The epidemiology of herpes simplex types 1 and 2 infection of the genital tract in Edinburgh 1978-1991

Seroprevalence of herpes simplex virus type 1 among people living with HIV in Mbeya, Tanzania

Background

Despite the significant decline in the prevalence of HIV in Tanzania, the prevalence rates in Mbeya, Iringa, and Njombe regions are higher than the national average and have remained stable for years. The current stable HIV prevalence may be driven by factors such as a high incidence of sexually transmitted infections (STIs) and high-risk behaviours. In sub-Saharan Africa, it has previously been observed that up to 50% of HIV cases were attributed to herpes simplex type 2 (HSV-2) among low-risk populations. Because the proportion of sexually transmitted HSV-1 is rising, it is essential to study the interaction between HSV-1 and HIV infections.

Methods

We conducted a study in Mbeya region using the archived blood sera of participants from the recently completed EU-funded EMINI project. A specially designed questionnaire was used to obtain the social and demographic characteristics of the study participants in the database. We tested archived participants’ sera for herpes simplex virus type 1 using Virotech HSV-1 (gG1) IgG ELISA (Enzygnost, Behring, Germany). Univariate and multivariate Poisson regression models were used to identify factors associated with HSV-1.

Results

A total of 640 adults were randomly recruited after stratification by HIV status (318 were HIV positive), age, and sex. The overall seroprevalence of HSV-1 in the study population was 92.1%. The extrapolated seroprevalence estimate of herpes simplex virus type 1 in the general population was 95.0% (96.0% in males versus 94.0% in females). Males and females were equally affected by HSV-1. HSV-1 was less prevalent in HIV-positive individuals than in HIV-negative individuals.

Conclusion

People living with HIV were less likely to be HSV-1 seropositive. Further prospective studies are necessary to conclude a causal association.

Herpes Simplex Virus Proctitis Masquerading as Rectal Cancer

Herpes simplex virus (HSV) is the leading cause of proctitis in HIV-infected individuals. However, no cases of rectal masses secondary to HSV infection have been reported to date. Herein, we present the case of a 45-year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer. Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms. Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis.

Seroprevalence of HSV-1 and 2 in HIV-infected males with and without GUD: Study from a tertiary care setting of India

BACKGROUND

Herpes simplex virus (HSV) infection is associated with an increased risk of both human immune deficiency virus (HIV) transmission and acquisition. However, in India, literature on HSV infections in in HIV-infected males has been scarce. The present study was carried out to assess the seroprevalence of these viruses in HIV-infected males, so as to provide a baseline data from India and report on HSV associated GUD prevalence in HIV infected males.

OBJECTIVE

The aim of the study was to estimate the seroprevalence of herpes simplex type 1 and 2 viruses in HIV-infected males with and without genital ulcers disease (GUD).

MATERIAL AND METHODS

It was a prospective study. We included a total of 351 male participants in this study. Among these 233 were HIV-infected and 118 HIV-uninfected males who served as controls. The seroprevalence was estimated, using HSV-1 and 2 type specific IgG and IgM antibodies by ELISA.

RESULTS

HIV-infected patients had a median age of 32 ± 6.97 years (interquartile range: 28-36). Of the 351 males, 25.92% (91/351) were infected with HSV-1 and HSV-2 both. The overall seroprevalence of HSV-1 singly infected, HSV-2 singly infected, and dual infection in HIV-infected males was 39.92%, 25.58%, and 37.33% whereas in HIV-uninfected group the corresponding figures were 71.18%, 5.08%, and 3.38%, respectively. Seven of 233 (3%) HIV-infected males were having incident HSV infection. GUD was reported in both HSV-1 and HSV-2 seropositive individuals.

CONCLUSIONS

Both HSV-1 and HSV-2 infections were found to be associated with GUD in HIV-infected patients. The prevalence of HIV-HSV co-infection among GUD patients is high.

Herpes Simplex Virus 1 and 2 in Herpes Genitalis: A Polymerase Chain Reaction-Based Study from Kerala

BACKGROUND

Herpes genitalis is an ulcerating sexually transmitted infection, the clinical importance of which lies in its ability to produce painful and recurrent disease in addition to its potential role as a cofactor in acquisition and transmission of human immunodeficiency virus. In recent years, there are increasing reports of genital herpes due to herpes simplex virus (HSV)-1 from various parts of the world. Molecular diagnostic methods such as polymerase chain reaction (PCR) have got both diagnostic and prognostic significance in genital herpes.

AIMS

The present study was designed to identify the viral serotype in herpes genitalis patients in our locality, using PCR.

