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.     

Low serum zinc in children with atopic eczema

Serum zinc was measured by atomic absorption spectrophotometry in sixty-five children with atopic eczema and seventy-nine control children. The mean serum zinc of the patients, (11.4 +/- 2.0 mumol/l) was significantly lower than that of the controls (13.7 +/- 2.3 mumol/l, P less than 0.0001). There was no significant correlation between the patients' serum zinc concentration and either the height/weight centile or a subjective assessment of severity and extent of the eczema. Of eleven patients with serum zinc below 10 mumol/l, six had recurrent infections of the skin, a significantly greater proportion than in patients whose serum zinc was 10 mumol/l or above. It is suspected that the decreased plasma zinc concentration in children with eczema is a non-specific consequence of the dermatological disorder, and therefore there is no indication for zinc supplementation.     

Development and use of a type-specific antibody avidity test based on herpes simplex virus type 2 glycoprotein G

OBJECTIVES: It is difficult to discriminate between lesions resulting from recently acquired versus established genital herpes simplex virus type 2 (HSV-2) infection. Methods not based on history or serum IgM status are needed. GOAL: Our goal was to use type-specific gG-2 antibody avidity determinations based on HerpeSelect HSV-2 enzyme-linked immunosorbent assay (ELISA) to identify new infections. STUDY: Sera (N = 168) from 71 patients with first-episode genital herpes and 45 sera from 21 patients with recurrent episodes were tested. RESULTS: Median avidity increased from 30.2 in sera drawn 6 weeks after infection (P <0.001). Patients with recurrent episodes and established HSV-2 infections (median, 6.1 years' duration) had higher avidity antibodies (median, 92.7; range, 55.1-100) than patients after first episodes (median, 33.7; range, 6.4-73.9; P <0.001). CONCLUSION: Avidity testing based on HerpeSelect ELISA could be a cost-effective method to identify patients with new HSV-2 infections.     

Recurrent genital candidosis and iron metabolism.

It was thought possible that recurrent genital candidosis, like chronic mucocutaneous candidiasis, might be related to abnormalities in iron metabolism. Haemoglobin, serum iron, and serum ferritin levels of patients with recurrent genital candidosis were compared with those of patients who harboured yeasts but had no history of 'thrush', and with a control group of patients with no evidence of yeasts or history of 'thrush'. The mean haemoglobin level in patients with recurrent genital candidosis was significantly lower than in the control group (P less than 0-05) but it was thought that this difference did not have much practical meaning. There was no significant difference in the serum iron and serum ferritin levels between the three groups.     

Reduction of cell mediated immunity in patients with genital warts of long duration.

Cell mediated immunity was studied by a leucocyte migration inhibition assay and by tuberculin and dinitrochlorobenzene skin tests in 30 patients with recurrent genital warts and in 34 healthy people (with no history of genital warts) who served as controls. Migration inhibition was significantly less in patients suffering from recurrences for more than one year than in controls (p less than 0.001). Dinitrochlorobenzene and tuberculin sensitivity were also found to be impaired in those with infection of long duration (p less than 0.001).     

Granulomatous inflammation of the vulva and penis--a genital counterpart to cheilitis granulomatosa.

3 patients are described, in whom chronic swelling of the external genitals occurred after recurrent infections. The histological findings were identical to those seen in cheilitis granulomatosa, the dermal component of Melkersson-Rosenthal syndrome. The authors suppose that the disease of the 3 patients is a genital counterpart to cheilitis granulomatosa, and the name vulvitis or posthitis granulomatosa is suggested.     

Topical zinc sulfate augmentation of human delayed type skin test response

The ability of topical zinc sulfate to augment the cutaneous delayed hypersensitivity response to Candida antigen was evaluated in 47 adults (15 controls and 32 hospitalized patients). On each adult subject, intradermal standard Candida extract was administered to each forearm followed immediately by topical application of 10% zinc sulfate in Aquaphor ointment on one arm and Aquaphor alone on the other arm. The reaction size was assessed in a single blinded manner. Of the 24 subjects who reacted positively to Candida antigen, a significantly larger (p less than 0.01) number of individuals showed an augmented cutaneous delayed hypersensitivity response in the arm on which the topical zinc sulfate had been applied. However, when patients were stratified by plasma zinc concentrations, only the normal plasma zinc patient group demonstrated a statistical augmentation. Possible mechanisms and selectivity of this observed effect are discussed. These findings suggest a role for topical zinc application to augment cutaneous immune responsiveness.     

Recurrent genital herpes: what helps adjustment?

Psychosocial adjustment to recurrent genital infections with herpes simplex virus (HSV) varies greatly among individuals. To identify the factors predictive of psychosocial adjustment to recurrent genital HSV infections, we analyzed data from interviews and psychological tests conducted with infected individuals. We found that avoidant coping strategies such as denial and social support from a counselor were negatively correlated with adjustment to genital HSV, whereas cognitive coping strategies and social support from one's spouse or lover were positively correlated with adjustment. We conclude that psychosocial adjustment to recurrent genital HSV infections might be facilitated by sharing one's diagnosis with supportive intimate others and avoiding denial as a defense mechanism.     

