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Clarke E, Patel R, Dickins D, Fidler K, Jackson A, Kingston M, Jones C, Lyall H, Nicholson M, Pelosi E, Porter D, Powell G, Foley E. Joint British Association for Sexual Health and HIV and Royal College of Obstetricians and Gynaecologists national UK guideline for the management of herpes simplex virus (HSV) in pregnancy and the neonate (2024 update). Int J STD AIDS 2024:9564624241280734. [PMID: 39348176 DOI: 10.1177/09564624241280734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
This updated national UK guideline offers recommendations on the management of genital herpes simplex virus (HSV) in mothers and pregnant people during pregnancy and within 4 weeks following birth. It includes recommendations for first episode and recurrent HSV, HSV in preterm pre-labour rupture of membranes and in co-infection with HSV and HIV. Recommendations around management of the neonate are made, on prevention of postnatal transmission, management of breastfeeding, and the management of clinically discordant couples. This guideline is aimed at healthcare professionals working in sexual health clinics, maternity units, and those working on postnatal wards and neonatal units in the UK. However, the principles of the recommendations should be adopted across all services, including community care.
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Affiliation(s)
- Emily Clarke
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Raj Patel
- Solent NHS Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Dyan Dickins
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Katy Fidler
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | | | - Margaret Kingston
- British Association for Sexual Health and HIV Clinical Excellence Group, London, UK
| | - Christine Jones
- University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Emanuela Pelosi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Porter
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Elizabeth Foley
- Solent NHS Trust, Southampton, UK
- University of Southampton, Southampton, UK
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2
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Motta A, Musella G, Dai Prà T, Ballini A, Dioguardi M, Bizzoca ME, Lo Muzio L, Cantore S. The literature discusses oral manifestations caused by sexually transmitted viruses: a narrative review. Minerva Dent Oral Sci 2024; 73:238-247. [PMID: 38869836 DOI: 10.23736/s2724-6329.24.04996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
This review provides practical recommendations for dental practitioners in dealing with oral lesions associated with sexually transmitted diseases (STDs), offering clinically relevant insights to increase the awareness of these diseases in the mainstream of everyday practice. STDs are acquired through unprotected vaginal, anal or oral sex and are caused by more than 30 different types of bacteria, viruses and protozoa. Saliva, precum, semen, vaginal secretions and menstrual blood could be likely vehicles of infections and defensive barriers to infection by pathogenic microbes could be represented via intact mucosal membrane, the diluent function of saliva, and the antimicrobial action of salivary enzymes that collectively contribute to oral health and protection. STD, can directly and indirectly affect mucous membranes, manifesting with characteristic diagnostic signs and lesions. Given their potential oral manifestations, dental professionals need a comprehensive understanding of STD. The findings of this review lay a foundation for comprehending several STDs, emphasizing the importance of physicians as well dental practitioners being open to discussing sexuality issues with patients and providing appropriate therapeutic interventions.
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Affiliation(s)
- Alessandro Motta
- Unit of Oral Surgery for Special Needs and Dentistry, Borgo Valsugana, Trento, Italy
| | - Gennaro Musella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Tommaso Dai Prà
- Unit of Oral Surgery for Special Needs and Dentistry, Borgo Valsugana, Trento, Italy
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria E Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy -
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Stefania Cantore
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Hill MAM, Satchell T, Troyer RM. Detection of Felis catus Gammaherpesvirus 1 in Domestic Cat Saliva: Prevalence, Risk Factors, and Attempted Virus Isolation. Pathogens 2024; 13:111. [PMID: 38392850 PMCID: PMC10891546 DOI: 10.3390/pathogens13020111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Felis catus gammaherpesvirus 1 (FcaGHV1) infects domestic cats worldwide, yet it has not been successfully propagated in cell culture, and little is known about how it is shed and transmitted. To investigate the salivary shedding of FcaGHV1, we quantified FcaGHV1 DNA in feline saliva by qPCR. For FcaGHV1-positive saliva, we sequenced a portion of the viral glycoprotein B (gB) gene and attempted to isolate the infectious virus by passage in several felid and non-felid cell lines. We detected FcaGHV1 DNA in 45/227 (19.8%) saliva samples with variable viral DNA loads from less than 100 to greater than 3 million copies/mL (median 4884 copies/mL). Multiple saliva samples collected from an infected cat over a two-month period were consistently positive, indicating that chronic shedding can occur for at least two months. Cat age, sex, and health status were not associated with shedding prevalence or viral DNA load in saliva. Feral status was also not associated with shedding prevalence. However, feral cats had significantly higher FcaGHV1 DNA load than non-feral cats. Sequencing of FcaGHV1 gB showed low sequence diversity and >99.5% nucleotide identity to the worldwide consensus FcaGHV1 gB sequence. We did not detect virus replication during the passage of FcaGHV1-positive saliva in cell culture, as indicated by consistently negative qPCR on cell lysate and supernatant. To our knowledge, these data show for the first time that cats in Canada are infected with FcaGHV1. The data further suggest that shedding of FcaGHV1 in saliva is common, can occur chronically over an extended period of time, and may occur at higher levels in feral compared to non-feral cats.
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Affiliation(s)
- Malcolm A. M. Hill
- Department of Microbiology and Immunology, University of Western Ontario, London, ON N6A 5C1, Canada;
| | | | - Ryan M. Troyer
- Department of Microbiology and Immunology, University of Western Ontario, London, ON N6A 5C1, Canada;
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Wang L, Zhou L, ZhangBao J, Huang W, Tan H, Fan Y, Lu C, Yu J, Wang M, Lu J, Zhao C, Zhang T, Quan C. Causal associations between prodromal infection and neuromyelitis optica spectrum disorder: A Mendelian randomization study. Eur J Neurol 2023; 30:3819-3827. [PMID: 37540821 DOI: 10.1111/ene.16014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND PURPOSE Prodromal infections are associated with neuromyelitis optica spectrum disorder (NMOSD), but it remains unclear which type of infection has a causal association with NMOSD. We aimed to explore the causal associations between four herpesvirus infections (chickenpox, cold sores, mononucleosis and shingles) and NMOSD, as well as between other types of infections and NMOSD. METHODS For data on infections, we used the genome-wide association study (GWAS) summary statistics from the 23andMe cohort. For outcomes, we used the GWAS data of participants of European ancestry, including 215 NMOSD patients (132 anti-aquaporin-4 antibody [AQP4-ab]-positive patients and 83 AQP4-ab-negative patients) and 1244 normal controls. Single-nucleotide polymorphism (SNP) identification and two-sample Mendelian randomization (MR) analyses were then performed. RESULTS In the 23andMe cohort, we identified one SNP for chickenpox (rs9266089 in HLA-B gene), one SNP for cold scores (rs885950 in the POU5F1 gene), one SNP for mononucleosis (rs2596465 in the HCP5 gene), and three SNPs for shingles (rs2523591 in the HLA-B gene; rs7047299 in the IFNA21 gene; rs9260809 in the MICD gene). The association between cold sores and AQP4-ab-positive NMOSD reached statistical significance (odds ratio [OR] 745.318; 95% confidence interval [CI] 22.176, 25,049.53 [p < 0.001, Q < 0.001]). The association between shingles and AQP4-ab-positive NMOSD was also statistically significant (OR 21.073; 95% CI 4.271, 103.974 [p < 0.001, Q < 0.001]). No significant association was observed between other infections and AQP4-ab-positive or AQP4-ab-negative NMOSD. CONCLUSION These findings suggest there are positive associations between cold sores and shingles and AQP4-ab-positive NMOSD, indicating there may be causal links between herpes simplex virus and varicella-zoster virus infection and AQP4-ab-positive NMOSD.