MATERIALS AND METHODS

The specimens from forty herpes genitalis patients were subjected to nested PCR and results were evaluated.

RESULTS

PCR was positive for HSV in 83% of cases, of which 58% were due to HSV-1. HSV-2 accounted for maximum number of recurrent herpes.

LIMITATION

Higher sample size would have been more representative.

CONCLUSION

A rising trend of type 1 HSV was observed in herpes genitalis in south India probably due to increasing practice of orogenital sex.

Maternal Antiviral Immunoglobulin Accumulates in Neural Tissue of Neonates To Prevent HSV Neurological Disease

While antibody responses to neurovirulent pathogens are critical for clearance, the extent to which antibodies access the nervous system to ameliorate infection is poorly understood. In this study on herpes simplex virus 1 (HSV-1), we demonstrate that HSV-specific antibodies are present during HSV-1 latency in the nervous systems of both mice and humans. We show that antibody-secreting cells entered the trigeminal ganglion (TG), a key site of HSV infection, and persisted long after the establishment of latent infection. We also demonstrate the ability of passively administered IgG to enter the TG independently of infection, showing that the naive TG is accessible to antibodies. The translational implication of this finding is that human fetal neural tissue could contain HSV-specific maternally derived antibodies. Exploring this possibility, we observed HSV-specific IgG in HSV DNA-negative human fetal TG, suggesting passive transfer of maternal immunity into the prenatal nervous system. To further investigate the role of maternal antibodies in the neonatal nervous system, we established a murine model to demonstrate that maternal IgG can access and persist in neonatal TG. This maternal antibody not only prevented disseminated infection but also completely protected the neonate from neurological disease and death following HSV challenge. Maternal antibodies therefore have a potent protective role in the neonatal nervous system against HSV infection. These findings strongly support the concept that prevention of prenatal and neonatal neurotropic infections can be achieved through maternal immunization.

Herpes simplex virus 1 is a common infection of the nervous system that causes devastating neonatal disease. Using mouse and human tissue, we discovered that antiviral antibodies accumulate in neural tissue after HSV-1 infection in adults. Similarly, these antibodies pass to the offspring during pregnancy. We found that antiviral maternal antibodies can readily access neural tissue of the fetus and neonate. These maternal antibodies then protect neonatal mice against HSV-1 neurological infection and death. These results underscore the previously unappreciated role of maternal antibodies in protecting fetal and newborn nervous systems against infection. These data suggest that maternal immunization would be efficacious at preventing fetal/neonatal neurological infections.

Herpesvirus entry mediator is a serotype specific determinant of pathogenesis in ocular herpes

Infection with herpes simplex virus type 1 (HSV-1) and HSV-2 is initiated by viral glycoprotein D (gD) binding to a receptor on the host cell. Two receptors, herpesvirus entry mediator (HVEM) and nectin-1, mediate entry in murine models of HSV-1 and HSV-2. HVEM is dispensable for HSV-2 infection of the vagina and brain, but is required for WT pathogenesis of HSV-1 infection of the cornea. By challenging WT and HVEM KO mice with multiple strains of HSV-1 and HSV-2, we demonstrate that without HVEM, all HSV-1 strains tested do not replicate well in the cornea and infection does not result in severe symptoms, as observed in WT mice. In contrast, all HSV-2 strains tested had no requirement for HVEM to replicate to WT levels in the cornea and still cause severe disease. These findings imply that HSV-2 does not require HVEM to cause disease regardless of route of entry, but HVEM must be present for HSV-1 to cause full pathogenesis in the eye. These findings uncover a unique role for HVEM in mediating HSV-1 infection in an area innervated by the trigeminal ganglion and may explain why the presence of HVEM can lead to severe inflammation in the cornea. Thus, the dependence on HVEM is a dividing point between HSV-1 and HSV-2 that evolved to infect areas innervated by different sensory ganglia.

Seroepidemiology of herpes simplex virus type 1 and 2 in northern iran

BACKGROUND

Herpes simplex virus (HSV) type 1 and 2 are common infectious agents worldwide. Data on prevalence of HSV-1 and HSV-2 infection are limited in Asia, especially in Iran. The aim of this study was to determine the seroprevalence of HSV type 1 and 2 based on age, gender, marital status, education, living area, job, symptoms and history of disease variables.

METHODS

The study population included 800 randomly selected persons from laboratories in Gilan Province, Iran, from 2010 to 2011. Demographic data gathered by a well-designed questionnaire and for serological studies, blood samples were collected and centrifuged. ELISA HSV-1, 2 and HSV-2 specific ELISA kits were used to determine IgG type specific antibodies in sera samples. Person's chi-square test was applied to compare HSV-1 and HSV-2 seropositivities.

