p < 0.05) to the week of recrudescence (T1,9 = 2.41; p < 0.05). On the other hand, in the week before recrudescence the number of natural killer cells was 58 units higher than the overall group mean for natural killer cell level (227 units). In the week before outbreak, elevated natural killer cell numbers were associated with a mood of discontentment (r = 0.64; p = 0.05). Elevated levels of epinephrine averaged across the 12 weekly blood draws were significantly correlated with higher scores on affect intensity (r = 0.72; p < 0.05). This study provides new data on the pattern of changes in stress, mood states, and immune and neuroendocrine markers associated with the recurrence of perioral herpes lesions. Putative mechanisms linking neuroendocrine and immune function are discussed.

Patient recognition of recrudescent herpes labialis: a clinical and virological assessment.

OBJECTIVES: The purpose of this study was to ascertain how accurate the general public was at diagnosing the condition of recrudescent herpes labialis. METHODS: An advertisement was placed in a local newspaper inviting patients to attend the Oral Medicine Clinic as soon as they thought they developed the clinically evident stage of herpes labialis. At the clinic, patients were examined to confirm the clinical presence of herpes labialis and also had a swab of the lesion(s) taken for virus culture. Virus culture was by the HEP-2 culture technique capable of detecting both herpes simplex Type 1 and herpes simplex Type 2. Patients also completed a detailed questionnaire concerning their knowledge of herpes labialis. RESULTS: In total, 41 patients attended for screening. The findings were that all patients had clinical herpes labialis, and herpes simplex virus was isolated in 96% of cases. In contrast, in only about 50% of cases were patients aware that their herpes labialis was caused by a virus. CONCLUSIONS: The general public are very good at recognizing herpes labialis lesions but need to be given more information about their infectivity.

Stress as a precipitating factor in subjects with recurrent herpes labialis.

The model of recurrent herpes labialis was selected to evaluate the role played by stress in increasing susceptibility to illness. Initially, 35 paid volunteers with recurrent herpes were enrolled in the project. Compared with 35 age- and sex-matched controls, this group demonstrated a familial predisposition for recurrent herpes labialis. Eighteen subjects without confounding variables known to precipitate recurrent herpes infections completed a pretested "stress" questionnaire during a dormant and again during an active stage of infection. In the week prior to the appearance of a recurrence, this group experienced increased daily hassles, increased stressful life events, and higher state anxiety. These findings are discussed in the broader context of stress-associated disease with some speculations concerning a possible biologic mechanism, which involves modulations of T-lymphocyte function.