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Affiliation(s)
- Liang Wang
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Lei Zhou
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Wenjuan Huang
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Hongmei Tan
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yuxin Fan
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiahong Lu
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Tiansong Zhang
- Department of Chinese Traditional Medicine, Jing'an District Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Chao Quan
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
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Wang J, Huang M, Du Y, Chen H, Li Z, Zhai T, Ou Z, Huang Y, Bu F, Zhen H, Pan R, Wang Y, Zhao X, Situ B, Zheng L, Hu X. Lactobacillus rhamnosus GG Regulates Host IFN-I Through the RIG-I Signalling Pathway to Inhibit Herpes Simplex Virus Type 2 Infection. Probiotics Antimicrob Proteins 2023:10.1007/s12602-023-10137-8. [PMID: 37624569 DOI: 10.1007/s12602-023-10137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Numerous recent studies have demonstrated that the commensal microbiota plays an important role in host immunity against infections. During the infection process, viruses can exhibit substantial and close interactions with the commensal microbiota. However, the associated mechanism remains largely unknown. Therefore, in this study, we explored the specific mechanisms by which the commensal microbiota modulates host immunity against viral infections. We found that the expression levels of type I interferon (IFN-I) and antiviral priming were significantly downregulated following the depletion of the commensal microbiota due to treatment with broad-spectrum antibiotics (ABX). In addition, we confirmed a unique molecular mechanism underlying the induction of IFN-I mediated by the commensal microbiota. In vivo and in vitro experiments confirmed that Lactobacillus rhamnosus GG (LGG) can suppress herpes simplex virus type 2 (HSV-2) infection by inducing IFN-I expression via the retinoic acid-inducible gene-I (RIG-I) signalling pathway. Therefore, the commensal microbiota-induced production of IFN-I provides a potential therapeutic approach to combat viral infections. Altogether, understanding the complexity and the molecular aspects linking the commensal microbiota to health will help provide the basis for novel therapies already being developed.
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Affiliation(s)
- Jingyu Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mei Huang
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuqi Du
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haoming Chen
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zixiong Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Taiyu Zhai
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihao Ou
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yiyi Huang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Bu
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Haojun Zhen
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruoru Pan
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yubing Wang
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohan Zhao
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bo Situ
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Xiumei Hu
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Tugizov SM. Molecular Pathogenesis of Human Immunodeficiency Virus-Associated Disease of Oropharyngeal Mucosal Epithelium. Biomedicines 2023; 11:1444. [PMID: 37239115 PMCID: PMC10216750 DOI: 10.3390/biomedicines11051444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The oropharyngeal mucosal epithelia have a polarized organization, which is critical for maintaining a highly efficient barrier as well as innate immune functions. In human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) disease, the barrier and innate immune functions of the oral mucosa are impaired via a number of mechanisms. The goal of this review was to discuss the molecular mechanisms of HIV/AIDS-associated changes in the oropharyngeal mucosa and their role in promoting HIV transmission and disease pathogenesis, notably the development of opportunistic infections, including human cytomegalovirus, herpes simplex virus, and Epstein-Barr virus. In addition, the significance of adult and newborn/infant oral mucosa in HIV resistance and transmission was analyzed. HIV/AIDS-associated changes in the oropharyngeal mucosal epithelium and their role in promoting human papillomavirus-positive and negative neoplastic malignancy are also discussed.
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Affiliation(s)
- Sharof M Tugizov
- Department of Medicine, School of Medicine, University of California, San Francisco, CA 94143, USA
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7
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Herpes Simplex Virus and Varicella Zoster Virus Infections in Cancer Patients. Viruses 2023; 15:v15020439. [PMID: 36851652 PMCID: PMC9961783 DOI: 10.3390/v15020439] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are alpha herpesviruses that establish life-long latent infection in neuronal ganglia after primary infection. Periodic reactivation of these viruses results in recurrent infections that can have significant impact on patients' quality of life. HSV commonly causes oral and genital mucocutaneous infections whereas VZV is responsible for varicella/chickenpox and herpes zoster/shingles, but cancer patients are at particularly higher risk of complications including disseminated and visceral infections due to impaired cell-mediated immunity. While diagnosis of more common HSV and/or VZV infections is frequently clinically based, immunocompromised hosts may have atypical skin presentation or visceral involvement. Thus, diagnostic confirmation using virus-specific tests such as polymerase chain reaction or immunohistochemical staining is crucial in some cases. Oral acyclovir, valacyclovir and famciclovir are usually used for mild to moderate infections and intravenous acyclovir is the drug of choice for severe or disseminated infections. Foscarnet can be used when acyclovir-resistance is confirmed or suspected. Pharmaceutical prophylaxis against HSV and/or VZV should be considered in high-risk cancers patients. Currently, there is no commercially available vaccine against HSV, but VZV vaccines are available to prevent varicella and zoster.
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Annaji M, Mita N, Rangari S, Aldawsari MF, Alsaqr A, Poudel I, Fasina O, Babu RJ. Enhanced Topical Co-delivery of Acyclovir and Lidocaine Gel Formulation Across Dermatomed Human Skin. AAPS PharmSciTech 2022; 23:305. [DOI: 10.1208/s12249-022-02458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
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9
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López-Muñoz AD, Rastrojo A, Martín R, Alcamí A. Herpes simplex virus 2 (HSV-2) evolves faster in cell culture than HSV-1 by generating greater genetic diversity. PLoS Pathog 2021; 17:e1009541. [PMID: 34437654 PMCID: PMC8389525 DOI: 10.1371/journal.ppat.1009541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Herpes simplex virus type 1 and 2 (HSV-1 and HSV-2, respectively) are prevalent human pathogens of clinical relevance that establish long-life latency in the nervous system. They have been considered, along with the Herpesviridae family, to exhibit a low level of genetic diversity during viral replication. However, the high ability shown by these viruses to rapidly evolve under different selective pressures does not correlates with that presumed genetic stability. High-throughput sequencing has revealed that heterogeneous or plaque-purified populations of both serotypes contain a broad range of genetic diversity, in terms of number and frequency of minor genetic variants, both in vivo and in vitro. This is reminiscent of the quasispecies phenomenon traditionally associated with RNA viruses. Here, by plaque-purification of two selected viral clones of each viral subtype, we reduced the high level of genetic variability found in the original viral stocks, to more genetically homogeneous populations. After having deeply characterized the genetic diversity present in the purified viral clones as a high confidence baseline, we examined the generation of de novo genetic diversity under culture conditions. We found that both serotypes gradually increased the number of de novo minor variants, as well as their frequency, in two different cell types after just five and ten passages. Remarkably, HSV-2 populations displayed a much higher raise of nonconservative de novo minor variants than the HSV-1 counterparts. Most of these minor variants exhibited a very low frequency in the population, increasing their frequency over sequential passages. These new appeared minor variants largely impacted the coding diversity of HSV-2, and we found some genes more prone to harbor higher variability. These data show that herpesviruses generate de novo genetic diversity differentially under equal in vitro culture conditions. This might have contributed to the evolutionary divergence of HSV-1 and HSV-2 adapting to different anatomical niche, boosted by selective pressures found at each epithelial and neuronal tissue. Herpesviruses are highly human pathogens that establish latency in neurons of the peripheral nervous system. Colonization of nerve endings is required for herpes simplex virus (HSV) persistence and pathogenesis. HSV-1 global prevalence is much higher than HSV-2, in addition to their preferential tendency to infect the oronasal and genital areas, respectively. How these closely related viruses have been adapting and evolving to replicate and colonize these two different anatomical areas remains unclear. Herpesviruses were presumed to mutate much less than viruses with RNA genomes, due to the higher fidelity of the DNA polymerase and proofreading mechanisms when replicating. However, the worldwide accessibility and development of high-throughput sequencing technologies have revealed the heterogenicity and high diversity present in viral populations clinically isolated. Here we show that HSV-2 mutates much faster than HSV-1, when compared under similar and controlled cell culture conditions. This high mutation rate is translated into an increase in coding diversity, since the great majority of these new mutations lead to nonconservative changes in viral proteins. Understanding how herpesviruses differentially mutate under similar selective pressures is critical to prevent resistance to anti-viral drugs.
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Affiliation(s)
- Alberto Domingo López-Muñoz
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Alberto Rastrojo
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Rocío Martín
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Antonio Alcamí
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
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Abstract
Viral venereal diseases remain difficult to treat. Human papilloma virus (HPV) and herpes simplex virus (HSV) are two common viral venereal diseases. HPV infections are characterized by anogenital warts and less commonly by premalignant or malignant lesions. HSV infections classically present as grouped vesicles on an erythematous base with associated burning or pain; however, immunosuppressed patients may have atypical presentations with nodular or ulcerative lesions. This review discusses the epidemiology, diagnosis, and management of anogenital HPV and HSV infections with an emphasis on treatment modalities for the practicing dermatologist. Diagnosis of these diseases typically relies on clinical assessment, although multiple diagnostic techniques can be utilized and are recommended when diagnosis is uncertain or evaluating an individual with increased risk of malignancy. Management of HPV and HSV infections involves appropriate counseling, screening, and multiple treatment techniques. Particularly for HPV infections, a practitioner may need to use a combination of techniques to achieve the desired outcome.