RESULTS

HSV-1 and HSV-2 IgG antibodies were positive in 467 (58.4%) and 28 (3.5%) subjects, respectively. There was significant correlation between age, marital status, job, symptoms, history of disease and HSV seroprevalence (P<0.05).

CONCLUSION

Our findings were in agreement with prior studies in which HSV-1 infections was more prevalent than HSV-2 and seropositivity increased with age.

Treatment and prevention of herpes labialis

OBJECTIVE

To review the evidence regarding the treatment and prevention of herpes labialis.

QUALITY OF EVIDENCE

The evidence relating to treatment and prevention of herpes labialis is derived from randomized controlled trials (level I evidence).

MAIN MESSAGE

Treatment with an indifferent cream (zinc oxide or zinc sulfate), an anesthetic cream, or an antiviral cream has a small favourable effect on the duration of symptoms, if applied promptly. This is also the case with oral antiviral medication. If antiviral medicine (cream or oral) is started before exposure to the triggering factor (sunlight), it will provide some protection. Research on sunscreens has shown mixed results: some protection has been reported under experimental conditions that could not be replicated under natural conditions. In the long term, the number of relapses of herpes labialis can be limited with oral antiviral medication.

CONCLUSION

Only prompt topical or oral therapy will alleviate symptoms of herpes labialis. Both topical and oral treatment can contribute to the prevention of herpes labialis.

Herpes simplex virus type 2 seroprevalence in Korea: rapid increase of HSV-2 seroprevalence in the 30s in the southern part

To determine the characteristics of seroprevalence of herpes simplex virus type 2 (HSV-2) infection among Korean people, a cross-sectional study was conducted on three groups in 2004. The three groups consisted of the general public who visited public health centers, commercial sex workers (CSWs), and human immunodeficiency virus (HIV)-infected persons. Among the general public, HSV-2 seroprevalence rates for age under the 20s, in the 20s, 30s, 40s and the above 22.6%, 32.7% and 32.3%, respectively, which showed rapid increase of the rate in the 30s (p<0.0001). In case of the above of 19 yr old, women (28.0%) was higher than men (21.7%) (p<0.0001). The rate of CSWs (81.6%) was about 10 times higher than that of general women. In case of HIV-infected men (47.6%), the figure was about 2-3 times higher than that of general men. The low rate in the teens and the 20s proved that it is essential to develop sexually transmitted infections (STIs) prevention programs of education and publicity for them as a precaution measure. This study is the first major study of its kind on HSV-2 and would provide basic data for prevention of STIs including information about target groups subject to vaccination program.

Increase in rates of herpes simplex virus type 1 as a cause of anogenital herpes in western Sydney, Australia, between 1979 and 2003

BACKGROUND/OBJECTIVE

Recent studies suggest that herpes simplex virus type 1 (HSV-1) is becoming more common as a cause for genital herpes, relative to HSV-2. We aimed to calculate trends in HSV type from isolates and serology samples sent to a reference virology laboratory in New South Wales (NSW), Australia.

METHODS

We compared the proportions of HSV-1 and HSV-2 positive samples, adjusting for age and sex of source patient, in three datasets: anogenital isolates from 1979 to 1988; anogenital isolates from 1989 to 2003; and HSV type specific IgM seropositivity from 1994 to 2003.

RESULTS

The number of specimens in each analysis was 17 512, 4359, and 497, respectively. There was a progressive rise in the proportions of typed specimens being HSV-1 in all analyses. The proportion of isolates that were HSV-1 ranged from 3% in 1980 to 41% in 2001. Female sex and age under 25 were associated with a greater proportion of HSV-1 isolates in both time periods. In the period 1979-88, comparing the proportions of HSV-1 and HSV-2 gave an odds ratio (OR) per additional year of 1.24 (95% confidence interval (CI) 1.20 to 1.27; p<0.005) after adjustment for age and sex. In the period 1989-2003 there was a steeper rise in the proportion of isolates that were HSV-1 in samples from younger individuals (OR per year 1.17, 1.12 to 1.22) compared to those over 25 (OR per year 1.06, 1.03 to 1.08). The rise in the proportion of IgM seropositive results reactive for HSV-1 compared to HSV-2 gave an OR of 1.36 per year (1.26 to 1.47; p<0.005).

CONCLUSIONS

These data suggest that HSV-1 has become more common as a cause of anogenital herpes in NSW.

Seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in former East and West Germany, 1997-1998

The aim of this study was to investigate the seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in representative samples of the total former East German (FEG) and total former West German (FWG) populations. Type-specific testing with the HSV-1 (gG1) and HSV-2 (gG2) indirect ELISA was performed on an age- and sex-stratified random subsample of 3,792 sera collected during the 1997-1998 German National Health Survey. Weighted seroprevalence estimates were calculated for the total FEG and FWG populations. The overall age-standardised seroprevalence of HSV-1 was 82.6% in Germany, 85.5% (95%CI, 83.4-87.3%) in FEG and 81.8% (95%CI, 79.9-83.6%) in FWG. The overall seroprevalence of HSV-2 was 13.3% (95%CI, 11.8-14.9) in Germany, 16.5% (95%CI, 14.1-18.9) in FEG and 12.6% (95%CI, 10.7-14.5%) in FWG. The difference between FEG and FWG was largely due to the significantly higher age-adjusted seroprevalence of HSV-1 and HSV-2 in women (but not men) in FEG as compared to FWG. The HSV seroprevalence estimates in this study are consistent with results of previous less representative seroprevalence studies in Germany. Differences in HSV-2 seroprevalence between FEG and FWG suggest differences in sexual behaviour that warrant further investigation.

Changing epidemiology of genital herpes simplex virus infection in Melbourne, Australia, between 1980 and 2003

OBJECTIVE

To investigate changes in the proportions of patients infected with genital herpes simplex virus (HSV) types 1 and 2 from 1980 to 2003 in Melbourne, Australia.

METHODS

A total of 25 372 patients were studied retrospectively. The proportions of HSV-1 and HSV-2 detected in these individuals were analysed by age, sex, and genital site.

RESULTS

In 1980 only 15.8% of HSV positive genital specimens were HSV-1 compared to 34.9% in 2003. In 2003 HSV-1 was detected in 77% of patients aged less than 20 years. Females were more likely to be infected with HSV-1, although the rate of increased detection was more pronounced in males. Except for females over the age of 40, the trend for the increase in HSV-1 was detected in all age groups. No specific genital site in either sex was associated with the increase.

CONCLUSIONS

The proportion of genital HSV-1 has increased in Australian patients, although HSV-2 is still the most common cause of genital infection. Confirmation of HSV type is necessary for optimal patient management.

The seroepidemiology of herpes simplex virus type 1 and 2 in Europe

OBJECTIVES

To describe the seroepidemiology of herpes simplex virus (HSV) types 1 and 2 in the general populations of eight European countries to better understand recent reported changes in disease epidemiology.

METHODS

Belgium, Bulgaria, Czech Republic, England and Wales, Finland, Germany, Netherlands, and Slovenia conducted national cross sectional serological surveys for HSV-1 and HSV-2 between 1989 and 2000. Survey sizes ranged from 3000 to 7166 sera. External quality control was ensured through reference panel testing.

RESULTS

Large intercountry and intracountry differences in HSV-1 and HSV-2 seroprevalence were observed. Age standardised HSV-1 seroprevalence ranged from 52% in Finland, to 57% in the Netherlands, 67% in Belgium, 81% in Czech Republic, and 84% in Bulgaria. Age standardised (>12 years) HSV-2 seroprevalence ranged from 24% in Bulgaria, to 14% in Germany, 13% in Finland, 11% in Belgium, 9% in Netherlands, 6% in Czech Republic, and 4% in England and Wales. In all countries, probability of seropositivity for both infections increased with age. A large proportion of teenagers and young adults remain HSV-1 susceptible particularly in northern Europe. Women were significantly more likely to be HSV-2 seropositive in six of seven (p<0.05) countries and HSV-1 seropositive in four of seven (p<0.05) countries, particularly in northern Europe. No significant evidence of a protective role of HSV-1 for HSV-2 infection was found adjusting for age and sex (p<0.05).

CONCLUSIONS

There is large variation in the seroepidemiology of HSV-1 and HSV-2 across Europe. The observation that a significant proportion of adolescents are now HSV-1 susceptible may have implications for transmission and clinical presentation of HSV-1 and HSV-2.

