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。     

丽珠威治疗生殖器疱诊44例的临床观察报告

丽珠威(盐酸万乃洛韦)是抗病毒新药。1998年3～8月我们对丽珠威治疗生殖器疱疹进行了临床观察,并与阿昔洛韦(Aciclovir)进行比较,结果丽珠威优于阿昔洛韦,现将结果报告如下: 1 病例选择 1.1根据典型的临床症状和体征而确诊的生殖器疱疹(含复发者,下同)病程在3天内。年龄18～62岁,就诊前未内服或外用其他抗病毒药的男、女患者。 1.2孕妇、哺乳妇女,患者有肝、肾疾病,免疫功能     

140例女性疑似生殖器疱疹患者HSV-Ⅱ抗体检测分析

目的:了解女性疑似生殖器疱疹GH患者感染生殖器疱疹发病情况。方法:对140例女性疑似生殖器疱疹患者血清检测HSV-Ⅱ-IgG抗体,并与140例正常人群作对照检测。结果:140例高危人群血清HSV-Ⅱ抗体阳性率为15%,正常人群阳性率为1.4%,两组阳性率比较有显著性差异(2=17.10,P<0.01)。结论:在性病门诊,对有多个性伴或性伴感染生殖器疱疹的女性高危人群在GH临床症状不明显时,应进行血清HSV-Ⅱ抗体检测。     

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。     

外用咪喹莫特降低生殖器疱疹复发率的效果观察

复发性生殖器疱疹(recurrent genital herpes,RGH)系指原发性生殖器疱疹(GH)愈合后复发,是由单纯疱疹病毒2型(HSV-2)侵犯生殖器皮肤黏膜引起的炎症、水疱、糜烂性病变的性传播性疾病.笔者选择102例频繁复发的RGH患者,采用5%咪喹莫特乳膏(艾达乐)、喷昔洛韦外用及阿昔洛韦单独口服进行1年抑制性治疗,降低其复发率,取得一定疗效,现报告如下.     

转移因子联合阿昔洛韦治疗频发性生殖器疱疹疗效观察

目的探讨转移因子联合阿昔洛韦治疗频发性生殖器疱疹的疗效。方法试验组46例,转移因子口服液10 mL2次/d,阿昔洛韦缓释片0.4 g,3次/d;对照组40例,阿昔洛韦缓释片0.4 g,3次/d;两组均治疗至HSV-2 IgG,IgM抗体阴性,但最长不超过6个月。结果试验组3个月、6个月后HSV-2 IgG,IgM抗体的阴转率均比对照组高(P(0.05)。结论转移因子可提高频发性生殖器疱疹的疗效。     

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.     

妊娠期生殖器HSV感染的研究进展与管理对策

生殖器疱疹是常见的性传播疾病之一,病原体为单纯疱疹病毒(HSV),导致慢性、复发性、终身性感染。妊娠期HSV感染可能通过垂直传播引起严重的新生儿疱疹。最容易导致垂直传播的危险因素包括:妊娠晚期原发感染、HSV-1感染,以及产道活动性皮损。妊娠期生殖器疱疹的诊断依靠临床表现及病原学/血清学检测。使用阿昔洛韦、伐昔洛韦、泛昔洛韦治疗是安全有效的。剖宫产可以降低新生儿感染风险,妊娠晚期原发感染或者产道活动性皮损者可考虑行剖宫产。     

阿昔洛韦联合重组人干扰素α-2b治疗复发性生殖器疱疹疗效观察

生殖器疱疹（GH）主要是由疱疹病毒-Ⅱ型（HSV-Ⅱ）感染引起的急性外生殖器部位易反复发作的疱疹性疾病,是常见的性传播疾病之一。笔者运用阿昔洛韦联合重组人干扰素α-2b治疗复发性生殖器疱疹取得了满意的疗效。现报告如下。     