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Gusai T, Dhavalkumar M, Soniwala M, Dudhat K, Vasoya J, Chavda J. Formulation and optimization of microsponge-loaded emulgel to improve the transdermal application of acyclovir-a DOE based approach. Drug Deliv Transl Res 2020; 11:2009-2029. [PMID: 33159290 DOI: 10.1007/s13346-020-00862-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/20/2022]
Abstract
The cutaneous penetration of acyclovir from the conventional topical formulations such as cream and ointments is poor due to low water solubility and low octanol buffer partition coefficient of the drug. The present investigation was aimed to prepare acyclovir-loaded microsponge-based emulgel to improve its topical delivery. The microsponges were prepared by the quasi-emulsion diffusion method. The central composite design was employed to investigate the effect of changes in various formulation and process parameters on critical product attributes. Homogenization speed (X1), drug/polymer ratio (X2), and concentration of PVA (X3) were selected as independent variables while particle size,b% yield, % drug loading efficiency, % entrapment efficiency, the drug released at 0.25 h and 6 h were selected as response variables. The regression analysis proved a significant effect of all the independent variables on the dependent variables (p < 0.05). All the designed batches released more than 40% drug in less than 1 h and were also able to sustain the drug release for more than 6 h. Based on the solution suggested by the software, the optimized batch was prepared with 1000-rpm homogenization speed, 1.6:1 drug/polymer ratio, and 0.088% of PVA. The optimized microsponge-loaded emulgel had acceptable viscosity (10,897 to 12,416 centipoise), spreadability (32.5 to 36.57 g × cm/s), pH (between 6 and 7), and drug content (93 to 95%). The results of the ex vivo permeation study proved significant improvement in drug permeation from optimized microsponge-loaded emulgel compared to the marketed formulation (f2 < 50).
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Affiliation(s)
- Tejal Gusai
- B.K. Mody Government Pharmacy College, Rajkot, Gujarat, India
| | | | | | - Kiran Dudhat
- K. V. Virani Institute of Pharmacy and Research Centre, Badhada, Gujarat, India
| | - Jaydip Vasoya
- B.K. Mody Government Pharmacy College, Rajkot, Gujarat, India
| | - Jayant Chavda
- B.K. Mody Government Pharmacy College, Rajkot, Gujarat, India
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12
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Foy JP, Bertolus C, Boutolleau D, Agut H, Gessain A, Herceg Z, Saintigny P. Arguments to Support a Viral Origin of Oral Squamous Cell Carcinoma in Non-Smoker and Non-Drinker Patients. Front Oncol 2020; 10:822. [PMID: 32528893 PMCID: PMC7253757 DOI: 10.3389/fonc.2020.00822] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
In some western countries, an increasing incidence of oral squamous cell carcinoma (OSCC) has been observed in non-smoker non-drinker patients (NSND), mostly in women with HPV-negative OSCC. In the context of the unknown etiology and mechanisms of tumorigenesis of OSCC in NSND, we discuss data supporting the hypothesis of a viral origin not related to HPV. OSCC from NSND are characterized by an antiviral DNA methylation and gene expression signature. Based on the similar increasing incidence of oral tongue SCC (OTSCC) and oropharyngeal SCC (OPSCC) in young women and men respectively, we hypothesize that changes in sexual behaviors may lead to an increasing incidence of herpesvirus in the oral cavity, especially HSV-2, similarly to what has already been described in HPV-positive OPSCC. Because viral genome integration has not been detected in OSCC from NSND, a "hit and run" viral mechanism involving epigenome deregulation could therefore play a key role at early steps of oral carcinogenesis in this population of patients. In conclusion, epidemiological, clinical and molecular data supports a "hit and run" viral origin of OSCC from NSND.
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Affiliation(s)
- Jean-Philippe Foy
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Department of Oral and Maxillo-Facial Surgery, Paris, France
| | - Chloé Bertolus
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Department of Oral and Maxillo-Facial Surgery, Paris, France
| | - David Boutolleau
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Centre National de Référence Herpèsvirus, Department of Virology, Paris, France
- Sorbonne Université, CR7, Centre d'Immunologie et de Maladies Infectieuses (CIMI-Paris), INSERM U1135, Paris, France
| | - Henri Agut
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Centre National de Référence Herpèsvirus, Department of Virology, Paris, France
- Sorbonne Université, CR7, Centre d'Immunologie et de Maladies Infectieuses (CIMI-Paris), INSERM U1135, Paris, France
| | - Antoine Gessain
- Department of Virology, Institut Pasteur, CNRS, UMR 3569, Paris, France
| | - Zdenko Herceg
- Epigenetics Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pierre Saintigny
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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13
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Zuo Y, Whitbeck JC, Haila GJ, Hakim AA, Rothlauf PW, Eisenberg RJ, Cohen GH, Krummenacher C. Saliva enhances infection of gingival fibroblasts by herpes simplex virus 1. PLoS One 2019; 14:e0223299. [PMID: 31581238 PMCID: PMC6776388 DOI: 10.1371/journal.pone.0223299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 09/19/2019] [Indexed: 02/01/2023] Open
Abstract
Oral herpes is a highly prevalent infection caused by herpes simplex virus 1 (HSV-1). After an initial infection of the oral cavity, HSV-1 remains latent in sensory neurons of the trigeminal ganglia. Episodic reactivation of the virus leads to the formation of mucocutaneous lesions (cold sores), but asymptomatic reactivation accompanied by viral shedding is more frequent and allows virus spread to new hosts. HSV-1 DNA has been detected in many oral tissues. In particular, HSV-1 can be found in periodontal lesions and several studies associated its presence with more severe periodontitis pathologies. Since gingival fibroblasts may become exposed to salivary components in periodontitis lesions, we analyzed the effect of saliva on HSV-1 and -2 infection of these cells. We observed that human gingival fibroblasts can be infected by HSV-1. However, pre-treatment of these cells with saliva extracts from some but not all individuals led to an increased susceptibility to infection. Furthermore, the active saliva could expand HSV-1 tropism to cells that are normally resistant to infection due to the absence of HSV entry receptors. The active factor in saliva was partially purified and comprised high molecular weight complexes of glycoproteins that included secretory Immunoglobulin A. Interestingly, we observed a broad variation in the activity of saliva between donors suggesting that this activity is selectively present in the population. The active saliva factor, has not been isolated, but may lead to the identification of a relevant biomarker for susceptibility to oral herpes. The presence of a salivary factor that enhances HSV-1 infection may influence the risk of oral herpes and/or the severity of associated oral pathologies.
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Affiliation(s)
- Yi Zuo
- Department of Microbiology, School of Dental Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - J. Charles Whitbeck
- Department of Microbiology, School of Dental Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gabriel J. Haila
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, New Jersey, United States of America
| | - Abraham A. Hakim
- Department of Biological Sciences, Rowan University, Glassboro, New Jersey, United States of America
| | - Paul W. Rothlauf
- Department of Biological Sciences, Rowan University, Glassboro, New Jersey, United States of America
| | - Roselyn J. Eisenberg
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gary H. Cohen
- Department of Microbiology, School of Dental Medicine University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Claude Krummenacher
- Department of Biological Sciences, Rowan University, Glassboro, New Jersey, United States of America
- Department of Molecular and Cellular Biosciences, Rowan University, Glassboro, New Jersey, United States of America
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14
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Mosmann JP, Talavera AD, Criscuolo MI, Venezuela RF, Kiguen AX, Panico R, Ferreyra De Prato R, López De Blanc SA, ré V, Cuffini CG. Sexually transmitted infections in oral cavity lesions: Human papillomavirus, Chlamydia trachomatis, and Herpes simplex virus. J Oral Microbiol 2019; 11:1632129. [PMID: 31275530 PMCID: PMC6598522 DOI: 10.1080/20002297.2019.1632129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/10/2019] [Indexed: 01/18/2023] Open
Abstract
Objective: Provide evidence of HPV, C. trachomatis, and HSV infection in the oral cavity from patients with different types of stomatological lesions. Materials and Methods: Oral swabs samples were collected from a total of 318 patients. The infectious agents were analyzed using the PCR technique. HPV genotyping and HSV type were studied using the RFLP method. Results: We studied 137 benign lesions (B), 96 potentially malignant disorders (PMD) and 85 oral squamous cell carcinomas (OSCC). The prevalence of HPV was 34%. The most frequently genotypes detected were 6 low risk and 16 high risk. The prevalence of C. trachomatis was 16% and HSV 3%. Co-infections were detected mostly in benign lesions as following: HPV-C. trachomatis in 4%, C. trachomatis- HSV in 1.8% and HPV-HSV in 0.3%. Conclusion: This report is the first contribution to the identification and genotype characterization of HPV in a scenario little studied in our area, and it also contributes to improving our understanding on sexually transmitted infectious agents and their associations with the oral cavity. Besides, we detect the presence of C. trachomatis and HSV and co-infection with HPV in the oral cavity, which they should be taken into account for diagnostic and treatment purposes.
