Genital herpes in two social groups

Universality and Cultural Diversity in Moral Reasoning and Judgment

Many theories have shaped the concept of morality and its development by anchoring it in the realm of the social systems and values of each culture. This review discusses the current formulation of moral theories that attempt to explain cultural factors affecting moral judgment and reasoning. It aims to survey key criticisms that emerged in the past decades. In both cases, we highlight examples of cultural differences in morality, to show that there are cultural patterns of moral cognition in Westerners' individualistic culture and Easterners' collectivist culture. It suggests a paradigmatic change in this field by proposing pluralist "moralities" thought to be universal and rooted in the human evolutionary past. Notwithstanding, cultures vary substantially in their promotion and transmission of a multitude of moral reasonings and judgments. Depending on history, religious beliefs, social ecology, and institutional regulations (e.g., kinship structure and economic markets), each society develops a moral system emphasizing several moral orientations. This variability raises questions for normative theories of morality from a cross-cultural perspective. Consequently, we shed light on future descriptive work on morality to identify the cultural characteristics likely to impact the expression or development of reasoning, justification, argumentation, and moral judgment in Westerners' individualistic culture and Easterners' collectivist culture.

Can behavior change explain increases in the proportion of genital ulcers attributable to herpes in sub-Saharan Africa? A simulation modeling study

BACKGROUND

The proportion of cases of genital ulcer disease attributable to herpes simplex virus type 2 (HSV-2) appears to be increasing in sub-Saharan Africa.

GOAL

To assess the contributions of HIV disease and behavioral response to the HIV epidemic to the increasing proportion of genital ulcer disease (GUD) attributable to HSV-2 in sub-Saharan Africa.

STUDY DESIGN

Simulations of the transmission dynamics of ulcerative sexually transmitted diseases (STDs) and HIV with use of the model STDSIM.

RESULTS

In simulations, 28% of GUD was caused by HSV-2 before a severe HIV epidemic. If HIV disease was assumed to double the duration and frequency of HSV-2 recurrences, this proportion rose to 35% by year 2000. If stronger effects of HIV were assumed, this proportion rose further, but because of increased HSV-2 transmission this would shift the peak in HSV-2 seroprevalence to an unrealistically young age. A simulated 25% reduction in partner-change rates increased the proportion of GUD caused by HSV-2 to 56%, following relatively large decreases in chancroid and syphilis.

CONCLUSION

Behavioral change may make an important contribution to relative increases in genital herpes.

Herpes simplex virus infections of women and their offspring: implications for a developed society

Herpes simplex virus infections of humans have been known since ancient times. Contemporary society has witnessed a series of devastating manifestations of herpes simplex virus infections--namely, genital herpes simplex virus infection and neonatal herpes simplex virus infection. With the evolution of society, particularly advances in birth control and increasing promiscuity, the seroprevalence of herpes simplex virus type 2 infections has increased worldwide, however, more so in developed societies. As a consequence, individuals of child-bearing age are at risk for either reactivation of herpes simplex virus at termination of gestation or acquisition of a new primary infection at that time. The consequences of vertical transmission of herpes simplex virus from mother to child, resulting in neonatal herpes simplex virus infection, can be devastating. Current efforts, which are directed toward the treatment of neonatal herpes, have established the value of drugs such as vidarabine and acyclovir. However, the real emphasis for future programs is the prevention of herpes simplex virus infections to avoid person-to-person transmission either horizontally or vertically. The development of vaccines directed against herpes simplex virus may be of value toward this end.

Reported herpes-virus-infection, fever and cancer incidence in a prospective study

As soon as the first clinico-epidemiology reports appeared describing an association of herpes virus infection with genital cancer, relevant questions were introduced into an ongoing follow-up of a cohort already being studied for psychosocial risk factors in cancer. The study, which was initiated in 1966, comprised 1353 persons; disease incidence was determined in 1976. Incidences of cancer (including extragenital cancer) were found to be directly related to the reported prevalence of genital herpes symptoms, but were related inversely to extragenital herpes prevalence and to previous fever episodes. With regard to the relatively common incidence of "fever blisters", i.e. facial herpes, attributed to HSV-type 1, the latter findings is less surprising than the strong association of HSV type 2 lesions with overall cancer incidence. This association was particularly noticeable in individuals who had not reported episodes of fever earlier. These findings indicate the predictive role of certain host factors which are possibly related to systematic responses of the organism, including a diminished protection against (latent) herpes genitalis infection (recurrences). Further prospective studies are needed to investigate the proper time-relationship between clinically-overt herpes genitalis and the manifestation of cancer and its possible role in provoking the recurrent eruption of latent infections.

