Historical findings in subjects from a high socioeconomic group who have genital infections with herpes simplex virus.

A highly motivated, self-selected group of 1,535 men and 1,607 women of middle-to-high socioeconomic class who had recurring genital herpes were surveyed in an assessment of the historical characteristics of these subjects and their disease. All subjects lived in the continental United States and were members of the national herpes organization, HELP, sponsored by the American Social Health Association. Subjects were predominantly well-educated white persons (mean educational level, 15.2 years) earning > $20,000 per year. The mean ages of acquisition of genital herpes were 26.9 years for women and 30.8 years for men. The mean durations of infection were 3.9 years for women and 5.1 years for men. Women usually acquired genital herpes between the ages of 20 and 29 years, whereas substantial numbers of men experienced their initial episodes of infection when they were in their thirties. The population studied was predominantly heterosexual. Many of the subjects, especially the men, had experienced other sexually transmitted diseases such as gonococcal or nongonococcal urethritis. Over two-thirds of the subjects experienced more than five relapses every year, and the percentage of subjects with more than five recurrences yearly did not decrease with time.     

Intrauterine herpes simplex virus infection presenting with hypopigmented lesions

Genital herpes simplex virus (HSV) is a sexually transmitted infection that can be transmitted from mother to child in utero, perinatally, or postnatally. Cutaneous infection with HSV commonly presents as vesicles affecting the skin, eyes, or mouth. In our case, we report a well child with cutaneous hypopigmented patches at birth that preceded typical blistering.     

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.     

单纯疱疹病毒抗原检测在生殖器疱疹诊断中的临床评价

生殖器疱疹(genital herpes,GH)是由单纯疱疹病毒(herpes simplex virus,HSV)感染引起的一种常见的性传播疾病。临床表现多种多样,是生殖器溃疡最     

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.     

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。     

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.     

大连市皮肤病医院疑似生殖器疱疹患者单纯疱疹病毒检测结果分析

目的了解大连地区皮肤性病科门诊患者单纯疱疹病毒(HSV)的感染现状及特点,并探讨各种方法学对单纯疱疹病毒(HSV)的诊断价值。方法选取2015年至2017年大连市皮肤病医院诊治的1 600例(男性、女性各800例)初诊疑似生殖器疱疹患者作为研究对象。采用酶联免疫吸附法(ELISA)检测血清中HSV1和HSV2的IgG、IgM抗体,其中200例有典型症状的生殖器疱疹患者同时采用实时荧光聚合酶链式反应技术(FQ-PCR)对其进行核酸检测。结果 1 600例疑似可能感染生殖器疱疹的高危患者HSV1-IgG和IgM的检出率分别为61.5%和4.88%,HSV2-IgG和IgM检出率分别为33.88%和7.06%。其中200例有典型生殖器疱疹症状者HSV1-DNA的感染率为3%,HSV2-DNA感染率为30%。疑似生殖器疱疹患者不同年龄组比较,其中HSV-IgG以25岁～60岁检出率较高。结论本地区皮肤性病门诊患者HSV抗体检出率较高,HSV1感染率男女大致相同; HSV2感染率女性远高于男性;HSV是性病的重要病原体之一。     

Sequential genital infections with herpes simplex virus types 1 and 2.

Herpes simplex virus (HSV) types 1 and 2, typed by an enzyme linked immunosorbent assay (ELISA), were isolated at different clinical episodes from five people with genital herpes. This finding has important implications for assessing resistance to antiviral drugs in therapeutic studies.     

Psychosocial implications of recurrent genital herpes simplex virus infection.

Fifty seven patients experiencing first attacks of genital herpes simplex virus infection (HSVI) were compared with 50 patients who were concerned about frequently recurring attacks despite routine counselling and reassurance. Using the general health questionnaire this latter group was found to be more psychologically distressed and more socially naive than the first attack group, as measured by socioeconomic class and the lie score of the Eysenck personality questionnaire; otherwise the two groups were similar. Patients presenting to clinics with frequently recurring genital HSVI may therefore be especially psychologically distressed, socially naive, and disadvantaged. Managing these patients needs to include understanding these problems as well as giving advice and using antiviral agents.     

Acyclovir prophylaxis of recurrent genital herpes: randomised placebo controlled crossover study.