Neonatal herpes simplex infection

Tremendous advances have occurred over the past 30 years in the diagnosis and management of neonatal herpes simplex virus (HSV) disease. Mortality in patients with disseminated disease has decreased from 85 to 29%, and that in patients with central nervous system (CNS) disease has decreased from 50 to 4%. Morbidity has been improved more modestly: the proportion of patients with disseminated disease who are developing normally at 1 year has increased from 50 to 83%. While the proportion of patients with neurologic morbidity following CNS disease has remained essentially unchanged over the past three decades, the total number of patients who are developing normally following HSV CNS disease has increased due to the improved survival. Although additional therapeutic advances in the future are possible, more immediate methods for further improvements in outcome for patients with this potentially devastating disease lie in an enhanced awareness of neonatal HSV infection and disease. A thorough understanding of the biology and natural history of HSV in the gravid woman and the neonate provides the basis for such an index of suspicion and is provided in this article.

Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka

BACKGROUND

The association between herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV) and the development of HSV vaccines have increased interest in the study of HSV epidemiology.

OBJECTIVES

To estimate the age and sex specific seroprevalence of HSV-1 and HSV-2 infections in selected populations in Brazil, Estonia, India, Morocco, and Sri Lanka.

METHODS

Serum samples were collected from various populations including children, antenatal clinic attenders, blood donors, hospital inpatients, and HIV sentinel surveillance groups. STD clinic attenders were enrolled in Sri Lanka, male military personnel in Morocco. Sera were tested using a common algorithm by type specific HSV-1 and HSV-2 antibody assay.

RESULTS

13,986 samples were tested, 45.0% from adult females, 32.7% from adult males, and 22.3% from children. The prevalence of HSV-1 varied by site ranging from 78.5%-93.6% in adult males and from 75.5%-97.8% in adult females. In all countries HSV-1 seroprevalence increased significantly with age (p<0.001) in both men and women. The prevalence of HSV-2 infection varied between sites. Brazil had the highest age specific rates of infection for both men and women, followed by Sri Lanka for men and Estonia for women, the lowest rates being found in Estonia for men and India for women. In all countries, HSV-2 seroprevalence increased significantly with age (p<0.01) and adult females had higher rates of infection than adult males by age of infection.

CONCLUSIONS

HSV-1 and HSV-2 seroprevalence was consistently higher in women than men, particularly for HSV-2. Population based data on HSV-1 and HSV-2 will be useful for designing potential HSV-2 vaccination strategies and for focusing prevention efforts for HSV-1 and HSV-2 infection.

Herpes simplex virus type 1 infection: a sexually transmitted infection of adolescence?

OBJECTIVES

To examine the factors associated with antibodies to herpes simplex virus type 1 (HSV-1).

DESIGN

Cross sectional study with HSV-1 antibody testing performed by University of Washington western blot assay.

SETTING

Central London STD clinic (1990-1) and central London blood donation centre (1992).

PARTICIPANTS

Representative sample of 869 new and rebooked GUM clinic attenders and 1494 consecutive blood donors.

RESULTS

The prevalence of HSV-1 antibody among clinic attenders was 60.4% (95% CI 57.0 to 63.7) and among donors was 46.1% (95% CI 43.5 to 48.7). HSV-1 antibody was independently associated with increasing age in both populations (p<0.001). Among clinic attenders, HSV-1 was less common among heterosexual men than women and homosexual men (p<0.005), and was more common among black people (p=0.001) and those of lower socioeconomic status (p=0.05). Among blood donors, being single rather than married was independently associated with HSV-1 infection (p=0.03). Early age at first intercourse was strongly associated with presence of HSV-1 in both populations. The adjusted odds of HSV-1 among GUM clinic attenders was 0.37 (95% CI 0.21 to 0.65) for someone aged 20 at first intercourse compared with someone aged <or=15. Among blood donors, those aged 20 had an adjusted odds of 0.64 (95% CI 0.39 to 1.05) compared with someone aged 15. HSV-1 was not associated with increasing number of lifetime partners after adjustment for other factors.

CONCLUSIONS

Genital herpes due to HSV-1 antibody is increasing in the United Kingdom, particularly among young people. In this study we found that HSV-1 was strongly associated with early age of first sexual intercourse, which may reflect the sexual practices of people initiating sex in this age group.