Identification and typing of herpes simplex viruses with monoclonal antibodies

Monoclonal antibodies which reacted with type-specific antigens of herpes simplex virus type 2 or with antigens shared by herpes simplex virus types 1 and 2 were used in an indirect immunofluorescence assay to type virus isolates and to detect viral antigens in cells obtained from herpetic lesions. Complete concordance was obtained for 42 isolates typed by endonuclease restriction analysis of viral DNA and by indirect immunofluorescence with monoclonal antibodies. Examination of a limited number of ulcerative lesions revealed that indirect immunofluorescence and virus isolation were comparable in detecting herpes simplex virus. The results indicate that monoclonal antibodies can be used to accurately identify and type isolates of herpes simplex virus.

Risk factors for cervical cancer

Despite a long history of research into the epidemiology and biology of cervical carcinoma, a definitive statement about its probable causes still remains elusive. This review recognizes the population based data on high and low risk groups and summarizes the findings from numerous case-control studies which have explored the marital, sexual and reproductive factors associated with cervical cancer. Although vigorously pursued, an increased risk from oral contraceptives has not been convincingly demonstrated. A variety of venereally transmitted organisms appear to be frequent cohabitants with cervical neoplastic cells. Herpesvirus type 2 still remains the prime suspect in the complex pathogenesis of cervical neoplasia. Clinical findings, biological characteristics of the virus, serological studies and interactions of host cells and viral particles continue to stimulate the most intensive investigative efforts.

Herpes simplex virus types 1 and 2 and multiple sclerosis

A hypothesis is proposed which states that multiple sclerosis (MS) is caused by herpes simplex virus type 2 (HSV-2) in persons lacking herpes simplex virus type 1(HSV-1) immunity. It is examined by comparing the epidemiology of these viruses with that of MS. The age at which HSV-2 infections are first detected, as well as the age of peak incidence are similar to those for MS. If age-specific HSV-1 immunity data from various places is compared, an inverse relationship of immunity levels with latitude is apparent, and may be related to the effects of ultraviolet irradiation on HSV-1 activation and transmission rates. Prior HSV-1 immunity, if related to subsequent risk of MS, would be protective. This hypothesis also appears to be consistent with the generalisations concerning effects of migration on subsequent rates of MS, and with certain other features of MS epidemiology.

Genital herpes simplex--concepts and treatment

Genital herpes simplex is an increasingly common venereal disease caused by either herpes simplex virus type 1 or 2. The disease can be manifested in a primary and/or recurrent form, the clinical features and complications of which are reviewed. Potential problems include psychosocial difficulties, neonatal herpes simplex infections, and the possibility of an oncogenic role in cervical cancer. Diagnostic modalities, prophylactic measures, and management technics are discussed.

Studies on the neutralizing antibody to herpes simplex virus. II. Quantitative analysis of type specific antibodies in rabbits immunized with both types of virus

A quantitative analysis was carried out on type specific antibody developed in rabbits primed with three doses of one type of herpes simplex virus at two week intervals, followed by administration of another type of virus. Complement-requiring neutralizing antibody assay and mutual absorbing methods were used. The homotype specific antibody produced against the type of virus used for priming persisted at a constant level for a long period, despite the lack of antigenic stimuli by the same type after priming. The homotype specific antibody was not affected by the heterotypic antigenic stimuli. On the other hand, the heterotype specific antibody developed after the first or second injection of heterotypic virus, and the titer tended to decline, reaching undetectable levels at 9 months. However, the heterotype specific antibody was produced rapidly after the third injection of virus at 9 months and the titers exceeded or closed to those of the homotype specific antibody. The homotype specific antibodies were mainly distributed in the IgG fraction, while the IgM fraction contained mainly the heterotype specific antibodies. In relationship between type specific antibody response and the values of II/I index, the coexistence of both type specific antibodies was apparent in sera with the values of 91 to 117 of II/I index and in the IgG fraction with the values of 90 to 115, respectively.

