评价在辅助生育中检测单纯疱疹病毒2抗体对诊断生殖器疱疹的意义

【摘要】 目的 在分析生殖器疱疹患者单纯疱疹病毒（HSV）流行株的基础上,探讨HSV-2 IgM抗体、型特异HSV-2 IgG抗体的敏感性、特异性、阴性预测值和阳性预测值,评价辅助生育中二种抗体检测在诊断生殖器疱疹上的意义。 方法 对2009—2011年中山大学附属第一医院皮肤科193例生殖器疱疹患者临床分离病毒株培养并鉴定分型,了解主要的流行病毒型。生殖中心术前筛查HSV-2 IgM和（或）IgG阳性、疑诊生殖器疱疹的女性,丈夫同时抽血检查,共57对为临床观察组;选取HSV培养阳性生殖器疱疹患者68例作为阳性对照组;8 ~ 10岁儿童120例为阴性对照组。血清标本采用酶联免疫吸附法（ELISA）检测HSV-1 IgM和HSV-2 IgM抗体及型特异HSV-1 IgG、HSV-2 IgG抗体,对结果进行比对分析。 结果 阳性对照组68例中,HSV-1 IgM 14例（20.59%）、HSV-2 IgM 9例（13.24%）、HSV-1 IgG 61例（89.71%）、HSV-2 IgG 62例（91.18%）阳性;阴性对照组120例,分别为26例（21.70%）、16例（13.30%）、49例（40.80%）和0例阳性;两组HSV-1 IgM及HSV-2 IgM阳性率差异均无统计学意义（P > 0.05）,但HSV-1 IgG及HSV-2 IgG阳性率差异均有统计学意义（P < 0.01）。临床观察组57例女性中,HSV-1 IgM 46例（80.70%）、HSV-2 IgM 52例（91.23%）、HSV-1 IgG 48例（84.21%）、HSV-2 IgG 8例（14.04%）阳性;男性（配偶）分别为11例（19.30%）、5例（8.77%）、50例（87.71%）和7例（12.28%）阳性;两性的HSV-1 IgM及HSV-2 IgM阳性率差异均有统计学意义（P < 0.01）,而HSV-1 IgG及HSV-2 IgG阳性率差异均无统计学意义（P > 0.05）。HSV-2 IgM诊断生殖器疱疹的敏感性为13.24%,特异性为86.67%,阳性预测值36.00%,阴性预测值63.80%;HSV-2 IgG诊断生殖器疱疹的敏感性91.18%,特异性100.00%,阳性预测值100.00%,阴性预测值95.24%。 结论 该地区生殖器疱疹主要流行病毒型为HSV-2,仅5.18%是HSV-1。HSV-2 IgM诊断生殖器疱疹的敏感性、阳性预测值以及特异性、阴性预测值均低于HSV-2 IgG;辅助生育中型特异性HSV-2 IgG检测在诊断生殖器疱疹上的意义大于HSV-2 IgM。 【关键词】 疱疹,生殖器; 单纯疱疹病毒属; 免疫球蛋白G; 免疫球蛋白M     

177例可疑生殖器疱疹患者HSV-ⅡIgM/IgG抗体检测结果分析

目的:探讨Ⅱ型单纯疱疹病毒抗体(HSV-ⅡIgM/IgG)与生殖器疱疹的相关性,辅助临床诊断。方法:应用酶联免疫吸附试验(ELISA)检测血清中HSV-ⅡIgM/IgG抗体,并用PCR荧光定量法检测分泌物的HSV-Ⅱ抗原(HSV-Ⅱ-DNA)进行对比。结果:177例可疑生殖器疱疹患者检出HSV-Ⅱ抗原131例,阳性率为74.0%;检出HSV-ⅡIgM和(或)IgG共144例,阳性率为81.4%,两者没有显著性差异(2=2.96,P>0.05)。其中19例为结痂型的患者中,HSV-Ⅱ抗原阳性4例,阳性率21.1%;而HSV-Ⅱ抗体阳性14例,阳性率为73.7%。结论:同时检测血清中HSV-ⅡIgG和HSV-ⅡIgM作为生殖器疱疹筛查试验,有利于症状不典型的HSV-Ⅱ感染者的检出,提高诊断率。     