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。     

妊娠合并生殖器疱疹一的相关因素分析及多元化干预对策

目的：探讨影响妊娠合并生殖器疱疹的相关因素,观察多元化干预措施后的临床效果。方法：随机选取2011年1月～2013年1月285例妊娠期的孕妇,对其中合并生殖器疱疹的35例患者为研究对象,对其影响因素进行分析,并观察多元化干预措施后的临床效果。结果：影响妊娠合并生殖器疱疹的危险因素有不良孕产史、妊娠期感染史、孕期焦虑、不洁性交史、多个性伴侣（〉2个）（P〈0．05）。而与患者的年龄、孕期体重、孕期体重指数、月经初潮年龄、月经紊乱史、痛经史、孕次、家族史等无关（P〉0．05）,其中妊娠期感染史、不洁性交史、多个性伴侣是高危险因素。经过多元化干预措施后总有效率为94．3％,抗复发有效率为77．8％。结论：妊娠期感染史、不洁性交史、多个性伴侣是影响妊娠合并生殖器疱疹的危险因素,多元化干预对临床效果大有裨益。     

Famciclovir reduces viral mucosal shedding in HSV-seropositive persons

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.     

Genital ulcer disease in women in Durban, South Africa.

OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in women. DESIGN--Microbial and clinical assessment of genital ulcers in women. SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu women with genital ulceration who had not received antibiotics in the previous two weeks. RESULTS--Syphilis was diagnosed in 40%, genital herpes in 18%, donovanosis (granuloma inguinale) in 16%, chancroid in 14%, lymphogranuloma venereum in 7% and scabies in 2%. No recognised cause was detected in 18%. Secondary syphilis was diagnosed in 21%, primary syphilis in 16% and mixed primary and secondary syphilis in 3%. Multiple infections were detected in 13 women, of whom 12 had syphilis. Bleeding was observed from the ulcers of 59 during swab collection. Three women had HIV-1 antibodies. Neisseria gonorrhoeae was isolated from the ulcers and endocervix of two women and from the endocervix alone in nine. Generalised scabies was diagnosed in 14. CONCLUSIONS--All the major causes of GUD are prevalent in Zulu women in Durban: secondary syphilis was the commonest diagnosis. Donovanosis, which often presents late with large ulcers, and genital herpes are now significant problems. Mixed infections with coexisting syphilis are common. All women in this population with GUD should be treated for syphilis and receive oral antibiotics effective for chancroid and donovanosis.     

间接免疫荧光法检测生殖器疱疹病毒

目的:评价间接免疫荧光试验(IFA)在生殖器疱疹(GH)诊断中的应用价值。方法:采用以单纯疱疹病毒(HSV)型共同性单克隆抗体为夹心的IFA法,检测了120例临床诊断为GH患者皮疹中的HSV,并与病毒培养法进行比较。结果:IFA检测HSV的总阳性率为85.8%,高于病毒培养法的阳性率(70.8%,χ2=12.04,P<0.01)。两种方法检测GH水疱内的HSV阳性率分别为93.3%和90.0%,无明显差异(χ2=1.96,P>0.05);而检测糜烂和结痂性皮疹内的HSV时,IFA的阳性率分别为92.6%和69.4%,均分别高于病毒培养法(75.9%,χ2=5.82,P<0.05;47.2%,χ2=14.17,P<0.01)。结论:IFA法具有简单、快速、敏感性高的优点,适于检测GH患者皮疹内HSV,有临床实用价值。     

HSV type specific serology in sexual health clinics: use, benefits, and who gets tested