Comparison of Chemicon SimulFluor direct fluorescent antibody staining with cell culture and shell vial direct immunoperoxidase staining for detection of herpes simplex virus and with cytospin direct immunofluorescence staining for detection of varicella-zoster virus

A new rapid direct immunofluorescence assay, the SimulFluor direct fluorescent-antibody (DFA) assay, which can simultaneously detect herpes simplex virus types 1 and 2 (HSV-1 and -2) and varicella-zoster virus (VZV), was evaluated in comparison with our current standard procedures of (i) shell vial direct immunoperoxidase (shell vial IP) staining and cell culture for detection of HSV and (ii) cytospin DFA staining for VZV detection. A total of 517 vesicular, oral, genital, and skin lesion specimens were tested by all three procedures. For HSV detection, the SimulFluor DFA assay had an overall sensitivity, specificity, positive predictive value, and negative predictive value of 80.0, 98.3, 92.3, and 95.1%, respectively, when compared to culture. Shell vial IP staining had a sensitivity, specificity, positive predictive value, and negative predictive value of 87.6, 100, 100, and 96.9%, respectively, when compared with cell culture. The SimulFluor DFA assay, however, offers same-day, 1.5-hours results versus a 1- to 2-day wait for shell vial IP staining results and a 1- to 6-day wait for culture results for HSV. For VZV detection SimulFluor DFA staining detected 27 positive specimens as compared to 31 by our standard cytospin DFA technique--a correlation of 87.1%. A positive SimulFluor reaction for VZV is indicated by yellow-gold fluorescence compared to the bright apple-green fluorescence observed by cytospin DFA staining. There is no difference in turnaround time between the two assays. The SimulFluor DFA assay is a rapid immunofluorescence assay that can detect 80% of the HSV-positive specimens and 87% of the VZV-positive specimens with a 1.5-h turnaround time.

Infectious disease dynamics: What characterizes a successful invader?

Against the background of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and other potentially emerging (or re-emerging) infectious diseases, this review will focus on the properties which enable an infectious agent to establish and maintain itself within a specified host population. We shall emphasize that for a pathogen to cross a species barrier is one thing, but for it successfully to maintain itself in the new population is must have a 'basic reproductive number', R(0), which satisfies R(0) > 1. We shall further discuss how behavioural factors interweave with the basic biology of the production of transmission stages by the pathogen, all subject to possible secular changes, to determine the magnitude of R(0). Although primarily focusing on HIV and AIDS, we shall review wider aspects of these questions.

Prevalence and association between herpes simplex virus types 1 and 2-specific antibodies in attendees at a sexually transmitted disease clinic

BACKGROUND

Seroprevalence of herpes simplex virus type 1 (HSV-1) and HSV-2 was determined in 1993 and 1998 in a randomly selected study group of 1024 and 654 attendees, respectively, at the sexually transmitted disease (STD) clinic of the University Hospital Rotterdam-Dijkzigt, The Netherlands. Correlations of HSV-1 and HSV-2 seropositivity were investigated. The relationship between HSV-1 and HSV-2 antibodies was also studied.

METHODS

Data were collected in a cross-sectional study from February 1993 until February 1994 and from January 1998 until December 1998. Glycoprotein G (gG) HSV type specific serum IgG was determined.

RESULTS

Seroprevalence of HSV-1 was 68% versus 59% (1993 versus 1998, chi(2)-test P < 0.001), of HSV-2 it was 30% versus 22% (1993 versus 1998, chi(2)-test P < 0.001). Using logistic regression analyses, HSV-1 and HSV-2 seropositivity were significantly associated with age and ethnicity in both groups. In 1993, HSV-1 seropositivity also correlated with lower level of education and female gender, whereas in 1998 it correlated with 'number of sexual partners in the past 6 months' and 'present diagnosis of STD'. In both groups, HSV-2 seropositivity was also more prevalent in females and related to sexual lifestyle variables. In an exposure-disease model, HSV-1 seropositivity was not correlated with HSV-2 seropositivity (odds ratio 1993 = 1.1, 95% CI : 0.8--1.7; odds ratio in 1998 = 1.0, 95% CI : 0.5--1.8).

CONCLUSIONS

Seroprevalence of HSV-1 and HSV-2 is falling among STD clinic attendees in Rotterdam. A changing pattern of risk factors for HSV-1 seropositivity indicates increasing sexual transmission of HSV-1. Seropositivity for HSV-2 correlated with known risk factors. A previous HSV-1 infection does not reduce susceptibility to subsequent genital HSV-2 infections.

Prevalence and risk factors of HSV-1 and HSV-2 antibodies in European HIV infected women

OBJECTIVES

To investigate the prevalence and risk factors of HSV-1 and HSV-2 antibodies in HIV infected women and the association between recurrent genital ulcerations and HIV disease progression in HSV-2 positive women.

METHODS

The presence of HSV antibodies was tested in 276 of the 487 women participating in a European cohort study of HIV infected women. Prevalence rate ratios described the association between HSV infection and its risk factors, using log binomial regression. Generalised estimating equations (GEE) analysis was performed to determine the impact of markers of HIV disease progression on recurrent genital ulcerations.