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Affiliation(s)
- Jessica P. Mosmann
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Angel D. Talavera
- Cátedra de Estomatología, Facultad de Odontología- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María I. Criscuolo
- Cátedra de Estomatología, Facultad de Odontología- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Raúl F. Venezuela
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana X. Kiguen
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Rene Panico
- Cátedra de Estomatología, Facultad de Odontología- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ruth Ferreyra De Prato
- Cátedra de Estomatología, Facultad de Odontología- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Silvia A. López De Blanc
- Cátedra de Estomatología, Facultad de Odontología- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Viviana ré
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Cecilia G. Cuffini
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
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15
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Vauloup-Fellous C. [Genital herpes and pregnancy: Serological and molecular diagnostic tools. Guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF)]. ACTA ACUST UNITED AC 2017; 45:655-663. [PMID: 29132769 DOI: 10.1016/j.gofs.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe serological and molecular tools available for genital and neonatal herpes, and their use in different clinical situations. METHODS Bibliographic investigations from MedLine database and consultation of international clinical practice guidelines. RESULTS Virological confirmation of genital herpes during pregnancy or neonatal herpes must rely on PCR (Professional consensus). HSV type-specific serology (IgG) will allow determining the immune status of a patient (in the absence of clinical lesions). However, there is currently no evidence to justify universal HSV serological testing during pregnancy (Professional consensus). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type-specific IgG in order to distinguish a true primary infection, a non-primary infection associated with first genital manifestation, from a recurrence (Grade C). HSV IgM is useless for diagnosis of genital herpes (Grade C). If a pregnant woman has personal history of genital herpes but no lesions, whatever the gestational age, it is not recommended to perform genital sampling nor serology (Professional consensus). In case of recurrence, if the lesion is characteristic of herpes, virological confirmation is not necessary (Professional Agreement). However, if the lesion is not characteristic, virological confirmation by PCR should be performed (Professional consensus). At birth, HSV PCR samples should be collected as soon as neonatal herpes is suspected (symptomatic neonate) (best before beginning antiviral treatment but must not delay the treatment), or after 24hours of life in case of asymptomatic neonate born to a mother with herpes lesions at delivery (Professional consensus). Clinical samples for virological confirmation should include at least blood and a peripheral location. In case of clinical manifestations of herpes in the neonate, first samples PCR positive, preterm birth, or maternal primary infection or non-primary infection associated with first genital manifestation at delivery, CSF should also be collected as well as samples of lesions in the neonate if present (Professional consensus). Sampling should be repeated in case of PCR negative but strong evidence of neonatal herpes (Professional consensus). HSV serology is useless for diagnosis of neonatal herpes (Grade C). CONCLUSIONS Virological confirmation for diagnosis of genital herpes during pregnancy or neonatal herpes must rely on PCR. PCR assays available in France are very reliable. Specific IgG are dedicated to restricted indications.
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Affiliation(s)
- C Vauloup-Fellous
- Laboratoire de virologie, hôpital Paul-Brousse, groupe hospitalier universitaire Paris-Sud, 12, rue Paul-Vaillant-Couturier, 94800 Villejuif, France.
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16
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Mäki J, Paavilainen H, Kero K, Hukkanen V, Syrjänen S. Herpes simplex and human papilloma virus coinfections in oral mucosa of men-A 6-year follow-up study. J Med Virol 2017; 90:564-570. [PMID: 28975630 DOI: 10.1002/jmv.24965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/06/2017] [Indexed: 11/11/2022]
Abstract
Herpes simplex virus (HSV) establishes latency in neurons and recurrent infections in oral mucosa. This prospective study analyzes HSV prevalence in oral mucosal brush samples from men with known human papillomavirus (HPV) status. We hypothesized that HSV-1-infection could facilitate HPV persistence as a cofactor. This study was a part of the Finnish Family HPV study accomplished at the University of Turku/Turku University Hospital, Finland. A total of 139 men (mean age 28.6 ± 4.9 years) were enrolled at 36+-weeks of their partner's pregnancy and thereafter followed-up for 6 years. Altogether, 722 samples, extracted from oral brush samples collected at the enrollment timepoint (baseline) and at 2-, 6-, 12-, 24-, 36-month, and 6 years, were available. HSV DNA was analyzed with quantitative PCR. HSV-1 results were compared with the known HPV data. The prevalence of oral HSV-1 shedding varied between 0-7.2% (mean 2.8%) among the men. Mean copy numbers varied between 4 and 550 genome copies/sample. A total of 18 (12.9%) men were found HSV-1-positive at least once, two of them twice. Neither smoking nor oral sex was associated with the oral HSV-1-DNA finding. HPV/HSV-1 co-infection was found in 6 (4.3%) men, all of them having persistent HPV-infection. In conclusion, HSV-1 and its coinfection with HPV in oral mucosa was rare.
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Affiliation(s)
- Johanna Mäki
- Faculty of Medicine, Department of Oral Pathology, Institute of Dentistry, and Medicity Research Laboratory, University of Turku, Turku, Finland.,Finnish Doctoral Programme in Oral Sciences, University of Turku, Turku, Finland
| | - Henrik Paavilainen
- Department of Virology, University of Turku, Turku, Finland.,Drug Research Doctoral Programme, University of Turku, Turku, Finland
| | - Katja Kero
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
| | - Veijo Hukkanen
- Department of Virology, University of Turku, Turku, Finland
| | - Stina Syrjänen
- Faculty of Medicine, Department of Oral Pathology, Institute of Dentistry, and Medicity Research Laboratory, University of Turku, Turku, Finland.,Department of Pathology, Turku University hospital, Turku, Finland
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17
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Matrajt L, Gantt S, Mayer BT, Krantz EM, Orem J, Wald A, Corey L, Schiffer JT, Casper C. Virus and host-specific differences in oral human herpesvirus shedding kinetics among Ugandan women and children. Sci Rep 2017; 7:13105. [PMID: 29026166 PMCID: PMC5638921 DOI: 10.1038/s41598-017-12994-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/13/2017] [Indexed: 01/12/2023] Open
Abstract
Human herpesviruses (HHV) establish lifelong latent infection and are transmitted primarily via shedding at mucosal surfaces. Each HHV causes a unique spectrum of disease depending on the infected individual’s age and immunity. We collected weekly oral swabs from young children and mothers in 32 Ugandan households for a median of one year. We characterized kinetics of oral shedding during primary and chronic infection for each virus. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and HHV-6 were shed at high rates following primary infection. The rate of oral herpes simplex virus (HSV) shedding was lower overall, and children and mothers with chronic HSV infection had lower shedding rates than children with primary infection. CMV shedding rate and viral load were higher in children with primary infection compared to children with chronic infection, and even lower in mothers with chronic infection. HHV-6 shedding rate and viral load were similar between children with primary or chronic infection, but lower in mothers. EBV shedding rate and quantity decreased less dramatically in mothers versus children, with HIV-positive mothers shedding at a higher rate than HIV-negative mothers. Each HHV has a distinct pattern of oral shedding which depends partially on the age and immune status of the host.