Forty patients were entered into a randomised placebo controlled crossover study to assess the efficacy and safety of oral acyclovir 200 mg four times a day in the prophylaxis of recurrent genital herpes. Each treatment began during a recurrence and continued for a maximum of 84 days or until the onset of the next recurrence, when the alternate medication was started. Of 28 patients who completed both treatment courses, only three developed a recurrence while taking acyclovir compared with 26 while taking placebo. The mean time to first recurrence was more than 84 days in patients receiving acyclovir and 24 days in patients receiving placebo (p less than 0.001). The mean time to first recurrence after treatment with acyclovir ceased was 16 days. Adverse events, though thought unlikely to be related to treatment, necessitated the withdrawal from the study of two patients while taking acyclovir and one patient while taking placebo. No clinically important effects on haematological or biochemical variables occurred during the acyclovir treatment. All viral isolates tested after treatment remained sensitive to acyclovir. Acyclovir prophylaxis of recurrent genital herpes is effective and safe but does not appear to influence the natural history of the disease after cessation of 84 days' continuous treatment.     

Natural history of genital herpes simplex virus type 1 infection

BACKGROUND: Herpes simplex virus type 1 (HSV-1) has been increasingly reported as a cause of genital herpes, yet there have been few studies on the long-term natural history of this infection.GOAL The goal was to examine the clinical course of genital HSV-1 infection. STUDY DESIGN: This was a cohort study of patients presenting with culture-proven primary genital HSV-1 infection. RESULTS: The median follow-up of the 77 patients was 736 days. The overall rate of recurrences was 1.3/year in the first year of infection, decreasing to 0.7/year in the second year. In the first year of infection, 43% of study patients did not have a recurrence. In the second year of infection, 67% of study patients did not have a recurrence. CONCLUSION: Genital HSV-1 recurs infrequently in most patients, and the rate decreases further in the subsequent years of infection. Because the prognoses of genital HSV-1 and HSV-2 infections differ, determination of the viral type is important for patient counseling.     

Anaerobic bacteria and herpes simplex virus in genital ulceration.

Of 91 patients with genital ulceration, herpes simplex virus was isolated from 52 (57%) and Haemophilus ducreyi from 12 (13%); none had syphilis. The difference in incidence of other aerobes in patients and controls was not significant. Anaerobes, predominantly Bacteroides spp, were isolated from a large proportion (77%) of men and women patients with ulcers but from few control men. The most common anaerobic species were B asaccharolyticus and B ureolyticus, with fewer isolates of the melaninogenicus/oralis group. The bacterial flora of herpetic and non-herpetic ulcers were similar, but Candida albicans was isolated significantly more often from non-herpetic ulcers. Anaerobic bacteria may contribute to the pathogenesis of genital ulcers.     

酶联免疫吸附试验检测单纯疱疹病毒抗体在生殖器疱疹筛查中的应用

目的:探讨酶联免疫吸附试验检测单纯疱疹病毒(HSV)抗体对生殖器疱疹筛查的意义。方法:选取50例2010年2月至2013年10月来我院治疗疑似生殖器疱疹患者,将其作为试验组,使用酶联免疫吸附试验进行HSV抗体检测,另外选择50例健康体检人员血清作为对照组。结果:在50例疑似生殖器疱疹患者HSV-I Ig M,HSV-I Ig G的检出率依次为14%,32%,HSV-ⅡIg M检出率为20%,HSV-ⅡIg G的检出率为34%;在对照组中HSV-I Ig M,HSV-I Ig G的检出率依次为0.8%,14%,HSV-ⅡIg M检出率为10%,HSV-ⅡIg G的检出率为24%,两组患者HSV抗体检测阳性率有显著的不同,二者明显的差异具有统计学意义(P0.05)。结论:疑似生殖器疱疹患者单纯疱疹病毒抗体检出率高,酶联免疫检测HSV抗原的方法可直接检测出泌尿生殖道及皮损中HSV病原体,在生殖器疱疹筛查中具有一定的优势。     