RESULTS

The prevalence of HSV-1 and HSV-2 antibodies was 76% (95% confidence interval (95% CI): 71-81) and 42% (95% CI: 36-50); 30% (95% CI: 24-35) of the women had antibodies against both HSV-1 and HSV-2. The prevalence of HSV-1 was 86% (95% CI: 80-92) in southern Europe compared with 69% (95% CI: 57-79) and 67% (95% CI: 55-77) in central and northern Europe (p=0.002). This geographical variation remained after adjustment for other risk factors. An increasing number of years of sexual activity (p=0.0002) and a history of prostitution (p=0.0001) were independently associated with HSV-2 prevalence. In HSV-2 positive women, symptomatic cases of HSV infection were minimal, but increased with decreasing CD4 count.

CONCLUSION

In HIV infected women, the prevalence of HSV antibodies is high and symptomatic cases of HSV infection are minimal, but increase with decreasing CD4 count. HSV-2 but not HSV-1 was related to sexual behaviour (that is, a history of prostitution and the number of sexually active years) in this group of HIV infected women.

Novel approach for specific detection of herpes simplex virus type 1 and 2 antibodies and immunoglobulin G and M antibodies

Recently a few new herpes simplex virus (HSV) type-specific serological diagnostic tests have been introduced to the commercial market, but these tests have some limitations. Moreover, it is not yet clear which commercial test can be regarded as a "gold standard" for the serodiagnosis of HSV infections. In order to improve the clinical diagnostic value of serological tests for the detection of HSV infections, we developed novel, competition-based enzyme-linked immunosorbent assays for the specific determination of HSV type 2 antibodies (SeroHSV2) and HSV type 1 antibodies (SeroHSV1) and two complementary tests for the detection of HSV immunoglobulin M (IgM) and IgG antibodies (SeroHSV IgM and SeroHSV IgG). These four new kits were evaluated in comparison with some commercial kits for the detection of HSV antibodies that are commonly used at present in Israeli clinical laboratories. The results indicate that SeroHSV2 is highly sensitive (>92%) and highly specific (>94%). SeroHSV2 does not cross-react with other alphaherpesvirus antibodies. SeroHSV1 is highly sensitive (>94%) and specific (>91%) compared to four commercial available kits. SeroHSV IgM is highly specific (>92%) in comparison with other commercial HSV IgM tests. The sensitivity of SeroHSV IgM ranges between 50 and 70% compared to these tests. Further investigation of the discrepant results obtained by using in-house competition tests indicated that SeroHSV IgM is more sensitive. SeroHSV IgG was also found to be highly sensitive (>94%) and highly specific (>92%) compared to the other commercial HSV IgG tests.

First episodes of genital herpes in a Swedish STD population: a study of epidemiology and transmission by the use of herpes simplex virus (HSV) typing and specific serology

OBJECTIVES

To determine the proportion of herpes simplex virus type 1 (HSV-1) and HSV type 2 (HSV-2) in first episodes of genital herpes. To evaluate the use of HSV specific serology for classifying first episodes of genital herpes and for defining HSV serostatus in the patients' sexual partners.

METHODS

108 consecutive patients with first episodes of genital herpes seen at three STD clinics in Sweden from 1995 to 1999 were included in the study. HSV culture and typing were performed and serum was tested for antibodies against a type common HSV antigen and a type specific HSV-2 antigen, glycoprotein G2 (gG2). A structured interview including questions about sexual behaviour and sexual partners was taken. "Steady" partners were offered a blood test for HSV serology and counselling.

RESULTS

Of 108 patients, 11 had a negative HSV culture. Of the 97 who were HSV culture positive, 44% (43/97) were typed as HSV-1 and 56% (54/97) as HSV-2. For 86 of these 97 patients, HSV serology from the initial visit was available. Of 52 primary infections, thus initially seronegative, 64% were HSV-1 infections and of 19 female primary infections 16 (84%) were HSV-1. In 17% the first episode of genital herpes corresponded to the first clinical recurrence of an infection acquired earlier in life. There was a significant correlation between having orogenital sex and being infected with HSV-1 and also a history of labial herpes in the partner. Only 20% of partners of patients with an HSV-2 infection had a history of genital herpes.

CONCLUSIONS

Almost half of first episodes of genital herpes are caused by HSV-1. In young women with a primary genital infection, HSV-1 is much more frequent than HSV-2. Besides HSV typing, we found specific HSV serology of value for classifying first episodes and for diagnosing a subclinical HSV-2 infection in partners. Anamnestic data supported the suggestion that the orogenital route of transmission was common in genital HSV-1 infections.