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Affiliation(s)
- Laura Matrajt
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Soren Gantt
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.
| | - Bryan T Mayer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Jackson Orem
- Uganda Cancer Institute, Makerere University, Kampala, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anna Wald
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, 98195, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Lawrence Corey
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, 98195, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joshua T Schiffer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, 98195, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corey Casper
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Infectious Disease Research Institute, Seattle, WA, USA
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18
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Shedding of HSV-1, HSV-2, CMV, and EBV in the saliva of hematopoietic stem cell transplant recipients at Fundación HOMI - Hospital de la Misericordia, Bogotá, D.C. BIOMEDICA 2016; 36:201-10. [PMID: 27622810 DOI: 10.7705/biomedica.v36i0.2985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 03/22/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation in pediatric patients is an alternative treatment for different diseases. The conditioning regimen for transplant predisposes recipients to the development of infections. Viral infections by herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), human cytomegalovirus (CMV), and Epstein-Barr virus (EBV), are the most common, and the leading cause of morbidity and mortality among these patients. These viruses lie dormant in various cell types and the reactivation of latent infections may lead to asymptomatic viral shedding in saliva. The detection of these viruses in secretions may contribute to understand the behavioral dynamics of these viral infections in transplanted patients, and to the early diagnosis of reactivation. OBJECTIVE To assess HSV-1, HSV-2, CMV and EBV viral shedding in the saliva of patients admitted for hematopoietic stem cell transplantation at Fundación HOMI - Hospital de la Misericordia between January and November of 2012. MATERIALS AND METHODS We evaluated stimulated saliva samples of 17 hematopoietic stem cell transplantation recipients weekly. We performed DNA extraction from saliva, and we evaluated the presence of DNA for HSV-1, HSV-2, CMV, and EBV by PCR. RESULTS While we detected HSV-2 and CMV DNA in the saliva of four patients, EBV DNA was detected in nine patients with leukopenia. In contrast, we did not detect HSV-1 DNA in saliva. Additionally, four out of the 17 patients showed a simultaneous shedding of CMV and EBV. CONCLUSIONS By conventional PCR, we demonstrated asymptomatic HSV-2, CMV, and EBV viral shedding in saliva, associated with leukopenia.
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19
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Otero RA, Nascimento FNN, Souza IPR, Silva RC, Lima RS, Robaina TF, Câmara FP, Santos N, Castro GF. LACK OF ASSOCIATION BETWEEN HERPESVIRUS DETECTION IN SALIVA AND GINGIVITIS IN HIV‑INFECTED CHILDREN. Rev Inst Med Trop Sao Paulo 2016. [PMID: 26200962 PMCID: PMC4544246 DOI: 10.1590/s0036-46652015000300007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aims of this study were to compare the detection of human herpesviruses (HHVs) in
the saliva of HIV-infected and healthy control children, and to evaluate associations
between viral infection and gingivitis and immunodeficiency. Saliva samples were
collected from 48 HIV-infected and 48 healthy control children. Clinical and
laboratory data were collected during dental visits and from medical records. A
trained dentist determined gingival indices and extension of gingivitis. Saliva
samples were tested for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2),
varicella zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by
nested polymerase chain reaction assays. Thirty-five HIV-infected and 16 control
children had gingivitis. Seventeen (35.4%) HIV-infected children and 13 (27%) control
children were positive for HHVs. CMV was the most commonly detected HHV in both
groups (HIV-infected, 25%; control, 12.5%), followed by HSV-1 (6.2% in both groups)
and HSV-2 (HIV-infected, 4.2%; control, 8.3%). The presence of HHVs in saliva was not
associated with the presence of gingivitis in HIV-1-infected children
(p = 0.104) or healthy control children (p =
0.251), or with immunosuppression in HIV-infected individuals (p =
0.447). Gingivitis was correlated with HIV infection (p = 0.0001).
These results suggest that asymptomatic salivary detection of HHVs is common in
HIV-infected and healthy children, and that it is not associated with gingivitis.
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Affiliation(s)
- Renata A Otero
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Flávia N N Nascimento
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Ivete P R Souza
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Raquel C Silva
- Department of Virology, Microbiology Institute, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Rodrigo S Lima
- Department of Virology, Microbiology Institute, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Tatiana F Robaina
- Department of Virology, Microbiology Institute, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Fernando P Câmara
- Department of Virology, Microbiology Institute, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Norma Santos
- Department of Virology, Microbiology Institute, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Gloria F Castro
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro, RJ, Brazil
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20
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Mäki J, Paavilainen H, Grénman S, Syrjänen S, Hukkanen V. Carriage of herpes simplex virus and human papillomavirus in oral mucosa is rare in young women: A long-term prospective follow-up. J Clin Virol 2015; 70:58-62. [DOI: 10.1016/j.jcv.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/01/2015] [Accepted: 07/06/2015] [Indexed: 01/26/2023]
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21
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ROSA MARIAINÊSDA, SOUZA SUÉLIL, FARIAS BRUNAFDE, PIRES PATRÍCIAD, DONDOSSOLA EDUARDOR, REIS MARIAEDUARDAFDOS. Efficacy of Topical 5% Acyclovir-1% Hydrocortisone Cream (ME-609) for Treatment of Herpes Labialis: a systematic review. ACTA ACUST UNITED AC 2015; 87:1415-20. [DOI: 10.1590/0001-3765201520140701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We performed a systematic review with the objective of verifying the efficacy of topical use 5% Acyclovir-1% Hydrocortisone cream compared to the placebo group for herpes simplex labialis treatment. We performed a literature search using MEDLINE, Embase, BIOSIS, LILACS, Scopus, Grey literature, the Cochrane Central Register of Controlled Trials, the ISI Web of Science and IBECS from 1990 to June 2014. We reported the outcomes using relative risk (RR) with 95% confidence intervals. The literature search yielded 180 potentially relevant publications. Reviews of the reference lists yielded two further citations. Among these papers, two were considered eligible for inclusion in this review. Both trials included 1,213 patients. A meta-analysis of these studies showed a RR = 0.77, (95% CI 0.70-0.86; p<0.001).This result suggests that an early episodic treatment with the combination of an antiviral and a steroid is beneficial for herpes simplex labialis treatment.
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22
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Patel R, Green J, Clarke E, Seneviratne K, Abbt N, Evans C, Bickford J, Nicholson M, O'Farrell N, Barton S, FitzGerald M, Foley E. 2014 UK national guideline for the management of anogenital herpes. Int J STD AIDS 2015; 26:763-76. [PMID: 25861804 DOI: 10.1177/0956462415580512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/13/2015] [Indexed: 11/16/2022]
Abstract
These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline.
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Affiliation(s)
- Raj Patel
- Royal South Hants Hospital, Southampton, UK
| | | | | | | | - Naomi Abbt
- Buckinghamshire Healthcare NHS Trust, UK
| | - Ceri Evans
- Chelsea and Westminster Hospital, London, UK
| | | | | | | | | | - Mark FitzGerald
- British Association for Sexual Health and HIV Clinical Effectiveness Group, London, UK
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23
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Sufiawati I, Tugizov SM. HIV-associated disruption of tight and adherens junctions of oral epithelial cells facilitates HSV-1 infection and spread. PLoS One 2014; 9:e88803. [PMID: 24586397 PMCID: PMC3931628 DOI: 10.1371/journal.pone.0088803] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/15/2014] [Indexed: 11/18/2022] Open
Abstract
Herpes simplex virus (HSV) types 1 and 2 are the most common opportunistic infections in HIV/AIDS. In these immunocompromised individuals, HSV-1 reactivates and replicates in oral epithelium, leading to oral disorders such as ulcers, gingivitis, and necrotic lesions. Although the increased risk of HSV infection may be mediated in part by HIV-induced immune dysfunction, direct or indirect interactions of HIV and HSV at the molecular level may also play a role. In this report we show that prolonged interaction of the HIV proteins tat and gp120 and cell-free HIV virions with polarized oral epithelial cells leads to disruption of tight and adherens junctions of epithelial cells through the mitogen-activated protein kinase signaling pathway. HIV-induced disruption of oral epithelial junctions facilitates HSV-1 paracellular spread between the epithelial cells. Furthermore, HIV-associated disruption of adherens junctions exposes sequestered nectin-1, an adhesion protein and critical receptor for HSV envelope glycoprotein D (gD). Exposure of nectin-1 facilitates binding of HSV-1 gD, which substantially increases HSV-1 infection of epithelial cells with disrupted junctions over that of cells with intact junctions. Exposed nectin-1 from disrupted adherens junctions also increases the cell-to-cell spread of HSV-1 from infected to uninfected oral epithelial cells. Antibodies to nectin-1 and HSV-1 gD substantially reduce HSV-1 infection and cell-to-cell spread, indicating that HIV-promoted HSV infection and spread are mediated by the interaction of HSV gD with HIV-exposed nectin-1. Our data suggest that HIV-associated disruption of oral epithelial junctions may potentiate HSV-1 infection and its paracellular and cell-to-cell spread within the oral mucosal epithelium. This could be one of the possible mechanisms of rapid development of HSV-associated oral lesions in HIV-infected individuals.