生殖器溃疡中单纯疱疹病毒的检测和分型

目的：了解性病门诊生殖器溃疡患者中单纯疱疹病毒（HSV）感染情况，并评价聚合酶链反应（PCR）－微孔板反向杂交检测和分型方法在生器疱疹诊断中的意义。方法：采用病毒分离培养、普通PCR和PCR－微孔板反向杂交法同时对200份生殖器溃疡标本作了HSV检测与分型。结果：PCR－微孔板反向杂交法的敏感性和特异性分别为98．1％和95．9％，PCR－微孔板杂交法分型结果与病毒分离培养法和普遍PCR的分型结果完全相符。生殖器溃疡中HSV检出率为30％（60／200），其中HSV－2感染占96．7％（58／60）。结论：HSV－2是性病门诊患者生殖器溃疡的主要病因之一，PCR－微孔板反向杂交法是一种适用生殖器溃疡标本中HSV的检测与分型的快速、敏感和特异的诊断方法。     

单纯疱疹病毒1型致原发性生殖器疱疹一例

患者女,23岁。因外阴红肿、刺痛4 d入院。4 d前出现会阴瘙痒、分泌物增多,查念珠菌阳性,拟诊念珠菌性阴道炎,给予氟康唑胶囊150 mg顿服,复方明矾散、双唑泰栓及联苯苄唑乳膏外用,3 d前瘙痒加重,出现轻微疼痛,予聚维酮碘溶液阴道冲洗,制霉菌素阴道泡腾片及硝酸咪康唑栓治疗,症状无改善,2 d前外阴明显肿胀,大量水疱及脓疱,渗出,行走时疼痛明显,外院拟急性女阴溃疡给予头孢曲松、泼尼松治疗,效果不佳,疼痛加剧,呈反复持续发作的刺痛,加用盐酸曲马多注射液肌内注射,疼痛未能改善……     

Duplex real-time polymerase chain reaction assay for detection and quantification of herpes simplex virus type 1 and herpes simplex virus type 2 in genital and cutaneous lesions

BACKGROUND: A sensitive and specific method for detecting herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) is important for diagnosing genital and cutaneous infections. GOAL: The goal of this study was to compare quantitative real-time polymerase chain reaction (qPCR) with virus culture for diagnosis of genital and cutaneous HSV-1 and HSV-2. STUDY DESIGN: A duplex qPCR system for quantification of DNA from HSV-1 and HSV-2 was developed. Duplicate swabs for PCR and virus culture were collected from 89 patients attending our sexually transmitted infection and dermatology clinic. RESULTS: The duplex qPCR had a linear measure interval of 10-10 copies/mL. The detection limit was between 1 and 5 copies per reaction. qPCR detected HSV in 57 (64%) specimens and virus was isolated in 45 (50%) cases. First-episode infections showed higher viral quantities with a median value of 4.2 x 10 copies per reaction compared with recurrent infections with 1.0 x 10 (P = 0.0002). HSV-1 was more likely to be the cause of first-episode genital infections (72%), and HSV-2 of recurrent and atypical genital manifestations (73%). CONCLUSION: Real-time PCR is a sensitive method for diagnosing genital herpes, and the duplex format is convenient for typing. The method increased the detection rate by 27% compared with virus culture.     

Acquisition of concomitant oral and genital infection with herpes simplex virus type 2

Primary oral and genital infections caused by herpes simplex virus type 2 were diagnosed in an 18-year-old female. A history of sexual practices was critical in determining the anatomic sites of infection. Restriction endonuclease analysis of viral DNAs helped to identify the male sexual partner from whom the virus had been acquired. He had been infected recently by a previous sexual partner but had not yet developed lesions. Clinicians should obtain a history of sexual practices from patients with newly acquired genital herpes and should advise patients with genital herpes that transmission of virus to sexual partners can occur in the absence of overt lesions.     

Analysis of DNA from recurrent genital herpes simplex virus isolates by restriction endonuclease digestion

In a blind study, DNA from 40 clinical isolates of herpes simplex viruses was analyzed by restriction endonucleases to determine whether serial isolates from an individual patient could be identified and whether exogenous reinfection occurred within this population. Five of the 40 isolates served as controls. Based on restriction patterns obtained following Bam H1 cleavage of DNA, 35 isolates were assigned to 15 patients. Isolates from two patients displayed variation in the electrophoretic mobility of certain Bam H1 fragments. However, the isolates from one patient were identical when digested with four additional enzymes. One of three sequential isolates from a patient, when cleaved with Eco R1 and Hind III, showed variable fragments in the terminal and joint regions of the S segment of the genome. The appearance of the fragments was not due to the addition of a known restriction site. We conclude that exogenous reinfection with a genetically distinct strain of herpes simplex virus type 2 (HSV-2) did not occur among these 15 patients with recurrent genital HSV infections.