The burden of infection with HSV-1 and HSV-2 in England and Wales: implications for the changing epidemiology of genital herpes

OBJECTIVE

To measure the burden of infection with herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2) in the general population of England and Wales and to assess temporal changes in the incidence of HSV-1 infection in childhood.

METHODS

4930 residual blood samples taken from people aged 0-69 years and submitted to 15 public health laboratories in England and Wales between January 1994 and June 1995, and 500 samples taken from people aged 10-14 years between November 1986 and December 1987, were screened for IgG antibody to HSV-1 and HSV-2 using type specific ELISA assays.

RESULTS

The prevalence of antibody to HSV-1 in 10-14 year olds declined from 34% in samples collected in 1986-7 to 24% in samples collected in 1994-5 (p < 0.001). HSV-1 antibody prevalence in adults increased with age and was higher in females than males, reaching 54% in females aged 25-30 years in 1994-5. In samples collected in 1994-5 from people aged 16-69 years HSV-2 antibody was detected in sera from 3.3% of men and 5.1% of women.

CONCLUSIONS

The incidence of HSV-1 infection in childhood is falling in England and Wales. The prevalence of HSV-2 infection in the general population is low, with the rate of infection significantly lower than that described for the general population in the United States and developing countries. The falling rate of HSV-1 infection in childhood may be one factor contributing to the increasing incidence of genital HSV-1 infection.

Genital herpes: review of the epidemic and potential use of type-specific serology

Prevention of genital herpes simplex virus (HSV) infections is desirable from both a public health standpoint and the patient's perspective. A key factor in the spread of genital herpes infections is the high proportion of undiagnosed infections. Persons with subclinical or unrecognized infections are best diagnosed by accurate, type-specific antibody tests. Unfortunately, these tests are only now becoming widely available. The use of current, conventional (non-type-specific) serologic tests for diagnosis of herpes infections has resulted in confusion and misdiagnosis of patients. This review provides recent information on the epidemiology of genital herpes infections, describes the importance of subclinical herpes infection and shedding, summarizes the status of HSV type-specific serologic assays being developed, and provides indications for using such assays.

Semen donors and STD screening

AIM

The British Andrology Society recommends screening semen donors for sexually transmitted infections to minimise the risk of pathogen transmission to the mother and fetus. The aim was to review recent findings of semen donor screening and, if appropriate, recommend changes to the screening protocol.

SUBJECTS

175 consecutive men attending for STD screening between January 1992 and December 1995 who had been preselected by the Department of Obstetrics and Gynaecology as suitable semen donors.

METHODS

Retrospective review of case notes and group comparison of demographic and sexual history data.

RESULTS

11 men (6%) had evidence of infection, excluding CMV seropositivity, at their first STD screen. After semen donation, 109 men (63%) were rescreened and, of these, 12% had positive findings. Positive findings at initial screening were predicted by a history of more than one partner in the preceding 6 months (OR 7.11, 95% CI 1.66-30.4) but it did not predict rescreening findings. Other factors such as age, marital status, employment status or past STDs were not predictive for either screen.

DISCUSSION

Less than 20% of initial volunteers meet the full criteria of high quality post-thaw semen, no transmissible genetic disorders, and no transmissible pathogens. Sexual history may predict but would not alone preclude all positive STD screening findings. It is essential that sequential STD screening of donors continues and that genitourinary physicians should be involved in this process. Validation of newer diagnostic techniques as screening tests in this setting is required.

A comparison of referral patterns and characteristics of patients with first episode symptomatic genital HSV-1 and HSV-2 infections in Sheffield

OBJECTIVE

To ascertain factors associated with HSV-1 and HSV-2 isolates in patients attending a genitourinary medicine clinic with symptomatic first episode genital herpes (FEGH).

DESIGN

Retrospective study.

SUBJECTS

A total of 606 females and 333 males presenting with culture positive FEGH between 1990-94.

SETTING

Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK.

METHODS

Group comparison of referral patterns, demographic data, prior and concurrent episodes of STD, recent partner change.

RESULTS

HSV-1 infected patients of either sex were more likely to be general practitioner (GP) referred, to be white, and less likely to have had preceding STD episodes. Recent sexual partner change had occurred significantly more often in HSV-2 infected females but there was no similar difference between HSV-1 and HSV-2 infected males.

CONCLUSION

The relative HSV-1:HSV-2 isolate ratio in FEGH is influenced by the referral patterns. HSV-1 isolates predominate in patients presenting to GPs who refer the patients to GUM clinics for accurate diagnosis, counselling, follow up and screening for other STDs.