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Affiliation(s)
- Irna Sufiawati
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sharof M. Tugizov
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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24
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HSV-1 as well as HSV-2 is frequent in oral mucosal lesions of children on chemotherapy. Support Care Cancer 2014; 22:1773-9. [DOI: 10.1007/s00520-014-2152-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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25
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Jie WANGJ, Bin ZHUZ, Xi YANG, Jing WU, Bo WANGH, Lin FENG, Wei DINGG, NORRIS JL, Ning WANG. Herpes simplex virus type 2 risks in female sex workers in the China-Vietnam border county of Hekou. BIOMEDICAL AND ENVIRONMENTAL SCIENCES : BES 2012; 25:706-710. [PMID: 23228841 PMCID: PMC5463540 DOI: 10.3967/0895-3988.2012.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 04/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To survey the prevalence and risk factors of HSV-2 among Chinese and Vietnamese female sex workers (FSW) in the border county of Hekou, Yunnan Province, China. METHODS A cross-sectional survey was conducted on demographics, sexual behavior, medical history, and drug use among FSWs. Laboratory samples were obtained to test for HSV-2 and other STIs such as HIV, Syphilis, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Bacterial vaginosis, and Yeast infections. Cervicitis and genital warts were also diagnosed. RESULTS Of the 345 FSWs who participated in this study, 112 (32.5%) were ethnic Chinese and 233 (67.5) were Vietnamese. Among FSWs in Hekou, the prevalence rates were 58.3% for HSV-2, 5.5% for HIV, and 4.1% for bacterial vaginosis (BV). Age<21 (OR: 0.5; 95% CI: 0.3, 0.8), duration of commercial sex work≤3 months (OR: 0.5; 95% CI: 0.3, 0.8), oral and vaginal sex with the last client (as opposed to only vaginal sex) (OR: 1.6; 95% CI: 1.0, 2.7), HIV (OR: 11.4; 95% CI: 1.5, 87.2), and bacterial vaginosis (BV) (OR: 5.6; 95% CI: 1.2, 26.9) were significantly correlated with HSV-2 infection. CONCLUSION Multivariate analysis showed that several factors were significantly correlated with the high prevalence of HSV-2 in FSWs in the border area between China and Vietnam. Further studies and interventions are needed for HSV-2 epidemiology in the border area.
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Affiliation(s)
- WANG Jun Jie
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - ZHU Zhi Bin
- Hekou Center for Disease Control and Prevention, Hekou 661300, Yunnan, China
| | - YANG Xi
- Hekou Center for Disease Control and Prevention, Hekou 661300, Yunnan, China
| | - WU Jing
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - WANG Hai Bo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - FENG Lin
- Yunnan Center for Disease Control and Prevention, Kunming 650022, China
| | - DING Guo Wei
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Jessie L. NORRIS
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - WANG Ning
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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Westley S, Seymour RA, Staines K. Recurrent intra-oral herpes simplex 1 infection. ACTA ACUST UNITED AC 2011; 38:368-70, 372-4. [DOI: 10.12968/denu.2011.38.6.368] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Suzanne Westley
- House officer, Newcastle Dental Hospital and School, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - R A Seymour
- Professor of Restorative Dentistry, Newcastle Dental Hospital and School, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - Konrad Staines
- Consultant in Oral Medicine, Newcastle Dental Hospital and School, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
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27
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Bauchat JR. Focused review: neuraxial morphine and oral herpes reactivation in the obstetric population. Anesth Analg 2010; 111:1238-41. [PMID: 20881282 DOI: 10.1213/ane.0b013e3181f57c30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neuraxial morphine administration is a common strategy for providing postcesarean delivery analgesia. Morphine delivered via this route increases the risk of herpes labialis (oral herpes) reactivation, a disease common in women of childbearing age. A primary concern is risk of transmission to the neonate from maternal reactivation. The benefits to the mother of this form of analgesia outweigh the risk of neonatal herpes acquired postpartum from maternal recurrence because serious neonatal morbidity from recurrent herpes has not been described.
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Affiliation(s)
- Jeanette R Bauchat
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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28
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Wang CC, Yepes LC, Danaher RJ, Berger JR, Mootoor Y, Kryscio RJ, Miller CS. Low prevalence of varicella zoster virus and herpes simplex virus type 2 in saliva from human immunodeficiency virus-infected persons in the era of highly active antiretroviral therapy. ACTA ACUST UNITED AC 2010; 109:232-7. [PMID: 20123407 DOI: 10.1016/j.tripleo.2009.08.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 08/12/2009] [Accepted: 08/17/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Human herpesviruses, e.g., herpes simplex virus (HSV) type 1, Epstein-Barr virus, and cytomegalovirus, appear in saliva at greater frequency in persons infected with human immunodeficiency virus (HIV) than in healthy individuals. However, it is not known if varicella zoster virus (VZV) and HSV-2 appear simultaneously during HIV infection at greater frequency in saliva in this era of highly active antiretroviral therapy (HAART). The aim of this study was to investigate the prevalence and amounts of VZV and HSV-2 in the saliva of HIV-infected orally asymptomatic patients. STUDY DESIGN Quantitative polymerase chain reaction was used to investigate the prevalence, quantity, risk, and correlations of salivary VZV and HSV-2 from 59 HIV-seropositive individuals and 53 healthy control subjects in a case-control cross-sectional study. Seventy-eight percent of the HIV-seropositive patients (46 out of 59) were taking HAART. RESULTS VZV DNA was detected in the saliva of 5.1% (3 out of 59) of the HIV-positive group and in only 1 healthy control 1.9% (1 out of 53; P = .62). The amount of VZV DNA in the expressors was low, generally <1,100 copies/mL, with no observed difference between the HIV-positive group and the control subjects (P = 1.0). HSV-2 DNA was not detected in either group. In the HIV-infected group, VZV shedding occurred in those on HAART, but was not associated with oral lesions, specific CD4(+) or CD8(+) T-cell levels, or demographic factors. CONCLUSIONS Varicella zoster virus was detected at low prevalence in the saliva of HIV-infected persons, whereas HSV-2 was not detected in the saliva of this cohort. HAART does not appear to diminish the risk for asymptomatic VZV shedding.
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Affiliation(s)
- Chunmei C Wang
- Department of Oral Health Practice, University of Kentucky College of Medicine and College of Dentistry, Lexington, Kentucky 40536-0297, USA.
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29
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Aga IE, Hollier LM. Managing genital herpes infections in pregnancy. ACTA ACUST UNITED AC 2009; 5:165-72; quiz 73-4. [PMID: 19245354 DOI: 10.2217/17455057.5.2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Genital herpes is the leading cause of genital ulcer disease worldwide and it is one of the most common sexually transmitted infections. Genital herpes simplex virus infection during pregnancy poses significant risks, predominantly vertical transmission of infection with resulting neonatal disease. While uncommon, neonatal infection has a high mortality rate and significant long-term morbidity. This article will examine the current recommendations for diagnosis using serologic and viral detection techniques. Treatment options for initial and recurrent genital herpes infection in pregnancy are reviewed. The use of prophylactic antivirals and cesarean delivery are discussed. The article concludes with a look to the future, including potential changes in the management of herpes simplex virus-infected pregnant women.
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Affiliation(s)
- Irene E Aga
- Department of Obstetrics, Gynecology & Reproductive Sciences, UT Houston LBJ General Hospital, Houston, TX 77026, USA.