女性原发性生殖器疱疹中HSV-Ⅱ的检测及意义

目的探讨单纯疱疹病毒Ⅱ型(HSV-Ⅱ)与女性原发性生殖器疱疹(GH)的相关性及意义。方法应用酶联免疫吸附法(ELISA)分别检测患者血清中HSV-Ⅱ抗体以及分泌物中的HSV-Ⅱ抗原。结果HSV-Ⅱ中IgG均阴性的138例女性生殖器疱疹患者中HSV-Ⅱ抗原阳性78例(56.52%);HSV-Ⅱ中IgM抗体阳性130例(94.20%),抗体阳性率明显高于抗原阳性率(P<0.01)。典型病例组抗原阳性65例(87.84%),IgM抗体阳性66例(89.19%);不典型病例组抗原阳性13例(20.31%),IgM抗体阳性64例(100.00%)。结论对于皮损时间短,症状典型者可检测HSV-Ⅱ抗原;皮损时间长,或反复者可检测HSV-Ⅱ抗体,可以有效提高HSV感染的临床诊断率。     

病毒性皮肤病

951983 单纯疱疹病毒2型血清IgG及IgM抗体的酶免疫检测/钱起丰…//中华皮肤科杂志。-1995,28(3).-185～186 为了解发病情况,采用德国Virotech公司生产的HSV-2 IgG及IgM抗体酶免疫试剂检测生殖器疱疹患者60例和40例正常人。结果HSV-2抗体总阳性率为88.3％(53/60),其中IgG抗体阳性率为73.3％(44/60),IgM抗体阳性率为20.0％(12/60),其中有3例两者均为阳性。40例正常人分别为20％(8/40)及0,与患者组相比差异有显著性(P<0.01)。初发型与     

荧光定量PCR和酶联免疫吸附试验检测生殖器疱疹病毒感染的意义

目的:探讨荧光定量聚合酶反应(fluorescent quantitative PCR,FQ-PCR)和酶联免疫吸附法(ELISA)检测生殖器疱疹病毒感染的临床意义。方法:对性病门诊140例有现症生殖器疱疹(GH)患者用FQ-PCR检测生殖器疱疹病毒II型(HSV-2)和ELISA方法进行HSV-2抗原和抗体(包括IgG和IgM)检测。结果:FQ-PCR和HSV-2抗原法检测140例GH患者的阳性率分别为92.14%和89.29%,均明显高于HSV-2 IgG(66.43%)和IgM(14.29%)(P<0.01);125例具有典型临床症状如水疱、溃疡和宫颈糜烂等患者中:FQ-PCR和HSV-2抗原分别为100%和97.60%,均明显高于HSV-2IgG(65.60%)和HSV-2 IgM(14.40%)(P<0.01);15例表现为结痂的患者中:FQ-PCR、HSV-2抗原和HSV-2 IgM阳性率分别为26.67%、20.0%和13.33%,均明显低于HSV-2 IgG阳性率(P<0.01)。结论:FQ-PCR法和ELISA HSV-2抗原法均能快速准确检测GH感染;ELISA HSV-2 IgM抗体诊断GH感染的价值不大;ELISA HSV-2 IgG法对诊断临床症状不典型的GH有较大的价值。     

不同孕期治疗孕妇生殖器疱疹对阻断新生儿感染的影响

目的探讨妊娠合并生殖器疱疹患者在不同时间进行治疗后的孕妇所生的新生儿生殖器疱疹阳性率的不同。方法对本院2001年1月-2009年12月确诊生殖器疱疹患者进行回顾性分析,其中妊娠前及妊娠中发现并进行治疗者133例,妊娠中发现未能进行治疗者47例。妊娠前患生殖器疱疹的妇女予口服抗病毒药及外用干扰素软膏和阿昔洛韦软膏治疗,妊娠中患生殖器疱疹的妇女予外用干扰素软膏和阿昔洛韦软膏治疗。新生儿在出生后随访3周,监测临床表现,并抽血查HSV-2抗体(IgG和IgM)以观察阳性情况。结果妊娠前进行治疗的孕妇所生新生儿的HSV-2抗体阳性率为2.26%(3/133),而未治疗患者新生儿抗体阳性率为17.02%(8/47),两者之间差异有统计学意义(P<0.005)。结论对于妊娠患有生殖器疱疹者,早期进行足量抗病毒治疗可以有效的防止胎儿感染生殖器疱疹。     