The preparation, efficacy and safety of 'antigenoid' vaccine NFU1 (S-L+) MRC toward prevention of herpes simplex virus infections in human subjects

Vaccine NFU1 (S-L+) MRC was prepared by high multiplicity infection of serum-deprived human embryonic lung (MRC 5) cells with type 1 Herpes simplex virus. The preparative process removed inoculum virus particles and virus DNA while virus particle and DNA synthesis was inhibited by the presence of lithium chloride in the cell culture medium. The vaccine stimulated neutralising antibody in vaccinated mice and provided long-term protection against intra-vaginal challenge with type 2 herpes virus. The safety of the vaccine was confirmed by inoculation into newborn mice and cell lines of human, mammalian, and rodent origin. There was no evidence of cell transformation in vitro or of oncogenicity or teratogenicity in rodent species. It is intended to investigate the efficiency of this vaccine in human subjects.

Asymptomatic virus shedding after herpes genitalis

Samples of cervical and vaginal secretions obtained daily from five women were studied for the presence of active virus and/or viral antigens. In women with a history of recurrent genital herpes, either infectious virus or viral antigen in exfoliated cells was repeatedly detected in the absence of overt clinical symptoms. The epidemiologic and obstetric importance of the observations is discussed.

Arthralgia associated with acute urinary retention. A syndrome of probable viral etiology

Four patients are described in whom paresthesia and arthralgia developed in association with acute urinary retention. Neurologic and musculoskeletal complaints persisted for varying periods, up to five year, after cessation of urinary symptoms. Significantly elevated titers to Herpes simplex and Herpes zoster viruses were observed in three and four subjects, respectively, although none exhibited cutaneous lesions of herpetic infection. The symptom complex, presumably the result of viral radiculitis, may present in varying patterns that can be confused with lumbar disc protrusion, obstructive uropathy or primary rheumatic disorder. Diagnostic studies requisite for documentation of a viral etiology of the syndrome are discussed.

Relationship between antigenic type of virus and antibody response in female patients with herpes genitalis

The antigenic types of virus recovered from genital sites in cases of adult female genital herpes and antibody response in these patients were investigated. Twelve strains were isolated from 23 clinical specimens, and half the number of the isolates was classified as type 1 virus and the remaining half as type 2 virus. The results of serological typing corresponded well to biological differentiation by plaque-forming ability on chick embryo cultures. The patients with type 1 virus infection had only the complement requiring neutralizing antibody, thus indicating a fresh infection. On the other hand, the noncomplement requiring neutralizing antibody was found in the patients with type 2 virus infection, indicating a later phase of infection.

Prepubertal vaccination of mice against experimental infection of the genital tract with type 2 herpes simplex virus

Pre-pubertal immunisation of mice with a formalin-inactivated type 1 and 2 herpes simplex virus vaccine conferred a level of life-long protection against primary type 2 genital infection. Protection levels were better with type 1 vaccine and strikingly influenced by vaccine dosage where a one-hundred-fold reduction from the standard vaccine dosage diminished protection to insignificant levels. Vaccine efficacy was not significantly affected by the method of virus inactivation, the number of immunisations or the age of the mouse at immunisation. Vaccination conferred better protection than previous type 2 genital infection; this may be a consequence of a higher antigenic dose, more acceptable antigenic presentation or to a perversion of the immune response in a latently infected animal to homologous virus challenge.

Cellular immune response in genital herpes simplex virus infection

We studied the relations between the cellular immune response, pre-existing complement-fixing antibody and virus type with duration of virus excretion in genital herpes simplex virus (HSV) infection. Thirty-six patients (seven with HSV-1 and 29 with HSV-2) with genital herpes underwent serologic testing, sequential viral cultures and weekly determination of lymphocyte-transformation stimulation index with inactivated HSV antic n. The duration of virus excretion was shortest in those with pre-existing complement-fixing antibody, was unrelated to virus type, and was inversely correlated with the magnitude of the mean peak stimulation index (r = -0.69, P less than 0.001). Prolonged virus excretion occurred in patients with a delayed and diminished peak index. Recurrent episodes had a higher peak index (29.4 compared to 14.5) (P less than 0.02), an earlier development of the peak during recurrences (9.1 vs. 25.8 days) (P less than 0.01) and a briefer duration of viral shedding than initial episodes. Thus, the temporal course and magnitude of the stimulation index correlate with and may determine the duration of genital HSV infection.

