National survey of diagnostic services for genital herpes

OBJECTIVE: To investigate the provision of diagnostic services for genital herpes simplex virus (HSV) infection in the United Kingdom. METHODS: National survey of laboratories providing diagnostic services for genital herpes. RESULTS: Completed questionnaires were returned from 25/32 (78%) laboratories participating in the Clinical Virology Network, including seven in London, 12 in the rest of England, one in Wales, four in Scotland, and one in Northern Ireland. Virus culture was the diagnostic method of choice in 20/25 (80%) laboratories; 5/25 (20%) routinely used HSV DNA detection by polymerase chain reaction (PCR). HSV PCR for DNA detection in cerebrospinal fluid (CSF) was available in 17/25 (68%) laboratories. Typing of isolates (HSV-1 or HSV-2) was performed routinely in 22/25 (88%) laboratories. Only 2/25 (8%) laboratories offered HSV type specific serology, although an additional 12/25 (48%) referred requests elsewhere. Consistent with this finding, the number of HSV type specific antibody tests referred to the Health Protection Agency increased by nearly fivefold between 1997 and 2003. CONCLUSIONS: Virus culture remains the preferred diagnostic method for genital herpes, despite evidence indicating that its sensitivity is suboptimal compared to PCR. As HSV PCR is widely available for testing of CSF, it is recommended that clinicians and virologists discuss ways to implement PCR testing of genital swabs, thus enabling greater diagnostic accuracy. A call is made for studies to assess the use of HSV type specific serology in genitourinary medicine (GUM) settings, now that rapid and validated assays have become available and guidelines have been issues to provide recommendations on their use.     

Recurrent genital herpes on the buttocks: "herpes disciformis"

We report a clinical variety of recurrent genital herpes on the buttocks of seven women ranging in age from thirty-four to eighty-one years. The lesions had recurred for one to nine years and had produced a characteristic cicatricial rounded area within the S2 to S3 dermatomes on one buttock. Herpes disciformis is believed to be an anatomical variant of the common genital herpes infection. We have only noted it in middle-aged or older women with no history of genital herpes.     

单纯疱疹病毒IgM抗体检测方法的比较

目的:了解两种不同血清学检测方法检测单纯疱疹病毒IgM抗体的敏感性。方法:收集2018年5-6月50例生殖器疱疹高危人群,分别采用酶联免疫法及化学发光免疫法检测血清中单纯疱疹病毒IgM抗体,统计比较两种方法检测结果。结果:50例高危人群中:化学发光免疫法检测单纯疱疹IgM阳性12例,阳性率24.00%,其中1型IgM阳性4例,阳性率8.00%,2型IgM阳性8例,阳性率16.00%;酶联免疫方法检测IgM阳性4例,阳性率8.00%,其中1型IgM阳性2例,阳性率4.00%,2型IgM阳性2例,阳性率4.00%。化学发光免疫法IgM阳性检测率高于酶联免疫法(2=8,P<0.05)。化学发光免疫法检测HSVIgM、HSV-1型IgM、HSV-2型IgM的结果相对酶联免疫法的特异度分别为82.61%、95.83%、87.50%,灵敏度均为100%。结论:化学发光免疫法检测生殖器疱疹高危人群单纯疱疹病毒IgM抗体阳性率高于酶联免疫法,且操作简单、所需时间短。     

Rapid diagnostic tests for cutaneous eruptions of herpes simplex.

Comparison was made of the results of virus isolation, indirect immunofluorescent staining (IF-test) and Tzanck smears from 32 patients with cutaneous eruptions clinically diagnosed as herpes simplex. Herpesvirus hominis was isolated from 21 patients; IF-test was positive in 22 patients; Tzanch smears were positive in 20 patients. 23 to 25 of the 25 patients in whom one of the diagnostic tests was positive could be identified by a combination of any two of the diagnostic methods employed. No false-positive reactions were observed for IF-test or Tzanck smear.     

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.     

吲哚美辛间歇口服预防生殖器疱疹复发的效果观察

目的 探讨吲哚美辛口服预防频繁复发的生殖器疱疹的效果。方法 选择无吲哚美辛口服禁忌证的频繁复发的生殖器疱疹患者(年复发频率6次以上)173例,分成4组(A,B,C,D),分别给予吲哚美辛联合阿昔洛韦口服、阿昔洛韦连续递减疗法、发作期阿昔洛韦治疗和单纯吲哚美辛间歇口服疗法。疗程1年,期间定期复诊,记录患者的药物反应、生殖器疱疹复发情况。结果 各组患者预防性治疗前的平均复发频率为9.6～10次/年,经过1年的连续性预防后,年均复发频率(中位数)分别为3次,3次,7次,4次;较1年前分别减少67%,70%,30%,62%。吲哚美辛的不良反应主要有轻度眼睑浮肿10%(3/30);阿昔洛韦主要有头疼、眩晕(10%)。结论 吲哚美辛间歇口服预防复发的生殖器疱疹有效,可以减少其复发频率62%～67%。     

