Genital herpes serotesting: a study of the epidemiology and patients' knowledge and attitude among STD clinic attenders in Coventry, UK

Performance of Commercial Enzyme-Linked Immunoassays for Diagnosis of Herpes Simplex Virus-1 and Herpes Simplex Virus-2 Infection in a Clinical Setting

BACKGROUND

US Food and Drug Administration-approved enzyme-linked immunoassays (EIA) for determining type-specific herpes simplex virus (HSV) serostatus are widely used in clinical practice. We compared the performance of such assays with the University of Washington Western blot (UW WB) in patients who sought confirmation of their HSV serology result.

METHODS

We reviewed charts of all persons evaluated at the Westover Heights Clinic in Portland, Oregon, from July 2010 through September 2015, who had a HSV EIA, followed by UW WB.

RESULTS

Of 864 persons, 47% were women. The median age was 36 years (range, 18-73 years). Using UW WB to define infection status, 286 (33%) persons were HSV-1 seropositive only, 104 (12%) were HSV-2 seropositive only, 134 (16%) were both HSV-1 and HSV-2 seropositive, 235 (27%) were HSV seronegative, and 105 (12%) had indeterminate results. Compared with the UW WB as the criterion standard, EIA was 70.2% sensitive and 91.6% specific for HSV-1, and 91.9% sensitive and 57.4% specific for HSV-2.Among 278 persons who were HSV-1 seropositive by EIA, 255 were confirmed by the UW WB (positive predictive value [PPV], 91.7%). Of the 360 persons that were HSV-1 seronegative by the EIA, 252 were seronegative by UW WB (negative predictive value [NPV], 70.0%). Among 381 persons with HSV-2 EIA seropositivity, 193 tested HSV-2 seropositive by the UW WB (PPV, 50.7%). Of the 270 persons HSV-2 seronegative by EIA, 17 were seropositive with the UW WB (NPV, 93.7%). Among 261 persons with an EIA HSV-2 index value = 1.1-2.9, 39.8% of results were confirmed by UW WB, compared with 78.6% of the 70 persons with an EIA index value of 3 or greater (P < 0.001). The risk of false-positive HSV-2 EIA results was higher in those with HSV-1 antibody (47.1% vs 37.1%, P = 0.036).

CONCLUSIONS

US Food and Drug Administration-approved EIAs have poor PPV for HSV-2 and poor NPV for HSV-1 in clinical practice. More accurate rapid type-specific HSV antibody tests are needed.

Ribosome inactivating proteins from plants inhibiting viruses

Many plants contain ribosome inactivating proteins (RIPs) with N-glycosidase activity, which depurinate large ribosomal RNA and arrest protein synthesis. RIPs so far tested inhibit replication of mRNA as well as DNA viruses and these proteins, isolated from plants, are found to be effective against a broad range of viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and herpes simplex virus (HSV). Most of the research work related to RIPs has been focused on antiviral activity against HIV; however, the exact mechanism of antiviral activity is still not clear. The mechanism of antiviral activity was thought to follow inactivation of the host cell ribosome, leading to inhibition of viral protein translation and host cell death. Enzymatic activity of RIPs is not limited to depurination of the large rRNA, in addition they can depurinate viral DNA as well as RNA. Recently, Phase I/II clinical trials have demonstrated the potential use of RIPs for treating patients with HIV disease. The aim of this review is to focus on various RIPs from plants associated with anti-HIV activity.

Herpes simplex virus type 2: Seroprevalence in antenatal women

AIMS

To determine the seroprevalence of herpes simplex type 2 (HSV-2) infection in pregnant females, assess the frequency of unrecognized infection and identify the demographic profile and risk factors associated with the seroprevalence.

MATERIALS AND METHODS

Two hundred randomly selected, asymptomatic pregnant females attending the Obstetrics and Gynecology Outpatient Department for a routine antenatal check-up constituted the study group. Serum specimens were screened for HSV-2 infection by detecting IgG class antibodies against HSV-2-specific glycoprotein G-2 using an enzyme-linked immunosorbent assay kit.

RESULTS

A seroprevalence of 7.5% was found in our study. Seropositivity was maximum in the age group ≥30 years (22.20%), followed by 26-30 years (9.7%), 21-25 years (2.20%) and ≤20 years (0%). HSV-2 seropositivity was found to be significantly associated with increasing age, parity, number of sexual partners, duration of sexual activity and history of abortions (P < 0.05). No statistically significant correlation was observed between seropositivity and other demographic variables such as place of residence, education, annual family income and occupation (P > 0.05). No statistically significant association of seropositivity with present or past history suggestive of other sexually transmitted infections was found. None of our cases tested positive for human immunodeficiency syndrome (HIV).