Genital herpesvirus infection in women attending a venereal diseases clinic

Routine cervical viral cultures (and cultures from lesions if present) were performed on 2630 female patients attending a venereal diseases clinic over a period of four years. Of these patients 96 (3.7%) had genital herpetic infection; of these 23 (24%) were asymptomatic. The association of herpesvirus with other genital infections is considered, but no increase in the incidence of Neisseria gonorrhoeae, Trichomonas vaginalis, and genital warts was found; there was an increased incidence of Candida albicans. A significantly higher percentage of the patients with herpesvirus took oral contraceptives. The findings are discussed and compared with previous reports.

Protective effect of an oral infection with herpes simplex virus type 1 against subsequent genital infection with herpes simplex virus type 2

The problem of whether oral Herpes simplex virus type 1 (HSV-1) infection provides protection against subsequent genital infection by Herpes simplex virus type 2 (HSV-2) was investigated. Mice were used as models. Following conditions in man, both the oral and genital infections applied were noninjurious. Mice infected orally with HSV-1 were weakly protected against virus 'take' following vaginal challenge with HSV-2. Genital 'takes' were found in 67% of the immunized mice, as compared with 83% of the controls (protection rate 20%, P = 0.002). The course of genital infection in the immunized mice, however, was relatively mild: Lethality decreased from 97% in the controls to 35% in the immunized mice (protection rate 63%, P less than 0.001). Furthermore, local and neurologic symptoms occurred less frequently. Attempts to isolate the virus from homogenized brain and spinal cord of immunized mice that died after genital challenge with HSV-2 failed in most cases. Also virus could not be recovered from the liver of infected mice, irrespective of the experimental group.

Systemic and topical use of poly I.C. in treatment of generalized neonatal herpes simplex infection with severe ocular involvement

A case of Neonatal Herpes Simlex Virus (RSV) Encephalitis with severe ocular manifestation treated by topical systemic and intrathecal Interferon inducer, Poly IC (Polyriboinosinic acid-Polyribocytidylic acid) is reported. Prior to the administration of Poly IC, no Interferon could be detected neither in blood nor in CSF and vesicular fluid from conjunctiva. Intravenous administration of the drug initiated measurable levels in blood and tears, but not in CSF. However, intrathecal injection induced persistent high levels of Interferon in CSF. Virus clearance from conjunctiva tears and vesicular fluid occurred after three days of topical application of Poly IC. The mechanism of action of Poly IC, the laboratory results and the therapeutic conclusions are discussed in detail. This is the first report of intrathecal administration of Poly IC in a case of HSV Encephalitis.

Genital infection with type 2 herpes simplex virus. A common venereal disease

Current evidence leaves little doubt that genital herpes is primarily a venereal disease. Like gonorrhea, it is frequently subclinical or asymptomatic. A high rate of infection is found among patients attending venereal disease clinics and among persons of low socioeconomic status. The infection (primary or recurrent) is generally self-limiting, but in a pregnant woman it poses a significant risk to the fetus. It also has been linked to an increased risk of cervical cancer. The Papanicolaou smear is a useful tool for early detection. Effective antiviral therapy for genital herpes is unavailable. Photodynamic inactivation appears promising in recurrent herpes but may be hazardous; malignant transformation of infected cells subjected to this process has been demonstrated in vitro.

Comparison of the treatment of herpes genitalis in men with proflavine photoinactivation, idoxuridine ointment, and normal saline

36 male patients with genital infection by HSV confirmed by culture were each allocated to one of three treatment groups: (1) Proflavine photoinactivation, (2) 0.5 per cent. idoxuridine ointment (IDU), (3) Normal saline. They were assessed objectively at each attendance by measurement of the lesions with an operating microscope fitted with a measuring grid in one eyepiece. Material for culture for HSV was taken at each visit; the presence of symptoms (pain, discomfort, and irritation) was noted. The areas of lesions in the proflavine photoinactivation group remained larger significantly longer than in the other groups, the healing time was slower, and HSV could be isolated for longer. It is concluded that proflavine photoinactivation is of no greater value than 0.5 per cent. IDU or normal saline in the treatment of genital infection by HSV in the male.

Characterization of genital strains of Herpesvirus hominis

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