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.     

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.     

Patient attitudes to type specific serological tests in the diagnosis of genital herpes.

OBJECTIVE: To assess patient attitudes to HSV-2 serotesting and the effect of providing detailed information regarding genital herpes, the blood test, and its implications. METHODS: Consecutive genitourinary medicine clinic attenders were asked to complete an anonymous self administered questionnaire. Half received minimal additional information while the other half received a detailed information sheet. RESULTS: Overall, 200 clinic attenders with a median age of 27 years (range 15-57) completed the questionnaire, 92.4% wanted to know if they, and 90.8% if their partners, had been infected with genital herpes; 65% expected testing as part of screening without further discussion. Overall, on a scale of 1-10, 2% scored 1 (equivalent to definitely not wanting a test), while 45.5% scored 10 (equivalent to definitely wanting a test). The overall median score was 9 (95% confidence interval 8-10) suggesting a strong opinion in favour of testing. The desire to test in each of five described hypothetical situations increased significantly (p < 0.001) when compared with the general desire. CONCLUSIONS: Clinic attenders expressed a strong preference to be serotested for HSV-2 which was unaltered by the provision of information highlighting implications, although influenced significantly by the context in which they were asked. Should reliable tests become available the level of demand could have important implications on laboratory and counselling resources.     

Herpes simplex virus seroprevalence and risk factors in 2 Canadian sexually transmitted disease clinics

OBJECTIVES: The objectives of this study were to determine the seroprevalence and risk factors for herpes simplex virus (HSV) types 1 and 2 in patients attending 2 Canadian sexually transmitted disease (STD) clinics. STUDY: Stored sera were tested for the presence of IgG class antibodies to HSV-1 and HSV-2 and results linked to that obtained from a risk behavior questionnaire. RESULTS: Overall prevalences for HSV-1 and -2 were 56% and 19%, respectively. HSV-1 and -2 seropositivity was associated with increasing age, female gender, nonwhite ethnicity, and a history of STD. HSV-2 seropositivity was also associated with a history of genital herpes, presence of genital sores, and coinfection with either human immunodeficiency virus (HIV) or hepatitis C (HCV). CONCLUSIONS: Herpes simplex infection is common in this high-risk Canadian population. Our finding that HCV seropositivity was a significant predictor for HSV-2 seropositivity emphasizes the overlap between pathogens that are primarily thought to be bloodborne pathogens and sexually transmitted infections and the need to target prevention in these areas concurrently.     

Genital herpes: general practitioners' knowledge and opinions

OBJECTIVES: To evaluate GPs' knowledge about genital herpes, especially recent information and to assess their attitudes towards serotesting. METHODS: GPs working in Coventry and the surrounding area were asked to complete an anonymous questionnaire. RESULTS: 70% of GPs (183 out of 261) responded to the questionnaire. Overall, 56% of the questions were answered correctly. 73% of participants knew that source partners in most transmission events are unaware of their infection and 77% were aware that patients shed the virus and transmit it even in the absence of clinical signs. As many as 43% did not know that the majority of infected individuals are unaware of their infection and 44% only knew that most transmission occurs during periods of asymptomatic shedding. Only 53% were aware that the proportion of genital herpes caused by HSV-1 is not decreasing. The majority (78%) supported the availability of its serotesting. CONCLUSIONS: This study demonstrates the lack of knowledge, among studied GPs, in some areas about genital herpes, especially recent information and indicates the need for more education about the condition. Most GPs in the study support the availability of genital herpes serotesting, although more studies need to be done before the wide availability of this testing.     

Recurrent genital herpes in a population attending a clinic for sexually transmitted diseases.

Patients with recurrent genital herpes attending a sexually transmitted disease clinic were studied and transmission of the infection was elucidated by evaluating serostatus in their partners. Of 84 patients attending for recurrent genital herpes, 94% had a herpes simplex virus type 2 (HSV-2) infection and only 6% (5 patients) a type 1 infection. The mean age of the patients was 36 years and the duration of their infection was up to 37 years (median 4 years). In most patients the number of recurrences had not decreased between the first year and the last year. About half had experienced a more severe first episode infection. Of the patients, 64% were not aware of asymptomatic shedding and the risk of sexual transmission without clinical symptoms. Of 67 steady partners of patients with genital HSV-2, 15% had a history of genital herpes. By HSV serology, HSV-2 antibodies (indicating subclinical genital herpes) were demonstrated in more than half of the partners. The duration of the relationship or condom use did not seem to influence the frequency of transmission to the partner, which may indicate an individual susceptibility for acquiring a genital HSV-2 infection. Eleven per cent of the patients were on suppressive antiviral therapy, while 39% had no experience of antiviral therapy. Type-specific HSV serology was found to be of value in counselling partners of patients with genital herpes.     

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.     

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.     

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.     

Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians

BACKGROUND AND OBJECTIVES: Sexual transmission of bacterial and viral sexually transmitted disease has been reported between women. No data are available on seroprevalence of herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2) among lesbians. GOAL: The goal was to define prevalence of infection with HSV-1 and HSV-2 among lesbians, and associated risk factors. STUDY DESIGN: Women who reported sex with another woman in the preceding year were eligible. Medical and sexual histories were obtained. Serum was tested for HSV-1 and HSV-2 antibodies using Western Blot assay. RESULTS: Among 392 subjects, antibodies to HSV-1 were detected in 46% and to HSV-2 in 8%. Increasing age predicted higher seroprevalence to both HSV types, and HSV-2 seropositivity was associated with a history of male partner with genital herpes. Of 78 women reporting no prior sex with men, 3% were HSV-2-seropositive. Most HSV-2-seropositive subjects (71%) reported no history of genital herpes. HSV-1 seroprevalence increased significantly with an increasing number of female sex partners. CONCLUSIONS: HSV-2 infection occurs in nearly 1 in 10 lesbians and is not predicted by report of sex with men or sexual identity. Most lesbians infected with HSV-2 are not aware of their infection. Sexual transmission of HSV-1 may occur more frequently among lesbians than among heterosexual women.     

The psychosocial impact of testing individuals with no history of genital herpes for herpes simplex virus type 2

BACKGROUND: Although approximately 20% of the population has a genital herpes (HSV-2) infection, 80% of these infections are unrecognized or asymptomatic. Serologic identification of HSV-2 leads to recognition of infection, which could lead to behavioral changes that reduce transmission. However, there has been concern that HSV-2 testing among persons without symptoms will cause substantial psychosocial harm. GOAL: The goal of this study was to assess the psychosocial impact of an HSV-2 diagnosis among individuals without a history of genital herpes attending a sexually transmitted disease (STD) clinic. STUDY: We conducted a cohort study of persons with no history of genital herpes attending an STD clinic and seeking herpes testing. Two follow-up interviews were conducted 1 week and 3 months after persons received their test results. Serum was tested using HerpeSelect 2. Psychosocial morbidity was assessed at baseline and each follow up using a mental health score, sexual attitude score, and perception of genital herpes score. RESULTS: Twenty-one percent (41 of 196) of participants tested positive for HSV-2 antibody. Among patients who were HSV-2-positive, there was no significant change in mental health score from baseline during either follow-up visit, nor was there any difference compared with persons who were HSV-2-negative. Patients who were HSV-2-positive did have a decline (P = 0.01) in their sexual attitude scores at the 1-week follow up compared with persons who were HSV-2-negative, indicating a decrease in positive sexual attitude, but this difference no longer remained at the 3-month follow up (P = 0.74). Patients who were HSV-2-positive viewed having genital herpes as significantly less traumatic than patients who were HSV-2-negative at both follow-up visits (P <0.01). CONCLUSION: There was no apparent lasting adverse psychosocial impact of detecting HSV-2 infection among individuals without a history of genital herpes seeking herpes testing at an STD clinic.     

Sexual and demographic risk factors for herpes simplex type 1 and 2 in women attending an antenatal clinic

OBJECTIVE: To establish risk factors for the presence of HSV-2 and HSV-1 infections in pregnant women. DESIGN, POPULATION, AND SETTING: A prospective study of 3306 women attending the antenatal department Westmead Hospital, Sydney, between June 1995 and April 1998. METHODS: Women completed a self administered questionnaire to establish risk factors for the presence of HSV-2 and HSV-1. Sera were tested for antibodies to HSV-2 and HSV-1. Data were analysed using SPSS and SAS. MAIN OUTCOME MEASURES: Seroprevalence of and risk factors for HSV-2 and HSV-1. RESULTS: 375 (11.3% (95% CI 10.3-12.5)) women were HSV-2 antibody positive. Increasing age, Asian country of birth, lower education level, public hospital status, confirmed genital herpes, a partner with genital herpes, early age of first sex, more than one lifetime sexual partner, and previous chlamydia infection were independently associated with HSV-2 seropositivity. Of 408 women tested for HSV-1 antibodies, 323 (79.2% (95% CI 74.9-83.0)) were positive. Oral herpes, oral blisters or sores, and being HSV-2 seropositive were independently associated with HSV-1 seropositive status. When the logistic regression model was rerun without HSV-2 status, parity of two or more and one or more sexual partners in the past 3 months were significant predictors of HSV-1 seropositivity. CONCLUSIONS: The presence of antibodies to HSV-2 and HSV-1 is related to a number of sexual and demographic risk factors. Public health campaigns directed at encouraging young people to delay the onset of sexual activity and reduce the number of sexual partners need to be evaluated. However, the possible availability of an HSV-2 vaccine that is able to protect over 70% of women offers the best hope for control of genital herpes.     

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.     

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.     