CONCLUSION

A relatively low prevalence of HSV-2 seropositivity was found in our study, with a high frequency of unrecognized and asymptomatic infections. Our findings suggest that type-specific serotesting could be an efficient strategy to diagnose clinically asymptomatic HSV-2 infections and, therefore, to reduce the risk of HSV-2 and HIV sexual transmission by prophylactic counseling against unprotected intercourse. It may also be a useful adjunct in detecting cases who present with symptoms not directly suggestive of genital herpes.

HSV-2 Seroepidemiology and Risk Factors among Iranian Women: A Time to New Thinking

BACKGROUND

Genital herpes is a common sexually transmitted disease in many developed and developing countries mostly caused by Herpes simplex virus type 2 (HSV-2). This study determines the prevalence of HSV-2 infection between two groups of women with high and low risk behaviors.

METHODS

In this seroepidemiologic study, 362 women attending obstetrics and gynecology clinics as low risk group and 156 prisoners and drop in center resident women in Tehran as high risk group were enrolled. HSV infection was identified by serologic tests on blood samples.

RESULTS

The prevalence of IgG antibody in high risk group was significantly more than low risk women (26.3% vs. 2.5%). The prevalence of IgM antibody in high risk group was less than low risk group (3.8% vs. 7.1%) but the difference was not statistically significant. In high risk group, there was significant association between positive IgG and anal/oral sex, use of condom, smoking and drug addiction as well as genital pain, burning, itching, ulcer, dysuria, and history of genital infection. In low risk group, association between positive IgM and IgG test results and risky behaviors were not significant. There was significant association between IgM and genital itching, rash, and ulcer.

CONCLUSION

Relatively high seroprevalence of anti-HSV-2 IgG and high frequency of genital Herpes among high risk women necessitates regular screening and safe sex education programs. Moreover, risk of acute infection in this group should not be ignored and its distribution in Iranian population should be alarmingly concerned.

Herpes simplex virus type 2: Seroprevalence in antenatal women

AIMS

To determine the seroprevalence of herpes simplex type 2 (HSV-2) infection in pregnant females, assess the frequency of unrecognized infection and identify the demographic profile and risk factors associated with the seroprevalence.

MATERIALS AND METHODS

Two hundred randomly selected, asymptomatic pregnant females attending the Obstetrics and Gynecology Outpatient Department for a routine antenatal check-up constituted the study group. Serum specimens were screened for HSV-2 infection by detecting IgG class antibodies against HSV-2-specific glycoprotein G-2 using an enzyme-linked immunosorbent assay kit.

RESULTS

A seroprevalence of 7.5% was found in our study. Seropositivity was maximum in the age group ≥30 years (22.20%), followed by 26-30 years (9.7%), 21-25 years (2.20%) and ≤20 years (0%). HSV-2 seropositivity was found to be significantly associated with increasing age, parity, number of sexual partners, duration of sexual activity and history of abortions (P < 0.05). No statistically significant correlation was observed between seropositivity and other demographic variables such as place of residence, education, annual family income and occupation (P > 0.05). No statistically significant association of seropositivity with present or past history suggestive of other sexually transmitted infections was found. None of our cases tested positive for human immunodeficiency syndrome (HIV).

CONCLUSION

A relatively low prevalence of HSV-2 seropositivity was found in our study, with a high frequency of unrecognized and asymptomatic infections. Our findings suggest that type-specific serotesting could be an efficient strategy to diagnose clinically asymptomatic HSV-2 infections and, therefore, to reduce the risk of HSV-2 and HIV sexual transmission by prophylactic counseling against unprotected intercourse. It may also be a useful adjunct in detecting cases who present with symptoms not directly suggestive of genital herpes.

Genital herpes: an Internet-based risk survey

Genital herpes is one of the most common sexually transmitted infections worldwide. We established a web-based survey to determine risk for genital herpes and encourage people to attend for herpes simplex virus testing. A survey was established on the Australian Herpes Management Forum (AHMF) website, consisting of 16 demographic and sexual health-related questions. Each question carried a numerical risk-weighting based on epidemiological data; the higher the overall score, the greater the risk of herpes. To determine how representative our sample was in relation to age and sex, we compared our survey with Australian Census data. Between October 2006 and August 2007 there were 5572 responses, 4358 (92%) were Australian. Compared with the Australian population, the survey population had a higher proportion of individuals aged less than 34 years, and a lower population over 55. Six hundred and eighty-six (13.8%) were classified as low risk, 2558 (51.6%) as medium risk and 1710 (34.5%) as high risk of having acquired genital herpes. In total, 39% reported four or fewer, and 38% reported 10 or more, sex partners in their lifetime. A large number of individuals participated in this survey, confirming that the Internet is a useful tool for health promotion for genital herpes.