OBJECTIVES: To determine which sexual health clinic clients were tested for herpes simplex virus (HSV) type specific antibodies and whether this test was useful for patient management. METHODS: Demographic, sexual and reproductive history, reasons for performing type specific serology, results, and benefits were derived from patient records from Parramatta Sexual Health Clinic for all patients who were tested between 13 September1993 and 31 December 2001. The value of serology was defined under five categories-diagnostic, counselling, initiating suppressive antiviral therapy, pregnancy counselling, and not useful. To establish whether patients tested for HSV were representative of clinic attendees, a sex matched "control" group was randomly selected. RESULTS: 382/886 (43.1%) were HSV-2 antibody positive and 774/884 (80.8%) were HSV-1 positive. The commonest reasons for requesting serology were having a partner with genital herpes (30%), undiagnosed recurrent genital ulceration (26%), and first episode of genital ulceration (22%). The test was of value in confirming the diagnosis in 57% of men and 60% of women with recurrent genital ulceration and in 28% of men and 40% of women with first episode genital herpes. In patients with a partner with genital herpes the test was of value in making a diagnosis in 27% men and 50% of women and in counselling 50% of women and 73% of men. Patients offered serology were older and more likely to have had genital herpes in the past than controls. CONCLUSION: Type specific serology should be recommended for the management of couples where one has genital herpes and the other apparently does not and in individuals with genital complaints suggestive of herpes.     

Management of women with recurrent genital herpes in pregnancy in Australia

OBJECTIVE: To document clinical practice for the management of recurrent genital herpes in pregnant women in Australia. DESIGN AND PARTICIPANTS: A questionnaire to all doctors associated with the Royal Australian College of Obstetricians and Gynaecologists. MAIN OUTCOME MEASURES: Policies for antenatal herpes screening, circumstances in which delivery by caesarean section was considered appropriate, and the use of aciclovir during pregnancy. The results were analysed by college status, sex, and whether the doctor worked in a public or private facility. RESULTS: 2855 (67.3%) obstetricians returned questionnaires. 696 (34.3%) stated that their hospital had a policy for managing recurrent genital herpes in pregnancy: 44.5% examined the genitalia and 33.8% took cultures during pregnancy. Fellows were more likely to examine the genitalia (87% v 37%, p < 0.001), and more likely to perform antenatal viral cultures than members (75% v 30%, p < 0.001). Doctors working at private hospitals were significantly more likely to take viral cultures than doctors in public hospitals (39% v 33% p < 0.05). Doctors were asked to consider five scenarios and judge whether caesarean section would be appropriate. 96% considered that a caesarean section was appropriate in women with active herpes at the onset of labour. In the case of a recurrence of genital HSV at the time of presentation with ruptured membranes longer than 4 hours, diplomats (79%) were significantly more likely to recommend a caesarean section than fellows (64%), members (63%), or trainees (49%) (all p < or = 0.001). Where there were positive viral cultures before the onset of labour fellows (45%) were more likely than members (29%) (p = 0.005), males (62%) were more likely than females (55%) (p = 0.03), and doctors working in private hospitals (69%) were more likely than those in the public sector (54%) (p < 0.001) to recommend caesarean section. CONCLUSION: There is considerable divergence of opinion regarding the appropriate management of recurrent genital herpes in pregnancy. The implementation of management guidelines would provide consistency of care.     

荧光多重PCR与血清型特异性抗体检测HSV感染的比较

目的：比较荧光多重PCR和血清型特异性抗体测定在生殖器疱疹临床诊断中的应用价值及评价各自的优缺点。方法：以细胞培养法作为“金标准”对照，分别用荧光多重PCR和血清型特异性抗体检测法对121例临床诊断为生殖器疱疹的标本进行检测。结果：以培养法作标准，并通过结果的差异性分析，荧光多重PCR的敏感性为100％，特异性为88．89％；血清型特异性抗体测定则分别为77．68％和77．78％，荧光多重PCR的敏感性和特异性均显高于血清型特异性抗体测（P＜0．05），但前不能检测出无皮损患HSV的DNA，而后可检测出无皮损患中的HSV抗体。结论：荧光多重PCR和血清型特异性抗体检测各有其自身的优缺点，单独用PCR和其它病毒分离的方法和单独使用血清特异性抗体检测的方法来诊断生殖器疱疹都是不完整的，均可造成漏诊。临床上将两种方法有机的结合起来应用能发挥各自的优势，取长补短，对早期、准确、快速地诊断生殖器疱疹及进行流行病学调查有着十分重要的意义和使用价值。     

