The epidemiology of genital infection with herpes simplex virus types 1 and 2 in genitourinary medicine attendees in inner London

Genital herpes as still significant dermatological, gynaecological and venereological problem

Genital herpes is one of the most commonly diagnosed sexually transmitted diseases and the most common factor in the formation of ulcers and erosions within the mucous membranes. It is characterized by a wide range of clinical symptoms from serous-filled blisters located on the erythematous and oedematous substrate to asymptomatic infection. Due to anatomical differences in the genital tract, there is a more than a 4-fold increase in the risk of a woman being infected by a partner than a man by a woman. In addition, the transmission of herpes simple virus from mother to foetus becomes a serious gynaecological and neonatal problem, especially in women of childbearing age. Despite epidemiological studies, the incidence of genital herpes has not been fully understood, probably due to lack of harmonization of disease reporting systems in many countries, and to difficulties in diagnosis and treatment.

2017 European guidelines for the management of genital herpes

Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

European guideline for the management of genital herpes, 2010

This is the guideline for genital herpes simplex virus (HSV) management for the IUSTI/WHO Europe, 2010. They describe the epidemiology, diagnosis, clinical features, treatment and prevention of genital HSV infection. They include details on the management of HSV in pregnancy, those who are immunocompromised and the clinical investigation and management of suspected HSV-resistant disease.

Socio-demographic and behavioral correlates of herpes simplex virus type 1 and 2 infections and co-infections among adults in the USA

OBJECTIVES

Although herpes simplex virus (HSV)-1 and HSV-2 may co-exist and interact, some epidemiologic features including geographical distribution, secular trends, route of transmission, and established risk factors may distinguish these HSV sub-types. With recent data indicating a link between genital herpes and either strain, a re-evaluation of risk factors for HSV-1/HSV-2 infection and co-infection is needed.

METHODS

We used the 1999-2004 National Health and Nutrition Examination Study (NHANES) data and logistic regression modeling to identify socio-demographic and behavioral risk factors that can independently predict HSV-1/HSV-2 infection and co-infection.

RESULTS

Approximately 48% were positive for HSV-1 alone, 7% were positive for HSV-2 alone and 12% were co-infected with HSV-1 and HSV-2. History of genital herpes was found in individuals infected with either or both HSV sub-types. Whereas age, sex, race, and level of education independently predicted all three outcomes, lifetime sexual activity as well as use of tobacco products and recreational drugs mainly correlated with HSV-2 infection and HSV-1/HSV-2 co-infection. Lifetime use of alcohol was not consistently associated with HSV-1/HSV-2 infection and co-infection.

CONCLUSIONS

Sexual activity played an important role for HSV-2 and was potentially important for HSV-1, with implications for healthcare practice and vaccine development.

Interactions and management issues in HSV and HIV coinfection

Significant synergistic interactions have been observed between HIV and herpes simplex virus (HSV). HIV-induced immune compromise can cause frequent and persistent HSV disease, while poorly controlled HSV replication may influence HIV pathogenicity and transmission. HSV-2 seroprevalence is high in HIV-infected cohorts worldwide, with rates of over 80% for HSV-1 and ranging from 33% to more than 80% for HSV-2. As seen in HIV-negative individuals, HSV-2 coinfection is associated with female gender, older age and black ethnicity. HSV infection is commonly under-diagnosed in HIV-infected individuals, although the use of PCR for HSV detection in mucocutaneous swabs and HSV type-specific serology can improve the diagnostic yield. In HIV-1-infected patients with frequent clinical episodes of HSV reactivation, suppressive antiviral therapy may prove beneficial in controlling HSV disease while also reducing HSV-mediated promotion of HIV replication. Antiretroviral therapy leads to a gradual recovery of HSV-specific T-cell responses and a reduction in HSV-related morbidity, indicating that successful management of coinfection should target both HIV and HSV replication. The aim of this review is to address the more speculative issues surrounding the management of HSV/HIV coinfection and to summarize the data that inform them.