Survey of diagnostic services for genital herpes in fourteen countries in Eastern Europe

This paper reports survey-based data on the diagnosis and management of genital herpes simplex virus (HSV) infection in 14 countries of the Eastern European Network for Sexual and Reproductive Health (EE SRH). Only 43% of the countries could provide the number of genital HSV cases recorded at national level. Eighty-six percent of countries employed syndromic management in cases of genital ulcer disease. Most countries performed type-specific and/or non-type-specific enzyme immunoassays to detect HSV antibodies. Non-type-specific serology for diagnostic purposes should be actively discouraged. Direct detection methods for HSV, such as PCR, antigen detection and culture, are available in the region, but their usage was extremely low. Their use in Eastern European countries should be actively promoted. The availability of laboratory services must be improved, and countries in the region should implement consensus recommendations for the laboratory diagnosis of genital HSV infections in order to improve clinical practice.     

中西医结合治疗生殖器疱疹的临床分析

目的:对门诊确诊的184例生殖器疱疹患者分别采用中西医结合治疗,进行对照观察。方法:治疗组方用中药清热解毒,利湿养阴,扶正固本汤,结合西医抗病毒药和免疫增强剂;对照组每天静脉给予抗病毒药和肌注、口服免疫调节药。两组均连续用药6天。结论:治疗组与对照组在规定治疗时间内疗效存在明显差异。     

Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes

OBJECTIVES: This study describes the differences in sexual behaviour in individuals with genital herpes (GH) during "symptomatic" and "asymptomatic" periods of the disease. METHODS: A cross sectional questionnaire was undertaken by 1193 individuals attending clinics between 1998 and 2001. All participants in this analysis were in heterosexual, monogamous partnerships, self identified with a history of symptomatic GH and with confirmed HSV-2 infection. RESULTS: Sexual activity reported during asymptomatic v symptomatic periods of GH was 98% v 40% (p<0.001), 76% v 29% (p<0.001), and 25% v 11% (p<0.001) for vaginal, oral, and anal intercourse, respectively, while "always" condom use during asymptomatic and symptomatic periods was 20% v 35% (p<0.001), 2% v 7% (p<0.001), and 10% v 15% (p = 0.131), respectively. The proportion of individuals who either abstained from vaginal intercourse or "always" used condoms was 21% v 74% (p<0.001), for asymptomatic v symptomatic periods. Multivariable analyses indicated that factors associated with engaging in intercourse during symptomatic periods of GH included current intrauterine device use (adjusted odds ratio (aOR) = 2.96, 95% confidence interval (CI) = 1.46 to 6.02); living in Latin America (aOR = 2.16, CI = 1.19 to 3.91) or Europe (aOR = 1.67, CI = 1.21 to 2.28), compared with North America; previous sexually transmitted disease (aOR = 1.42, CI = 1.08 to 1.89); a higher number of sexual acts per month (aOR = 1.09, CI = 1.06 to 1.11); and a higher number of GH recurrences per year (aOR = 1.08, CI = 1.03 to 1.12). CONCLUSIONS: These data indicate that the majority of people with GH either abstained from intercourse or "always" used condoms during symptomatic periods of GH. However, condom use was relatively low during asymptomatic periods in comparison with symptomatic periods. These results highlight that further education on GH prevention is warranted, particularly for symptomatic periods.     

112例生殖器疱疹复发诱因和前驱症状分析

目的：研究GH复发的诱因以及发作前的前驱症状，以便掌握GH的发作规律，更好地进行早期预防和治疗。方法：对确诊的GH患者进行详细的病史询问，做好患者GH复发的诱因和发作前驱表现的记录。结果：共112例复发性GH患者，22．3％GH患者在复发前无明显诱因；18．7％复发与频繁的性接触有关；16．1％与劳累过度有关；13．4％与进食刺激性食物有关；26％在上述因素存在时均容易复发；1％女性患者在月经来潮时可引起GH发作。45％的患者在复发前无明显不适；26．8％发作前感到外阴部瘙痒、疼痛；9．8％下肢酸痛；8％有生殖器皮肤针刺感；有5．4％有局部灼热感和腰部胀痛。结论：在复发性GH患者中，22．3％复发前无任何诱因，频繁的性接触、劳累过度、刺激性食物是部分GH复发的诱因；45％GH患者复发前无任何不适。关注GH患者复发的前驱表现以及伴随的早期排毒现象对预防GH的传播有重要意义。     

生殖器疱疹的研究及治疗进展

生殖器疱疹是一种常见的、易反复发作的性传播疾病。该病有间断排毒的特点,且目前尚无有效的根治方法。近几年随着患病人数的增多,已越来越引起人们的重视。目前国内关于联合应用抗病毒药物及免疫调节剂的研究较多,本文就该病的最新研究和治疗进展做一综述。     