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30
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Tan DHS, Kaul R, Walsmley S. Left out but not forgotten: Should closer attention be paid to coinfection with herpes simplex virus type 1 and HIV? THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2009; 20:e1-7. [PMID: 20190881 PMCID: PMC2690523 DOI: 10.1155/2009/965263] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are among the most common coinfections seen in individuals infected with HIV-1. Most research on HSV-HIV coinfection has focused on HSV-2, and in particular, on its impact on HIV transmission. HSV-2 is associated with micro- and macroulcerations in genital mucosal surfaces, increased numbers of HIV target cells in genital mucosal tissue and increases in plasma HIV viral load of up to 0.5 log(10) copies/mL, such that HSV-2 infection increases the risk of both HIV acquisition and transmission. Because plasma HIV RNA levels are a major determinant of rates of CD4 cell decline, HSV-2 coinfection may also adversely affect the progression of HIV disease. Anti-HSV medications have in fact been associated with reciprocal decreases in HIV viral load in short-term studies. These findings have led to the development of several clinical trials of HSV-2 suppression as strategies for preventing HIV transmission and slowing the rate of HIV disease progression. HSV-1 coinfection has largely been ignored from this growing body of research, yet there are several reasons that this coinfection remains an important issue for study. First, the seroprevalence of HSV-1 is consistently higher than that of HSV-2 among both HIV-infected and HIV-uninfected populations, underscoring the relevance of HSV-1 coinfection to the majority of HIV-infected persons. Second, pre-existing HSV-1 antibodies in individuals may modulate the course of subsequently acquired HSV-2 infection; the implications of such changes on HSV-HIV coinfection remain unexplored. Third, HSV-1 and HSV-2 are closely related viruses that share 83% genetic homology. Their virological and pathobiological similarities suggest that their implications on HIV pathogenesis may be similar as well. Finally, HSV-1 is becoming increasingly relevant because the incidence of genital HSV-1 has risen. Although genital herpes is traditionally associated with HSV-2, recent studies have shown that the majority of serologically confirmed primary genital herpes in some settings is attributable to HSV-1. Because the genital tract is an important site of biological interaction between HSV and HIV, this epidemiological change may be clinically important.
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Affiliation(s)
- Darrell H S Tan
- Division of Infectious Diseases, University Health Network, Toronto, Ontario
| | - Rupert Kaul
- Division of Infectious Diseases, University Health Network, Toronto, Ontario
| | - Sharon Walsmley
- Division of Infectious Diseases, University Health Network, Toronto, Ontario
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31
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Hollier LM, Workowski K. Treatment of Sexually Transmitted Infections in Women. Infect Dis Clin North Am 2008; 22:665-691. [DOI: 10.1016/j.idc.2008.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Legoff J, Aymard M, Braig S, Ramel F, Dreno B, Bélec L, Malkin JE. [Herpes serology for genital herpes]. Presse Med 2008; 37:1251-60. [PMID: 18436423 DOI: 10.1016/j.lpm.2007.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 06/28/2007] [Accepted: 07/07/2007] [Indexed: 11/30/2022] Open
Abstract
The epidemiology of genital herpes is changing. The seroprevalence of HSV-2 infections is increasing, while HSV-1 is an increasingly common cause of herpetic ulcerations. The reference examination provides direct diagnosis after viral isolation in a cell culture or genome amplification. Herpes serology is indicated principally if direct examination is negative and in the absence of lesions. Non-type-specific serology detects antibodies common to HSV-1 and HSV-2. Its specificity and sensitivity are excellent, and it is approved as a reimbursable laboratory procedure. It cannot specify the viral type involved. Type-specific serology can distinguish between anti-HSV-1 and anti-HSV-2 antibodies. Currently available kits have a sensitivity and specificity, depending on the population studied, of 90 to 100%. It is not approved as a reimbursable laboratory procedure. HSV-1-specific serology cannot diagnose old HSV-1 genital infections, but seropositivity for HSV-2 generally suffices to diagnose HSV-2 genital herpes. The indication for type-specific serology must be discussed according to clinical context. The value of non-type-specific serology is limited.
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Affiliation(s)
- Jérôme Legoff
- Université Paris V, Laboratoire de virologie, Hôpital européen Georges Pompidou, F-75015 Paris, France
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33
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Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med 2008; 37:107-21. [PMID: 18197856 DOI: 10.1111/j.1600-0714.2007.00586.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Herpes Simplex Virus Type 1 (HSV-1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva). The prevalence of HSV-1 infection increases progressively from childhood, the seroprevalence being inversely related to socioeconomic background. Primary HSV-1 infections in children are either asymptomatic or following an incubation period of about 1 week gives rise to mucocutaneous vesicular eruptions. Herpetic gingivostomatitis typically affects the tongue, lips, gingival, buccal mucosa and the hard and soft palate. Most primary oro-facial HSV infection is caused by HSV-1, infection by HSV-2 is increasingly common. Recurrent infections, which occur at variable intervals, typically give rise to vesiculo-ulcerative lesions at mucocutaneous junctions particularly the lips (herpes labialis). Recurrent HSV-1 infection within the mouth is uncommon in otherwise healthy patients, although in immunocompromised patients, recurrent infection can be more extensive and/or aggressive. The diagnosis of common herpetic infection can usually be based upon the clinical history and presenting features. Confirmatory laboratory diagnosis is, however, required when patients are, or may be, immunocompromised.
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Affiliation(s)
- Paolo G Arduino
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, University of Turin, Turin, Italy.
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34
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Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol 2007; 57:737-63; quiz 764-6. [PMID: 17939933 DOI: 10.1016/j.jaad.2007.06.027] [Citation(s) in RCA: 265] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 04/28/2007] [Accepted: 06/22/2007] [Indexed: 11/29/2022]
Abstract
Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.
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Affiliation(s)
- Mahnaz Fatahzadeh
- Department of Oral Medicine, New Jersey Dental School, Newark, New Jersey 07103, USA.
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35
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Leone P, Warren T, Hamed K, Fife K, Wald A. Famciclovir Reduces Viral Mucosal Shedding in HSV-Seropositive Persons. Sex Transm Dis 2007; 34:900-7. [PMID: 17538513 DOI: 10.1097/olq.0b013e318063c749] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many cases of herpes simplex virus (HSV) infection occur through asymptomatic shedding from persons without evidence of clinical disease. This study explores whether famciclovir reduces HSV shedding in HSV-2 seropositive persons with or without a history of symptomatic genital herpes. STUDY DESIGN One hundred twenty-seven HSV-2 seropositive participants were randomly assigned to 42 days of famciclovir, followed by 14 days of washout and 42 days of placebo, or vice versa. All subjects swabbed the genital/perianal area; those with HSV-1 infection also swabbed the oral area daily for HSV DNA PCR. RESULTS Famciclovir reduced genital and oral HSV shedding from 11.4% of days during the placebo period to 4.7% of days during famciclovir therapy. The reduction was greater in participants with a history of genital herpes (74%) than in those without such a history (30%). In multivariate analyses, famciclovir protected against total (clinical and subclinical) genital shedding among persons with a clinical history of genital herpes (RR, 0.23; 95% CI, 0.15-0.35; P < 0.001). Among HSV-2 seropositive participants without a history of genital herpes, 60% had HSV detected in the genital area at least once during the study. Famciclovir therapy did not result in a statistically significant reduction in total HSV shedding in participants without a history of genital herpes. CONCLUSION Famciclovir therapy decreases genital HSV shedding in HSV-seropositive persons, especially those with a history of genital herpes. Overall, antiviral drugs may have varying effects on symptomatic and asymptomatic viral shedding, depending on the clinical history of the disease.
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Affiliation(s)
- Peter Leone
- University of North Carolina, Chapel Hill, NC 27599-7030, USA.
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36
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Miller CS, Danaher RJ. Asymptomatic shedding of herpes simplex virus (HSV) in the oral cavity. ACTA ACUST UNITED AC 2007; 105:43-50. [PMID: 17703961 DOI: 10.1016/j.tripleo.2007.06.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the rate of herpes simplex virus (HSV) shedding from the oral cavity, because recent studies suggest that shedding is more frequent than originally reported. Factors that could influence the rate and duration of shedding from the oral cavity were examined. METHODS Existing epidemiologic data from 22 reports of HSV shedding from more than 3,500 individuals were analyzed with regard to demographics, frequency of sampling, and methodologic assays. RESULTS HSV-1 was more likely to be detected than HSV-2 in the oral cavity of asymptomatic persons (7.5 odds ratio, 95% confidence interval 4.4-12.8; P < .0001). The rate of shedding was highly variable among individuals, ranging from none to 92% of days tested, and occurred in seropositive and seronegative individuals. In cell culture studies, the rate of detection on a single day was 6.3%. Polymerase chain reaction studies provided a different picture. HSV-1 DNA was present in 97 of 180 patients (53.9%) at multiple visits, with a rate of daily detection of 33.3%. The mean duration of shedding was between 1 and 3 days, but more than 3 days in about 10% of patients. CONCLUSIONS At least 70% of the population shed HSV-1 asymptomatically at least once a month, and many individuals appear to shed HSV-1 more than 6 times per month. Shedding of HSV-1 is present at many intraoral sites, for brief periods, at copy numbers sufficient to be transmitted, and even in seronegative individuals. The dental implications of these findings are discussed.