Inapparent genital herpes simplex infection in women attending a venereal disease clinic

The purpose of this study was to determine the prevalence of asymptomatic genital infection with herpes simplex virus in women attending a venereal disease clinic in Puerto Rico. Genital samples were obtained from 123 consecutively enrolled patients. Vero cells were used for viral isolation; isolates demonstrating cytopathic effect were stored at -70 C and were typed by use of monoclonal antibodies. Herpes simplex virus was isolated from six patients, three of whom were free of any possible complaint that might be associated with a genital herpes virus infection. One patient was diagnosed as having herpetic cervicitis, and the remaining two were clinically diagnosed as well as laboratory confirmed cases of genital herpes. Virus isolated from all six women was identified as herpes simplex virus type 2. Thus the prevalence of laboratory confirmed genital herpes infection in women attending this clinic was 4.9% (6/123). Inapparent virus infection was detected in 2.5% (3/120) of the patients.     

Detection of varicella zoster virus in genital specimens using a multiplex polymerase chain reaction

OBJECTIVE: To compare the relative proportions of varicella zoster virus (VZV) and herpes simplex viruses in specimens obtained from the genital lesions of adults presenting with presumed genital herpes infection. METHODS: Swabs of genital lesions from 6210 patients attending general practices, infectious diseases clinics within hospitals, or sexual health centres for treatment of their genital lesions were tested using polymerase chain reaction (PCR) technology. The multiplexed PCR was capable of detecting herpes simplex virus types 1 and 2 (HSV-1, HSV-2), VZV, and cytomegalovirus in a single sample. RESULTS: A total of 2225 patients had viruses detected by PCR. HSV-1 was detected in 36%, HSV-2 in 61%, and VZV in 2.9% of PCR positive samples. Of the 65 patients with VZV genital infection, many were thought to have HSV infection before laboratory testing. CONCLUSIONS: The finding of VZV in nearly 3% of virus positive genital specimens demonstrates that this virus needs to be considered as a differential diagnosis for genital herpetic lesions. Advice provided to patients with VZV genital infection regarding the source of infection, likelihood of recurrence, and potential for transmission of the virus will be different from that given to patients with HSV infection.     

Neonatal herpes prevention: a minor public health problem in some communities

BACKGROUND: Neonatal herpes is a condition with high morbidity and mortality. The greatest risk occurs when the mother acquires herpes simplex virus (HSV) towards the end of pregnancy. A study from Seattle has suggested that the risk of acquisition of HSV during pregnancy was 3.7%. In Australia, HSV-2 infection is less common in pregnant women than in the United States. Consequently we conducted a study to establish HSV seroprevalence and the rate of HSV seroconversion in this population. METHODS: The study was conducted at Westmead Hospital, Sydney, between June 1995 and April 1998. Women completed a questionnaire covering risk factors for the acquisition of genital herpes. A serum sample during pregnancy and a specimen of cord blood were obtained and tested for antibodies to HSV-2 using a type specific indirect enzyme linked immunosorbent assay (ELISA). Equivocal results were resolved by western blot. A subset of the paired sera was tested for antibodies to HSV-1. The data were analysed using SPSS. RESULTS: 326 of the 2616 (12.5%) women were HSV-2 seropositive. Three women (0.15%) acquired HSV-2 infection during pregnancy. None of the three babies of these mothers developed neonatal herpes. 416 maternal cord pairs were tested for HSV-1 antibodies and 330 (79.3%) were positive. No HSV-1 seroconversions occurred. CONCLUSIONS: In this population, HSV acquisition was uncommon (0.34% per year) and neonatal herpes was rare. A cost effective analysis suggested that type specific serology to screen pregnant women and their partners in low prevalence communities was not cost effective.