Suppressive valacyclovir therapy to reduce genital herpes transmission: good public health policy?

Nocturnal asthma (NA) is increasing in prevalence, affecting millions of people Genital herpes is a widespread sexually transmitted infection caused by the herpes simplex viruses (HSV). Suppressive valacyclovir therapy has been shown to significantly reduce HSV transmission. The benefits and costs of using valacyclovir to reduce transmission in couples discordant for genital herpes will be analyzed in order to better inform decision-making. By reducing transmission, the physical and psychological harms of living with symptomatic genital herpes will be prevented while saving on certain healthcare costs. However, the large number needed to treat and the low symptomatic rate among infected individuals may outweigh these benefits. The costs of trying to achieve a significant reduction in incidence include the psychological harms of identifying asymptomatic individuals through a large screening program and the economic costs of the antiviral agent and screening. When these issues are weighed, the high economic costs render a program to reduce incidence unfeasible. Nevertheless, it is clinically important to consider the consequences of transmission at an individual level. The specific circumstances that influence the decision to use suppressive therapy are identified.

Knowledge about Genital Herpes Amongst First Time Attenders at a Department of Genitourinary Medicine

Background and Aims

Genital herpes is the most common cause of genital ulceration in the developed world, and its prevalence in the United Kingdom is rising. Public knowledge of the infection is often limited. We aimed to assess knowledge among patients attending an outpatient genitourinary clinic in Scotland.

Methods

A questionnaire was designed to collect information about educational qualifications and knowledge of genital herpes. In the knowledge section, each correct answer was given a score of 1; thus the maximum possible score was 12. Two hundred and ten individuals who attended as new patients at a walk-in genitourinary medicine clinic were invited to complete the questionnaire.

Results

Two hundred and seven patients completed the questionnaire. Overall 63% of responses were answered correctly. Knowledge of genital herpes was better in patients who worked in healthcare (8.3 v 6.9, p=0.019) and in patients with educational qualifications gained from college or university compared to those gained at school (7.6 v 6.5, p=0.009). Level of knowledge was not related to age or gender; receiving sex education at school did not appear to improve knowledge of genital herpes.

Conclusion

Knowledge of genital herpes among patients attending an outpatient genitourinary clinic in Scotland is reasonable but needs to improve to combat the rising prevalence of the infection. The areas of misunderstanding identified in our study could be targeted for public education.

HSV-2 Serologic Testing in an HMO Population: Uptake and Psychosocial Sequelae

OBJECTIVES

To prospectively measure the uptake of Herpes simplex virus Type 2 (HSV-2) testing and psychosocial response to a new serologic diagnosis of HSV-2 in a health maintenance organization (HMO) population.

STUDY DESIGN

Randomly selected urban HMO enrollees were invited to be tested for HSV-2 antibody at a research clinic. Participants had blood drawn and completed demographic and psychosocial questionnaires.

RESULTS

Of 3111 eligible enrollees contacted, 344 (11%) were tested. Eighty-seven (26%) tested HSV-2 seropositive, and 44 (51%) of these did not report a prior genital herpes diagnosis. Distress, measured by the total mood disturbance, was 6.5 points higher on average following a new genital herpes diagnosis relative to baseline (actual range = 109 points, P = 0.003) but not statistically different from HSV-2 negative or previously diagnosed participants.

CONCLUSIONS

HMO enrollees unexpectedly testing HSV-2 positive showed short-term psychosocial distress that resolved during 6-month follow-up. Findings suggest that concerns about psychosocial burden should not deter voluntary serologic HSV-2 testing in primary care settings.

Seroprevalence of herpes simplex virus-1 and -2 in attendees of a sexually transmitted infection clinic in Singapore

BACKGROUND

We studied the seroprevalance of HSV (herpes simplex virus)-1 and HSV-2 in outpatient attendees of a sexually transmitted infection (STI) clinic in Singapore and examined their knowledge and attitudes towards HSV infection.