Seroprevalence of herpes simplex virus type 1 and type 2 in Turkey

BACKGROUND: Herpes simplex virus (HSV) infections are among the most common infectious diseases in humans. The prevalence of herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) varies widely across the world. HSV-2 infection is the primary cause of genital herpes. It is highly prevalent in human populations in many parts of the world, and is the most common cause of genital ulcer disease worldwide. In spite of the large prevalence and growing incidence of herpes simplex infection (HSV-1 and HSV-2), relatively few data have been published regarding the seroprevalence of herpes simplex infection, while no data exist regarding the Turkish population. METHODS: We aimed to investigate the prevalence of HSV-1 and HSV-2 in selected populations in Turkey. A cross-sectional study was conducted involving 2082 serum samples of 725 adults, 300 pregnant women, 200 blood donors, 483 sex workers and 110 patients with genital warts and 264 hotel staff in Istanbul, Turkey. All serum samples were assessed for HSV1 and HSV-2 IgG antibodies using an HSV-type specific, enzyme-linked immunosorbent assay (ELISA). RESULTS: The prevalence of HSV-2 and HSV-1 antibodies was 4.8 and 85.3% in sexually active adults; 5.5 and 96% in blood donors; 5 and 98% in pregnant women, 17.3 and 93.6% in patients with genital warts; 8.3 and 97.3% in hotel staff; and 60% and 99% in sex workers. CONCLUSION: These results confirm a higher prevalence of HSV infection than estimated, especially in high risk groups in Turkey. The high prevalence of HSV infection underlines the need for education among these populations.     

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.     

The psychosocial impact of serological herpes simplex type 2 testing in an urban HIV clinic

BACKGROUND/OBJECTIVES: Herpes simplex virus type 2 (HSV-2) is a common infection among HIV infected people. HSV type specific serologies permit the diagnosis of previously unrecognised HSV-2 infection. While substantial psychosocial morbidity has been associated with a clinical diagnosis of genital herpes, the burden associated with a serological diagnosis of HSV-2 is unclear. This study prospectively measured the psychosocial response to a new serological HSV-2 diagnosis in patients receiving care at an urban HIV clinic. METHODS: At entry, sera were tested for HSV-1 and HSV-2 antibodies by western blot. Participants completed a 90 item psychosocial and life quality questionnaire at enrollment, and at 2 weeks, 3 months, and 6 months after receiving test results. RESULTS: Of 248 HIV infected participants, 172 (69.4%) were HSV-2 seropositive and 116 (67.4%) seropositive people did not have a previous history of genital herpes. After correction for multiple comparisons, no statistically significant differences were detected on the psychosocial and life quality scales between those who received a new HSV-2 serological diagnosis compared with those who were HSV-2 seropositive with a history of genital herpes, or those who tested HSV-2 seronegative. Additionally, no significant changes in scores were observed during follow up. CONCLUSIONS: HSV-2 was a common but often unrecognised infection in this urban HIV clinic and participants coped well with a positive HSV-2 result. Concerns about psychosocial burden should not deter serological testing for HSV-2. Given the epidemiological and clinical interaction between HSV-2 and HIV, these data support routine HSV-2 testing of HIV infected people.     

生殖器疱疹患者530例HSV抗体型别检测分析

目的了解生殖器疱疹患者HSV-1和HSV-2的感染情况,并分析生殖器疱疹的流行特点。方法采用酶联免疫吸附试验(ELISA)法对性病门诊530例临床诊断为生殖器疱疹的患者进行了HSV血清抗体检测。结果 530例中男311例(58.68%),女219例(41.32%)。HSV-1IgM抗体阳性60例(11.32%),HSV-1IgG抗体阳性471例(88.87%),HSV-2IgM抗体阳性213例(40.19%),HSV-2IgG抗体阳性349例(65.85%)。年龄以31～40岁最多,为210例,其次为21～30岁194例。职业中最多的是自由职业和民工。初发者304例(57.36%),复发者226例(42.64%),其中频繁发作(≥6次/年)85例(16.04%)。结论长春地区生殖器疱疹患者以HSV-2感染为主。女性近期感染多于男性。以21～40岁性活跃人群为高发年龄组。     

Trends in herpes simplex virus type 1 and 2 infections among patients diagnosed with genital herpes in a Finnish sexually transmitted disease clinic, 1994-2002

OBJECTIVE: The objective of this study was to analyze the proportion of herpes simplex virus types 1 and 2 (HSV-1 and -2) in genital infections during a 9-year period (1994-2002) in a Finnish sexually transmitted disease (STD) clinic population. STUDY DESIGN: We analyzed prospectively the proportion of HSV-1- or -2-positive culture samples from our STD clinic patients with genital herpes during years 1994-2002 and compared the proportions of HSV-1 and HSV-2 findings with the age and gender of the patients. RESULTS: The proportion of HSV-1 infections increased from 18.7% (39 of 209) in 1994-1996 to 25.9% (52 of 201) in 2000-2002 (P = 0.032). Female patients with genital herpes and laboratory isolation of HSV-1 were 35.9% of the cohort from 1994-1996 and 67.3% of the cohort from 2000-2002. The mean age of male patients with HSV-1 decreased from 29.3 years in 1994-1996 to 24.1 years in 2000-2002 (P = 0.023). CONCLUSIONS: An increase in the proportion of genital infections caused by HSV-1 was found. The increase was mainly the result of the increase in the number of female patients with HSV-1. Male patients acquire genital HSV-1 infection at a younger age than 10 years ago.