不同人群单纯疱疹病毒2型IgG抗体的检测情况分析

目的:了解珠海市一般人群、无症状可疑生殖器疱疹患者及有症状可疑生殖器疱疹患者血清单纯疱疹病毒2型(HSV-2)IgG抗体感染水平。方法:应用酶标仪对一般人群、无症状可疑患者、有症状可疑患者三组人群进行HSV-2IgG抗体检测,分析三组人群HSV-2的感染率,并比较无症状与有症状可疑生殖器疱疹患者血清学的状况。结果:在96名一般人员中HSV-2IgG抗体阳性率13.54%,175例无症状可疑患者HSV-2IgG抗体阳性率57.1%,174例有症状可疑患者HSV-2IgG抗体阳性率72.41%。结论:HSV-2IgG抗体对无症状可疑患者和中、后期及复发有症状患者具有协助诊断的意义。     

单纯疱疹病毒2型血清IgG及IgM抗体的酶免疫检测

单纯疱疹病毒2型(HSV-2)主要感染腰以下部位(如生殖器、肛门等),多通过性交而传染、在我国,生殖器疱疹已不少见^[1],为了解该病的发病情况,人群中HSV-2感染状况及机体对其免疫反应,我们采用德国Virotech公司生产的HSV-2IgG及IgM抗体酶免疫试剂检测生殖器疱疹病人及正常人,现将结果报告如下。一、检测对象病例选择:60例均为我院性病门诊病人,临床诊断为生殖器疱疹。男54例,女6例;年龄20～52岁(平均28岁);病期2天至3年不等。大多数病人有非婚性接触史。原发型15例(25%),复发型45例(75%)。     

生殖器疱疹的血清学检测及感染特征分析

采用ELISA检测78例临床诊断为生殖器疱疹的患者及36名正常人血清HSV-ⅡIgG、IgM抗体。结果发现生殖器疱疹患者组及正常对照组HSV-Ⅱ抗体有一定意义,并总结了本组患者的临床感染特征。     

生殖器疱疹无症状排毒与血清抗体及药物干预的研究

目的 探讨生殖器疱疹患者无症状排毒与血清抗体及药物干预的相关性.方法 收集生殖器疱疹患者650例,分别用荧光PCR和酶联免疫法(ELISA)测定排毒率、质粒数和不同病程、不同复发频率的生殖器疱疹患者无症状排毒阳性情况及血清抗体(IgG和IgM)的分泌情况,药物干预后的排毒情况和复发评价.结果 入选的650例患者中,排毒阳性354例(54.5％),DNA质粒数为63～ 9400拷见/ml,平均3100拷贝/ml.病程超过3年与小于3年的患者比较,排毒阳性率差异有统计学意义(x2=6.41,P＜0.05).频发(每年复发频率＞6次)与少发患者比较,差异有统计学意义(x2=9.46,P＜0.01).排毒阳性与阴性患者HSV-Ⅰ和ⅡIgG双阳性率、HSV-Ⅰ IgG单阳性率比较,差异均有统计学意义(P＜ 0.01); HSV-ⅡIgM单阳性率比较,差异无统计学意义(P＞0.05).对排毒阳性患者进行药物干预,伐昔洛韦组、阿昔洛韦组与对照组比较,干预后的排毒阳性率差异均有统计学意义(P＜0.01),停药后与对照组比较无统计学意义(P＞0.05).药物干预能够明显降低患者复发次数,而药物干预组间没有差异(P＞0.05).结论 生殖器疱疹患者无症状排毒率高达54.5％,血清学检测提示,部分生殖器疱疹患者存在HSV-Ⅰ及HSV-Ⅱ混合感染.患者病程越长阳性检测率越低,排毒阳性患者用药干预后能明显降低患者复发,抑制患者排毒.     

Is HSV serology useful for the management of first episode genital herpes?