METHODS

Two hundred male and 200 female participants were recruited in the study. Questionnaires were administered and blood samples were taken and analysed using the HerpeSelect 1 and 2 enzyme-linked immunosorbent assay (ELISA) IgG assays (type-specific serological tests).

RESULTS

HSV-1 was positive in 223 (55.8%) individuals, negative in 175 (43.8%) and indeterminate in two (0.5%), whereas HSV-2 was positive in 114 (28.5%) individuals, negative in 284 (71.0%) and indeterminate in two (0.5%). The seroprevalance of HSV-2 was 26% and 31% in males and females, respectively. The correlation between a previous history of cold sores and HSV-1 infection was poor. On univariate analysis, there was a significant association with age, marital status and years of sex (P < 0.05) but after adjusting for confounders, none of the variables were significantly associated with HSV-2 seroprevalance. Most of the respondents (65.8%) were aware that herpes is an STI, whereas only half of them were aware of the possibility of asymptomatic transmission.

CONCLUSION

Although HSV-2 is a common infection among STI clinic attendees in Singapore, there is an unsatisfactory level of knowledge among the attendees about HSV infection and public education programs should be introduced to address this.

How safe is safer sex? High levels of HSV-1 and HSV-2 in female sex workers in London

Female sex workers in Europe have low levels of sexually transmitted infections, attributable to condom use. The aim of this paper is to describe the seroepidemiology of HSV-1 and HSV-2 in female sex workers in London by using a 15-year prospective study of 453 sex workers. The seroprevalence of HSV-1 was 74.4% and independently associated with birth in a 'transitional country' (OR 5.4, 95% CI 1.61-18.20). The seroprevalence of HSV-2 was 60% and declined over time; it was also independently associated with time in sex work (OR 2.12, 95% CI 1.23-3.65) and birth in a 'developing country' (OR 2.95, 95% CI 1.34-6.48). We show that a cohort of sex workers with extensive condom use and little known sexually transmitted infection have high levels of HSV-1 and HSV-2 infection, suggesting that condoms may not be universally protective. Sex workers are candidates for HSV vaccine efficacy or intervention studies.

Herpes simplex virus type 2 (HSV-2) seroprevalence at the time of HIV-1 diagnosis and seroincidence after HIV-1 diagnosis in an ethnically diverse cohort of HIV-1-infected persons

OBJECTIVE

The objective of this study was to determine herpes simplex virus type 2 (HSV-2) seroprevalence at HIV-1 diagnosis and seroincidence > or =1 year after HIV-1 diagnosis.

METHODS

HSV type-specific antibodies were detected by enzyme immunoassay.

RESULTS

The cohort comprised 850 adults diagnosed HIV-positive in 1986-2001 and followed for a median of 3 years. HSV-2 seroprevalence was 63% (95% confidence interval [CI], 60-66%) and was associated with female gender, heterosexual risk group, black ethnicity, and older age. HSV-2 seroincidence was 1.8 per 100 person-years (95% CI, 0.8-2.8) and was associated with other sexually transmitted diseases, including human papilloma virus infection (P = 0.005) and gonorrhea (P = 0.05). A diagnosis of genital herpes was made in 21% HSV-2-seropositive persons and was more likely in those who tested HIV-positive before 1997 (adjusted odds ratio, 5.11; 95% CI, 3.28-7.98; P = 0.0001).

CONCLUSIONS

Results confirm the epidemiologic association between HIV-1 and HSV-2. HSV-2 seroconversion was a marker of high-risk sexual behavior. The likelihood of developing symptoms of genital herpes declined from 1997 onward.

Demographic, behavioral, and knowledge factors associated with herpes simplex virus type 2 infection among men whose current female partner has genital herpes

OBJECTIVE/GOAL

The objective of this study was to evaluate risk factors for herpes simplex virus type 2 (HSV-2) infection among men whose female partners have genital herpes (GH).

STUDY

Between 1998 and 2001, 717 men in heterosexual monogamous relationships, without a history of GH, completed a cross-sectional questionnaire on demographic, behavioral, and knowledge factors for GH. Their female partners were symptomatic and HSV-2-seropositive. Risk factors for HSV-2 seropositivity were assessed using logistic regression.

RESULTS

On laboratory confirmation, 25% of the men were HSV-2-seropositive. Factors significantly (P<0.01) associated with HSV-2 infection included: never using condoms (adjusted odds ratio [aOR], 1.84; 95% confidence interval [CI], 1.15-2.95), prior sexually transmitted disease (STD) (aOR, 1.80; CI, 1.27-2.58), vaginal intercourse during symptomatic episodes (aOR, 1.77; CI, 1.19-2.62), longer partnership (for each additional year aOR, 1.07; CI, 1.03-1.09), and lower knowledge of GH (aOR, 1.14; CI, 1.05-1.23).

CONCLUSION

Potentially modifiable risk factors for HSV-2 infection included engaging in vaginal sex during symptomatic episodes, never using condoms, and lower knowledge of GH.

Factors Predicting the Acceptance of Herpes Simplex Virus Type 2 Antibody Testing Among Adolescents and Young Adults

BACKGROUND

The rates and determinants of acceptance of herpes simplex virus type 2 (HSV-2) testing have not been adequately studied.

OBJECTIVES

The objective of this study was to identify factors associated with acceptance of HSV-2 antibody testing in individuals with no history of genital herpes.

STUDY

We conducted a cross-sectional survey study followed by the offer of free HSV-2 serologic testing at an urban sexually transmitted disease (STD) clinic, 2 general adult medical clinics, an urban university campus, and an urban adolescent medicine clinic. A total of 1199 individuals aged 14 to 30 years completed the survey and were offered testing.

RESULTS

A total of 68.4% accepted HSV-2 testing. Factors independently associated with acceptance were female sex, older age, having an STD history, having 1 or more sexual partners in the last 6 months, perceived vulnerability to HSV-2 infection, and perceived benefits of HSV-2 testing. Fear of needles predicted rejection of testing, as did attending a general medical clinic versus an STD clinic and nonwhite race.

CONCLUSION

There is a substantial interest in HSV-2 antibody testing across a variety of settings. Those at greatest behavioral and historic risk for HSV-2 infection, women, and persons whose health beliefs are consistent with testing are more likely to accept serologic testing when it is offered.

New estimates of herpes simplex virus type 2 seroprevalence in England: 'high' but stable seroprevalence over the last decade

OBJECTIVES

There have been few recent population-based herpes simplex virus type 2 (HSV-2) seroprevalence studies in England, but reports from the United States have indicated a 30% rise in HSV-2 seroprevalence between 1976 and 1994. This study aimed to ascertain trends in HSV-2 infection in England between 1991 and 2000.

STUDY DESIGN

Anonymized serum residues collected through public health laboratories across England from individuals aged 16 to 64 years seeking health care through the National Health Service in 1991 (n = 2259) and 2000 (n = 3646) were tested for anti-HSV-2 IgG using the HerpeSelect 2 enzyme-linked immunosorbent assay IgG (Focus).

RESULTS

In 9 sites across England, the age- and sex-standardized HSV-2 seroprevalence was 9.7% (95% confidence interval, 8.4-11.0%). Data from 4 sites common to both study years indicated no change in HSV-2 seroprevalence between 1991 and 2000.

CONCLUSIONS

After adjustment for age, sex, and geographic location, there was no evidence of a change in seroprevalence between 1991 and 2000.

Sexually transmitted herpes simplex viruses

Herpes simplex virus type 2 (HSV-2) is the dominant primary causative agent in genital ulcerative infections. Since infections with HSV-2 usually are acquired through sexual contacts, antibodies are rarely found before the age of onset of sexual activity. Although most genital infections are caused by HSV-2, a rising proportion has become attributable to primary type 1 herpes simplex virus (HSV-1) infection. Genital HSV-1 infections are usually both less severe clinically and less prone to recur. HSV-1 infection might render a certain protection against an HSV-2 infection and seems to mitigate the HSV-2 illness. It is not yet clear whether the advent of HSV-1 genitally will reduce the general occurrence of HSV-2. Increased efforts to protect against sexual transmission of the herpes viruses should have an effect on the transmission of other chronic diseases, such as the human immunodeficiency virus (HIV). In conclusion, it seems that increased sexual promiscuity and more advanced sexual techniques contribute to an unnecessary rise in prevalence of genital HSV infections, thus also affecting transmission of other genitally manifested diseases in targeted populations.

Study of knowledge of genital herpes infection and attitudes to testing for genital herpes among antenatal clinic attendees

A descriptive survey of knowledge of genital herpes and attitudes to testing was conducted among antenatal clinic attendees at the Gold Coast Hospital, Australia. The study subjects showed a good knowledge of genital herpes, to a level that appears sufficient for an informed choice regarding herpes serology testing to be made. A preference for testing for genital herpes was suggested. Although serological testing is not routinely required, the results of the study indicate that discussion of genital herpes should be considered in the antenatal clinic setting.