Sexually transmitted viral infections in homosexual men

Nuclear bodies (sphaeridia) in Sertoli cells of a man with acquired immunodeficiency syndrome (AIDS) and testicular infection by cytomegalovirus

Histological and ultrastructural study of an adult man with acquired immunodeficiency syndrome (AIDS) revealed multiple testicular lesions. The seminiferous tubules varied from dilated tubules with hypospermatogenesis, to tubules with Sertoli cells and a few spermatogonia, to necrotic tubules. The testicular interstitium showed abundant inflammatory infiltrates, some of them forming microabscesses. The Sertoli cells exhibited spherical intranuclear inclusions corresponding to both cytomegalovirus and sphaeridia. Some sphaeridia stained intensely with EDTA as granular and fibrillar portions of the nucleolus; however, many sphaeridia stained weakly as nucleolar fibrillar centers. These observations suggest that a Sertoli cell response to cytomegalovirus is the proliferation of nucleolar organizing centers that in some instances may transform to give rise to more or less abnormally developed nucleoli.

First-episode, recurrent, and asymptomatic herpes simplex infections

Genital herpes simplex virus infections should be classified into first-episode and recurrent infections. First-episode infections include true primary infections in patients with seronegative results who have never been infected with any type of herpes and nonprimary first-episode infections in patients who have been infected before and have serum antibody and humoral immunity, an example being genital infection with type 2 in adolescence after orolabial infection with type 1 in childhood. First-episode infections show more extensive disease, more systemic symptoms, and greater viral shedding than do recurrent infections. Ten percent to 15% of patients with first-episode primary genital herpes have oropharyngeal infections with the same virus strain. Herpesvirus can be isolated from the urethra in about 30% of male patients with first-episode infections. In recurrent vulvar herpes, virus can be isolated from the cervix in 10% to 15% of patients. Many genital lesions that clinically suggest something else turn out to be herpes; herpes may be diagnosed 5% of the time clinically but cultures are positive 14% of the time. Primary genital herpes type 2 infections recur about 95% of the time whereas type 1 infections recur about 50% of the time. Recurrences are highly unpredictable from patient to patient and time to time. The role of asymptomatic shedding in the spread of herpes is a major area for future study. Antiviral treatment is probably going to change the epidemiology of herpetic infections very little.

Antiviral antibodies in the sera of homosexual men: correlation with their lifestyle and drug usage

Healthy homosexual men between the ages of 21 and 65 years, from the Washington, DC (n = 162), and New York City (n = 89) areas, were studied for antibodies in the serum against cytomegalovirus (CMV), herpes simplex virus (HSV) types 1 and 2, and Epstein Barr virus (EBV) viral capsid antigen (VCA). CMV-specific antibodies were assayed by enzyme-linked immunosorbent assay (ELISA), anti-HSV-1 and -2 antibodies were measured by indirect hemagglutination (IHA), and antibodies to EBV VCA were measured by the immunofluorescence assay. Antibodies to human T lymphotrophic virus III (HTLV-III) were detected by ELISA and Western blot procedures. T lymphocytes were enumerated using OKT4 monoclonal antibody. Healthy male volunteer blood donors (n = 90) matched for age range and race proportions were used as controls. The percentage of seropositive individuals in the homosexual group was higher (90-98%) for all the viruses tested than in the control group (47-87%). Comparisons of the geometric mean titers, expressed as reciprocal serum dilutions, of seropositive individuals in homosexual (H) vs control (C) group were as follows: CMV-IgG (ELISA) H = 1:794, C = 1:68; HSV-1 (IHA) H = 1:248, C = 1:14; HSV-2 (IHA) H = 1:56, C = 1:17; EBV-VCA (IFA) H = 1:385, C = 1:131. The homosexual group also showed a higher frequency of individuals with elevated titers than the control group. The CMV IgM antibody was prevalent in 17.7% of the homosexual group and 5% of the control group; arithmetic means for ELISA values for CMV IgM were 0.207 for the homosexual group and 0.05 for the control group. In the homosexual group, the anti-CMV antibody titers increased with age (P = 0.01) and with numbers of sex partners (P = 0.06). Both anti-HSV-1 and anti-HSV-2 antibodies correlated with the number of sex partners (P = 0.04 and P = 0.05, respectively). Neither age nor partner number correlated with response to EBV, and no particular sex act was related to the EBV VCA titer level. HTLV-III seropositivity was associated with higher herpes virus group antibody titers, probably because of life style cofactors. Among the HTLV-III-seropositive subjects, those with less than or equal to 400 T-helper lymphocytes/mm3 had lower antibody titers than those with greater than 400 T-helper lymphocytes/mm3 counts, suggesting an impaired immune response secondary to immunosuppression.

Cytomegaloviral epididymitis in a patient with the acquired immune deficiency syndrome

We report on a patient with cytomegaloviral epididymitis and the acquired immune deficiency syndrome. The diagnosis was suggested by epididymitis that was refractory to antibiotics, and by isolation of cytomegalovirus from the urine and semen. The definitive diagnosis was made with immunohistochemical staining for cytomegaloviral antigens in the epididymal ductal cells. Because of the ineffectiveness of antimicrobial agents in this disorder, epididymectomy is the current treatment of choice.