BACKGROUND: First episode genital herpes simplex virus (HSV) infections can be classified into three groups, primary genital herpes (no previous exposure to HSV), non-primary first episode (IgG antibody to HSV of the non-presenting type), and first episode with pre-existing IgG HSV antibodies. The use of IgM to classify first episode genital herpes has not been evaluated. OBJECTIVE: To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HSV-1 and HSV-2 IgM antibodies for the diagnosis of first episode genital herpes, when compared with clinical diagnosis. METHODS: Patients with a first clinical episode of genital herpes were recruited. Sera were tested for IgG antibodies to HSV-2 using an indirect enzyme linked immunosorbent assay (ELISA). Equivocal results were resolved by western blot. HSV-1 IgG and IgM and HSV-2 IgM antibodies were detected using western blot. RESULTS: 157 patients were recruited. 31 were excluded (missing data or no detectable antibodies and negative viral isolation). Therefore, 126 patients were included in the analysis. 23 (18.3%) had primary genital herpes, 34 (27.0%) non-primary first episode, and 69 (54.8%) had pre-existing genital herpes. The specificity and PPV of HSV IgM was 100%; the sensitivity was 79% and the NPV 85%. CONCLUSION: IgM HSV serology may be useful in the management of some patients with first episode genital herpes and provide an indication of the source of infection. Drawbacks include the low sensitivity and NPV, lack of availability, IgM antibodies may occasionally be produced in response to recurrent infection and, finally, IgM antibodies may take up to 10 days to develop and last 7-10 days.     

Sequential genital infections by herpes simplex viruses types 1 and 2: restriction nuclease analyses of viruses from recurrent infections

Virus isolated from a woman presenting with the first symptomatic episode of genital herpes was identified as herpes simplex virus type 1 (HSV-1) by restriction nuclease fingerprinting. Testing for IgM antibody to HSV indicated that the patient had recently contracted a new HSV infection. Virus microneutralization and the micro-solid phase radioimmunometric test for IgG, however, showed that the patient had had prior infection with herpes simplex virus type 2 (HSV-2); thus the HSV-1 infection was acquired despite the presence of antibody to HSV-2. Genital herpes recurred about four, seven, and nine months after the HSV-1 infection. Isolates from the latter three episodes all were of an identical strain of HSV-2 and were not recombinants or a mixture of the viruses. The data show that two distinctly different herpes simplex viruses can initiate genital infections in one individual and suggest that HSV-2 is more likely to recur than HSV-1.     

Confirmation of herpes simplex virus type 2 infections in herpes-like genital lesions by a simple complement-fixation test.

The presence of complement-fixing antibody to an early herpes simplex virus type 2 (HSV-2) antigen (the AG-4 antigen) was correlated with HSV-2 infection in the sera of patients with genital herpes. Eighty-eight per cent of sera taken two weeks after clinical diagnosis of a primary or recurrent herpes infection in patients, confirmed to have HSV-2 by virus isolation and typing, contained the anti-AG-4 complement-fixing antibody. None of the patients with genital HSV-1 had the antibody, and only 9% of controls or patients with facial HSV-1 infection had positive results for the antibody. This correlation was used to identify genital HSV-2 infections when either no virus sample had been taken or when virus isolations had been unsuccessful. Thus, a simple complement-fixation test can confirm an HSV-2 virus infection without isolation of the virus from the herpetic lesion.     

Herpes simplex virus type 1 is the prevailing cause of genital herpes in the Tel Aviv area, Israel

BACKGROUND AND GOAL: The changing epidemiology of genital herpes with the increasing importance of herpes simplex virus (HSV) type 1 prompted a study on the relative prevalence of HSV-1 and HSV-2 among cases of genital herpes in the Tel Aviv area, Israel. STUDY DESIGN: A retrospective laboratory-based study of positive genital and nongenital herpes cultures performed at the Beilinson Medical Center between 1993 and 2002. Data regarding the number of isolates of each type and the age and sex of patients with genital lesions were retrieved from the database. Cultures were performed using Vero cells, and positive results were confirmed and typed by immunofluorescence. RESULTS: A total of 285 positive genital cultures and 659 positive nongenital cultures were recorded. HSV-1 was identified in 189 (66.3%) of the positive genital specimens and in 656 (99.55%) of the nongenital specimens. HSV-1 was isolated in 174 of 262 (66.4%) female subjects and 15 of 23 (65.2%) male subjects. The proportion of HSV-1 genital isolates was 72.7% in patients 15 to 24 years of age, 62% in those 25 to 44 years, and 46% in those aged 45 years or older. Overall, the annual isolation rate of genital HSV-1 has not changed markedly over the years. CONCLUSION: Herpes simplex virus type 1 has clearly been the predominant HSV type isolated from genital specimens in the Tel Aviv area over the last decade.     