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Affiliation(s)
- Craig S Miller
- Oral Medicine Section, Department of Oral Health Practice, Center for Oral Health Research, Lexington, Kentucky, USA.
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37
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Woo SB, Challacombe SJ. Management of recurrent oral herpes simplex infections. ACTA ACUST UNITED AC 2007; 103 Suppl:S12.e1-18. [PMID: 17379150 DOI: 10.1016/j.tripleo.2006.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 11/06/2006] [Indexed: 11/18/2022]
Abstract
The literature has been reviewed for evidence of the efficacy of antiviral agents in both the prophylaxis and treatment of recurrent oral herpes simplex virus (HSV) infections and discussed by a panel of experts. Emphasis was given to randomized controlled trials. Management of herpes-associated erythema multiforme and Bell palsy were also considered. The evidence suggests that 5% acyclovir (ACV) in the cream base may reduce the duration of lesions if applied early. Recurrent herpes labialis (RHL) and recurrent intraoral HSV infections can be effectively treated with systemic ACV 400 mg 3 times a day or systemic valacyclovir 500 to 1000 mg twice a day for 3 to 5 days (longer in the immunocompromised). RHL in the immunocompetent can be effectively prevented with (1) sunscreen alone (SPF 15 or above), (2) systemic ACV 400 mg 2 to 3 times a day, or (3) systemic valacyclovir 500 to 2000 mg twice a day. Valacyclovir 500 mg twice a day is also effective in suppressing erythema multiforme triggered by HSV. Further studies are needed to compare treatment efficacy between topical penciclovir, docosanol, and ACV cream for RHL.
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Affiliation(s)
- Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA.
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38
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Casper C, Krantz E, Selke S, Kuntz SR, Wang J, Huang ML, Pauk JS, Corey L, Wald A. Frequent and asymptomatic oropharyngeal shedding of human herpesvirus 8 among immunocompetent men. J Infect Dis 2006; 195:30-6. [PMID: 17152006 PMCID: PMC2128060 DOI: 10.1086/509621] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 08/20/2006] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Little is known about the clinical and virologic manifestations of human herpesvirus (HHV)-8 infection in immunocompetent persons in the absence of malignancy. METHODS A total of 46 human immunodeficiency virus-negative, HHV-8-seropositive men collected saliva daily, and 25 recorded 15 common symptoms daily (gastrointestinal, constitutional, and oropharyngeal) and absences from work or school. Quantitative polymerase chain reaction measured HHV-8 DNA in saliva. RESULTS Some 44 (96%) of 46 men reported having sex with men (MSM). Of the 44 MSM, 27 (61%) had HHV-8 detected in saliva on > or = 1 day; heterosexual men also shed HHV-8. In analyses restricted to MSM, HHV-8 DNA was detected on 636 (22%) of 2897 days. Among MSM with HHV-8 detected in saliva, the median rate was 20% (range, 1%-100%), with 30% shedding on > 50% of days, and the median quantity was 4.5 log10 copies/mL (range, 2.0-7.3 log10 copies/mL). The quantity of HHV-8 shed was lower in nonwhites (P<.001) and younger participants (P=.03). The frequency of HHV-8 detection and quantity were correlated (r=0.62; P<.001). Symptoms were reported on 10 (9%) of 114 days when HHV-8 was present, compared with 78 (9%) of 830 days without (odds ratio, 0.93 [95% confidence interval, 0.30-2.88]; P=.9). CONCLUSIONS HHV-8 is detected frequently and intermittently in the saliva of chronically infected immunocompetent MSM, but this infection is asymptomatic.
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Affiliation(s)
- Corey Casper
- Department of Medicine, University of Washington, Seattle, WA, USA.
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39
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Abstract
BACKGROUND Reactivation of herpes simplex virus-1 (HSV-1) can result in recurrent herpes labialis lesions (RHL) and in oral shedding of virus. This study utilized polymerase chain reaction (PCR) to document the frequency and quantity of such shedding. METHODS Thirty adults with greater than three RHL episodes per year were followed through one recurrence. They collected swabs for PCR every 12 h starting at prodrome and for 10 days thereafter. Shedding was analyzed with regard to frequency, timing and quantity. RESULTS HSV-1 was detectable in 87% of participants for a mean of 4 days. Shedding occurred most frequently during the vesicle/ulcer stage (91% of subjects), but was common in both clinical and subclinical stages (50% vs. 23%, average log DNA copy number/ml(2) 2.6 vs. 1.4). CONCLUSION The majority of RHL patients shed viral DNA. Shedding occurred before and after the appearance of clinical lesions. Such findings may be useful in designing methods to reduce viral shedding and prevent transmission.
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Affiliation(s)
- Stanley C Gilbert
- Department of Medicine, University of Washington, Seattle WA 98195, USA.
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40
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Abstract
This paper reviews the current concepts of viral classification, infection and replication. The clinical presentation of common oral viral infections encountered in the dental practice are discussed, including: herpes simplex virus types 1 and 2; Epstein-Barr virus; varicella-zoster virus; Coxsackie virus; human papilloma virus; and human immunodeficiency virus. The diagnosis, principles of management and pharmacological agents available for the treatment of oral viral infections are also discussed.
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Affiliation(s)
- M J McCullough
- Oral Medicine, School of Dental Science, The University of Melbourne.
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41
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Abstract
Approximately 22% of pregnant women are infected with herpes simplex virus (HSV)-2, and 2% of women will acquire HSV during pregnancy. Remarkably, up to 90% of these women are undiagnosed because they are asymptomatic or have subtle symptoms attributed to other vulvovaginal disorders. Diagnosis of genital herpes relies on laboratory confirmation with culture or polymerase chain reaction assay of genital lesions and type-specific glycoprotein G-based serologic testing. Neonatal herpes is the most severe complication of genital HSV infection and is caused by contact with infected genital secretions at the time of labor. Maternal acquisition of HSV in the third trimester of pregnancy carries the highest risk of neonatal transmission. Despite advances in the diagnosis and treatment of neonatal herpes, little change in the incidence or serious sequelae from this infection has occurred. As such, prevention of the initial neonatal infection is critically important. Obstetricians are in a unique position to prevent vertical HSV transmission by identifying women with genital lesions at the time of labor for cesarean delivery, prescribing antiviral suppressive therapy as appropriate, and avoiding unnecessary invasive intrapartum procedures in women with genital herpes. Enhanced prevention strategies include identification of women at risk for HSV acquisition during pregnancy by testing women and possibly their partners for HSV antibodies and providing counseling to prevent transmission to women in late pregnancy.
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Affiliation(s)
- Zane A Brown
- Department of Obstetrics and Gynecology, Laboratory Medicine, Medicine and Epidemiology, University of Washington, Seattle, 98195-6460, USA.
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Abstract
Sexually transmitted infections remain a major public health concern in the United States. An estimated 19 million infections occur each year. The economic burden imposed by sexually transmitted infections is impressive: direct medical costs have been estimated as high as 15.5 billion US dollars annually. Sexually transmitted infections are relatively common during pregnancy, especially in indigent, urban populations. Education, screening, treatment, and prevention are important components of prenatal care for women at increased risk for these infections. Treatment of these sexually transmitted infections is clearly associated with improved pregnancy outcome and reductions in perinatal mortality.
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Affiliation(s)
- Lisa M Hollier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Houston Medical School, Lyndon Baines Johnson General Hospital, Houston, TX 77026, USA.
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Warren T, Ebel C. Counseling the Patient who has Genital Herpes or Genital Human Papillomavirus Infection. Infect Dis Clin North Am 2005; 19:459-76. [PMID: 15963883 DOI: 10.1016/j.idc.2005.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Educational counseling has an important role in managing patients who have viral STIs, such as genital herpes and genital HPV infections. Given the lack of a curative therapy for both, patients may require long-term management and may need to be attentive to recurring symptoms. In addition, both diagnoses may raise issues of persisting infectiousness along with a need for patient counseling about the potential risk to partners and risk reduction strategies. Lastly, dozens of published papers over the years describe potential psychosocial sequelae for patients who have genital herpes, and there is a growing psychosocial literature on genital HPV as well. Clinicians can make a significant difference in patient adjustment to the diagnosis of an STI, and addressing these challenging issues will benefit patients greatly.
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Affiliation(s)
- Terri Warren
- Westover Heights Clinic, 2330 NW Flanders Street, Suite 207, P.O. Box 13827, Portland, OR 97210, USA.
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