生殖器疱疹的研究和治疗进展

生殖器疱疹是一种常见的性传播疾病,容易反复发作,很难彻底治愈,给患者的生理和心理造成极大的困扰。目前对该病复发机制的研究较多,尤其是潜伏相关转录体(LAT)、Us3基因及Toll样受体。本文就近几年的研究和治疗进展做一综述。     

审证求因治疗生殖器疱疹

目的:总结辨证论治生殖器疱疹经验。方法:以医案形式阐述生殖器疱疹的病因病机、证型、治法、方药。结果:生殖器疱疹病因病机为发于外阴,病在下焦,与肝、脾、肾关系密切,多因房室不洁,触染邪毒,外阴皮肤黏膜腠理疏松破损,淫毒之邪乘虚而入,加之素体湿热内蕴,湿毒蕴结下焦,搏结外阴,久之,伤津耗气,正虚邪恋。结论:辨证论治生殖器疱疹疗效显著。     

卡介菌多糖核酸治疗女性复发性生殖器疱疹的临床研究

目的:探讨卡介菌多糖核酸对女性复发性生殖器疱疹患者的治疗疗效,以及其对患者血清IL-2、IL-10水平的影响。方法:将56例RGH患者按照随机数表法随机分为A、B两组,A组患者34例,采用口服阿昔洛韦片联合肌内注射卡介菌多糖核酸;B组患者22例,仅采用口服阿昔洛韦片;再选择正常对照组20例,比较三组患者治疗3个月后的血清IL-2、IL-10水平变化,以及A、B两组患者的1年后疗效及复发情况。结果:A组患者的有效率为97.1%,B组患者的有效率为95.5%,P>0.05,两组有效率比较不存在统计学显著性差异。A组复发率下降79.6%,B组复发率下降60.4%,P<0.05,A组复发率下降程度显著大于B组。治疗前A、B两组IL-2水平低于健康对照组(P<0.05),治疗后A组IL-2水平显著高于治疗前(P<0.05),B组治疗前后IL-2水平不存在差异(P>0.05);治疗前A、B两组IL-10水平高于健康对照组(P<0.05),治疗后A组IL-10水平显著低于治疗前(P<0.05),B组治疗前后IL-10水平不存在差异(P>0.05)。结论:卡介菌多糖核酸治疗女性复发性生殖器疱疹能够显著降低患者的复发率,并且能够显著升高患者血清IL-2水平、降低患者IL-10水平,从而起到增强患者免疫力的作用。     

泛昔洛韦联合匹多莫德治疗频发性生殖器疱疹的临床观察

目的：探讨泛昔洛韦联合匹多莫德治疗频发性生殖器疱疹的疗效及安全性。方法：将98例患者随机分为两组,治疗组50例,口服泛昔洛韦联合匹多莫德;对照组48例,仅口服泛昔洛韦治疗。疗程均为2个月,随访1年。结果：两组疗效差异无显著性（P〉0．05）,治疗组复发率明显低于对照组（P〈0．01）。患者均未见明显不良反应。结论：泛昔洛韦联合匹多莫德对预防生殖器疱疹复发疗效确切,安全性好,值得临床应用。     

A model of the transmission and control of genital herpes

BACKGROUND: Mathematical modeling of herpes simplex virus type 2 transmission can provide insight into the behavior of the epidemic and the effects of control measures. GOAL: To examine parameter sensitivity and assess control strategies. STUDY DESIGN: The model simulates transmission in a young, sexually active, nonmonogamous population. The population is divided into compartments representing disease status (susceptible, exposed, primary infectious, asymptomatic, recurrent, vaccinated), and flows between compartments are described by differential equations. RESULTS: With a base set of parameter values, the basic reproduction rate (R0) is 1.79, indicating that ultimate prevalence in this population will be 44%. The course of the epidemic is most sensitive to changes in behavioral parameters (time nonmonogamous and partner-change rate) and to the probability of transmission during the asymptomatic stage. CONCLUSION: In the absence of behavior change, efforts to control the epidemic must focus on vaccine development and prevention of transmission during both symptomatic and asymptomatic phases.     

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。     

早期联合药物干预治疗生殖器疱疹疗效评价

目的：探讨早期匹多莫德联合伐昔洛韦干预治疗生殖器疱疹的临床疗效。方法：将86例生殖器疱疹患者随机分为早期干预组和对照组,每组43例。早期干预组给予口服匹多莫德联合伐昔洛韦进行早期干预治疗,对照组只给予口服伐昔洛韦治疗。两组患者同时治疗半个月左右,观察两组患者临床疗效。主要观察患者的皮损消退时间及皮损积分。结果：早期干预组的患者皮损消退时间短于对照组,与对照组比较差异无明显统计学意义（P〈0.05）,早期干预组的皮损积分值低于对照组,两组比较差异有统计学意义（P〈0.05）。结论：匹多莫德联合伐昔洛韦早期干预治疗生殖器疱疹疗效显著,患者耐受性较好,值得在临床推广运用。