Confirmation of herpes simplex virus type 2 infections in herpes-like genital lesions by a simple complement-fixation test

The presence of complement-fixing antibody to an early herpes simplex virus type 2 (HSV-2) antigen (the AG-4 antigen) was correlated with HSV-2 infection in the sera of patients with genital herpes. Eighty-eight per cent of sera taken two weeks after clinical diagnosis of a primary or recurrent herpes infection in patients, confirmed to have HSV-2 by virus isolation and typing, contained the anti-AG-4 complement-fixing antibody. None of the patients with genital HSV-1 had the antibody, and only 9% of controls or patients with facial HSV-1 infection had positive results for the antibody. This correlation was used to identify genital HSV-2 infections when either no virus sample had been taken or when virus isolations had been unsuccessful. Thus, a simple complement-fixation test can confirm an HSV-2 virus infection without isolation of the virus from the herpetic lesion.     

寻常型银屑病与单纯疱疹病毒1型相关性的研究

目的 探讨寻常型银屑病与单纯疱疹病毒1型(HSV-1)的可能相关性。方法 应用PCR法检测患者皮损、外周血单一核细胞(PBMCs)和咽拭子中HSV-1DNA,ELISA法检测患者血清中抗HSV-1的IgM、IgG抗体,并与正常人对照做比较。结果 患者皮损、PBMCs和咽拭子中HSV-1DNA检出率分别为37.5%、18.6%和18.8%,血清中抗HSV-1的IgM、IgG抗体检出率分别为37.2%和53.5%.经χ²检验,患者皮损、PBMCs中HSV-1DNA和血清中IgM抗体检出率显着高于正常人对照,点滴状患者的皮损、PBMCs和咽拭子中HSV-1DNA以及血清中抗HSV-1IgM抗体检出率显着高于斑块状患者。结论 寻常型银屑病尤其是皮损呈点滴状者与HSV-1显着相关,患者可能存在HSV-1的近期感染。     

Acceptance and outcome of herpes simplex virus type 2 antibody testing in patients attending an STD clinic--recognized and unrecognized infections

The majority of herpes simplex virus type 2 (HSV-2) genital infections are asymptomatic. We wanted to evaluate the acceptance of HSV-2 antibody testing among people attending an STD clinic and to estimate, after counselling, the percentage of recognized and unrecognized HSV-2 infections. First visitors to an STD clinic were invited to participate by answering a questionnaire and taking a blood test for HSV-2 antibodies. HSV-2 seropositive individuals, who were unaware of having genital herpes, were offered an HSV-2 counselling visit and follow-up. Of 1769 patients offered testing, 57% accepted. Of 152 (15%) HSV-2 seropositive individuals, 41% had a self-reported history of genital herpes, approximately 30% had genital symptoms and 30% had no genital symptoms. The percentage of patients reporting genital symptoms was much higher in HSV-2 seropositives (45%) without a history of genital herpes than in an HSV-2 seronegative group (28%). HSV-2 antibody testing should be performed generously in all cases of uncharacteristic genital symptoms.     

汕头市孕妇生殖器疱疹血清流行病学初步调查研究

目的：调查汕头市不同年龄段、不同孕期、不同妊娠史和不同职业孕妇血清中HSV-2特异性抗体IgG的存在情况。方法：随机选取汕头市520例无症状的正常孕妇进行研究，采用酶联免疫吸附法（ELISA）检测孕妇血清中HSV-2特异性抗体IgG。结果：共调查520例孕妇，阳性率为26．2％（136／520），不同孕期感染率无显著性差异；年龄在26～35岁孕妇、有异常妊娠史、文化程度低的孕妇HSV感染的危险性高。结论：孕妇HSV-2感染率高，对孕妇进行HSV-2感染的血清学监测，有利于识别有生殖器疱疹危险因素的孕妇和亚临床型孕妇，降低漏诊率，对预防新生儿HSV感染、降低流产、早产和死产的发生具有十分重要的意义。     

Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia,España: estudio observacional retrospectivo

Introduction and objectiveThe epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes.Material and methodsA retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included.ResultsWe identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P = .015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2.ConclusionsThere has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur.