Herpes simplex type 1 versus Herpes simplex type 2 in anogenital herpes; a 10 year study from the Waikato region of New Zealand.

AIM: To determine the proportion of Herpes simplex type 1 vs Herpes simplex type 2, as a cause of anogenital herpes in the Waikato region. We specifically looked for changes in the proportions over time, and for gender or age group associations. METHOD: We undertook a retrospective data-analysis of all anogenital isolates positive for Herpes simplex types 1 or 2 in those greater than and equal to 14 years of age, received at Waikato Hospital Laboratory (Hamilton, New Zealand) over a 10-year period. Around half way through the study period, the test type changed from viral culture to HSV nucleic acid amplification assay. RESULTS: Between 1997 and 2006, 3933 anogenital isolates were positive for either Herpes simplex types 1 or 2. The proportion of type 1 vs type 2 oscillated around 30 to 40% over the 10 years, with no particular trend. Overall, 71% of positive isolates were from females, with 80% of the type 1 isolates from females. Presence of type 1 was inversely proportional to age, accounting for 53% of positive isolates in the <25 year age group, 30% in the 25-35 year group, and 26% in the >35 year group. CONCLUSION: Herpes simplex type 1 is a major contributor to anogenital herpes in the Waikato. Females accounted for the majority of both types and there was a much higher proportion of type 1 seen in the younger age groups. These findings have been reported overseas but this is the first reported New Zealand data.

Swiss recommendations for the management of genital herpes and herpes simplex virus infection of the neonate.

Genital herpes is being recognised as a medical problem of increasing importance. Diagnosis and management are complex. The present recommendations have been established by a multidisciplinary panel of specialists and endorsed by all Swiss medical societies involved in the medical care of such patients. The aim is to improve the care of affected patients, to reduce horizontal and vertical transmission and to diminish the psychosocial burden.

Is HSV serology useful for the management of first episode genital herpes?

BACKGROUND: First episode genital herpes simplex virus (HSV) infections can be classified into three groups, primary genital herpes (no previous exposure to HSV), non-primary first episode (IgG antibody to HSV of the non-presenting type), and first episode with pre-existing IgG HSV antibodies. The use of IgM to classify first episode genital herpes has not been evaluated. OBJECTIVE: To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HSV-1 and HSV-2 IgM antibodies for the diagnosis of first episode genital herpes, when compared with clinical diagnosis. METHODS: Patients with a first clinical episode of genital herpes were recruited. Sera were tested for IgG antibodies to HSV-2 using an indirect enzyme linked immunosorbent assay (ELISA). Equivocal results were resolved by western blot. HSV-1 IgG and IgM and HSV-2 IgM antibodies were detected using western blot. RESULTS: 157 patients were recruited. 31 were excluded (missing data or no detectable antibodies and negative viral isolation). Therefore, 126 patients were included in the analysis. 23 (18.3%) had primary genital herpes, 34 (27.0%) non-primary first episode, and 69 (54.8%) had pre-existing genital herpes. The specificity and PPV of HSV IgM was 100%; the sensitivity was 79% and the NPV 85%. CONCLUSION: IgM HSV serology may be useful in the management of some patients with first episode genital herpes and provide an indication of the source of infection. Drawbacks include the low sensitivity and NPV, lack of availability, IgM antibodies may occasionally be produced in response to recurrent infection and, finally, IgM antibodies may take up to 10 days to develop and last 7-10 days.

Herpes genital na gravidez / Genital herpes in pregnancy

Os autores fazem uma atualizaçÝoda infecçÝo das gestantes pelo herpes vírus simples tipo 2, mostrando a sua fisiopatologia, epidemiologia, classificaçÝo, diagnóstico, conduta obstétrica e uso de aciclovir na gravidez, identificando e discutindo soluçSes para questSes ainda nÝo resolvidas. Face ao aumento progressivo desta afecçÝo, é necessária uma permanente atualizaçÝo, buscando uma diminuiçÝo da morbidade nestas gestantes e, consequentemente, morbidade e mortalidade fetais

Genital herpes during pregnancy: inability to distinguish primary and recurrent infections clinically.

OBJECTIVE: To determine if the signs and symptoms of genital herpes in pregnancy accurately identify primary genital herpes infections using serologic testing for final classification. METHODS: Twenty-three women with clinical signs and symptoms suggestive of primary genital herpes infections in the second and third trimesters of pregnancy were subsequently cultured and tested serologically (for herpes simplex virus type 1 and herpes simplex virus type 2 antibodies) and classified as having true primary (no herpes simplex virus type 1 or type 2 antibodies), nonprimary (heterologous herpes simplex virus antibodies present), or recurrent (homologous antibodies present) infections. RESULTS: Only one of 23 women with clinical illnesses consistent with primary genital herpes virus simplex infections had serologically-verified primary infection. This primary infection was caused by herpes simplex virus type 1. Three women had nonprimary type 2 infections, and 19 women had recurrent infections. Among culture-proven recurrent infections, 12 were caused by herpes simplex virus type 2 and three by herpes simplex virus type 1. Only one infant was born preterm, and no clinically significant perinatal morbidity was observed. CONCLUSION: Correct classification of gestational genital herpes infections can be accomplished only when clinical evaluation is correlated with viral isolation and serologic testing using a type-specific assay. Severe first episodes of genital herpes infections among women in the second and third trimesters of pregnancy are not usually primary infections and are not commonly associated with perinatal morbidity.

Tipificación de cepas de herpes genital / Typing of herpes genitalis strains

Hace algunos años se pensaba que el herpes genital era causado por el virus del herpes simple tipo 2. Actualmente se sabe que la causa de esta unidad puede estar asociada tanto al virus tipo 1 como al tipo 2 de los herpes simples. Con el objetivo de determinar ambos tipos de virus se realizó un estudio de caracterización de cepas, aisladas a partir de muestras tomadas de lesiones genitales en pacientes femeninas, utilizando dos marcadores biológicos y como resultado se presentaron casi con igual frecuencia ambos tipos de virus aunque con ligero predominio del herpes simple tipo 2

Tipificación de cepas de herpes genital / Typing of herpes genitalis strains

Hace algunos años se pensaba que el herpes genital era causado por el virus del herpes simple tipo 2. Actualmente se sabe que la causa de esta unidad puede estar asociada tanto al virus tipo 1 como al tipo 2 de los herpes simples. Con el objetivo de determinar ambos tipos de virus se realizó un estudio de caracterización de cepas, aisladas a partir de muestras tomadas de lesiones genitales en pacientes femeninas, utilizando dos marcadores biológicos y como resultado se presentaron casi con igual frecuencia ambos tipos de virus aunque con ligero predominio del herpes simple tipo 2