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.     

Genital herpes: an increasing problem?

Over the past 10 years there has been a pronounced increase in the number of cases of genital herpes seen in sexually transmitted disease (STD) clinics in the United Kingdom. The reporting system, however, does not differentiate between primary and recurrent infections, and consequently any increase in the number of patients reattending clinics with recurrent genital herpes would falsely inflate the statistics. A study of cases of herpes seen in the department of genitourinary medicine of this hospital in the two years 1972 and 1982 is presented. It showed that the proportion of patients attending with recurrent herpes had increased from 18% in 1972 to 31% in 1982. As a result of this, the 68% increase between 1972 and 1982 in the total number of cases of herpes seen in the clinic overestimates the real increase in the size of the problem, which is closer to 40%, based upon cases of primary herpes only. Modifications to the national recording system are necessary to overcome the problems highlighted by this study. These modifications could include classifying each case of genital herpes as primary, recurrent, or recurrent but not previously recorded, which would provide a more accurate picture of the size of the problem of genital herpes in the population.     

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.     

Cutaneous manifestations of zinc deficiency in ethylic cirrhosis

Thirty-three patients with alcoholic cirrhosis (AC), selected on widely recognized criteria (16, 57), were investigated prospectively for cutaneous manifestations of zinc deficiency. The patients were divided into 3 groups: group A (n = 12): AC without skin lesions; group B (n = 12): AC with skin lesions responsive to a zinc-free topical treatment or resistant to enteral zinc sulfate intake; group C (n = 9): AC with skin lesions cured by oral zinc replacement therapy alone. The lesions observed in group C were studied microscopically. Data concerning zinc metabolism (Zn concentrations in plasma, red cells, urine and hair; alkaline phosphatase values), biochemical criteria of AC (plasma serum-albumin concentration, IgA/transferrin ratio) and a malabsorption test (xylosemia 120 min after oral absorption of D-xylose 25 g) were compared by the variance analysis method. A control group (D, n = 12) was used as reference. Few cases of cutaneous manifestations of zinc deficiency in AC patients have been published. In more than one half of the 15 or so we found in the literature, an aggravating factor (total parenteral nutrition, digestive tract surgery) had to be taken into account. In this prospective study 9 new cases in which AC was the only cause of zinc deficiency are reported. A clinical picture similar to acrodermatitis enteropathica with peribuccal bullous lesions was observed in only one patient. In all other cases the patients presented with a cracked and reticulated eczema on the extensor aspect of the limbs and (often erosive) in the perianal and genital regions. The eczema was associated with cheilitis, glossitis, stomatitis, alopecia and, seldom, ungual Beau's lines. Disorders of behaviour, diarrhoea and bouts of lever regressing under zinc replacement therapy were frequent. Histology was not very specific, except for the presence of necrotic areas in the stratum germinativum, sometimes associated with small subcorneal pustules containing altered polymorphonuclears. In every case, it was the rapid regression of symptoms under zinc sulfate treatment that confirmed the diagnosis. Plasma zinc concentrations were most significantly decreased in all AC groups as compared to controls (61.2 +/- 19.4 vs 97.8 +/- 10.4 micrograms/100 ml) and also in AC patients with skin manifestations of zinc deficiency as compared to the other AC patients (44.4 +/- 9.2 vs 66.5 +/- 18.8 micrograms/100 ml) table V). Changes in serum-albumin levels and in hepatocellular function were parallel to changes in plasma zinc concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)     

Frequency of acquisition of first-episode genital infection with herpes simplex virus from symptomatic and asymptomatic source contacts

Sixty-six source contacts of index patients with first-episode genital infection caused by herpes simplex virus (HSV) were evaluated for evidence of current or past HSV infections. Forty-three source contacts (65%) reported a history consistent with previous recurrent HSV infection or were experiencing a first episode of genital herpes when initially examined. However, 60% of these 43 contacts were not aware that they had transmissible HSV infection. Twenty-nine (67%) of the 43 individuals had had recent sexual contact with an index patient when lesions were present. All of the remaining 23 source contacts, who were without a history of symptoms consistent with HSV infection, had detectable neutralizing antibody to HSV; HSV type 2 was isolated from the cervix of two of these asymptomatic source contacts. Efforts to identify individuals with undiagnosed genital herpes and to instruct these individuals concerning the risk of disease transmission in the presence of lesions are needed if the rate of transmission is to be decreased; however, methods designed to decrease the rate of transmission by asymptomatic individuals must also be evaluated.     

The epidemiology of genital infection with herpes simplex virus types 1 and 2 in genitourinary medicine attendees in inner London

OBJECTIVE: To characterise the epidemiological and clinical features of genital herpes and the diagnostic role of HSV-2 specific serology in an ethnically diverse cohort of genitourinary medicine (GUM) attendees in inner London. METHODS: Genital swabs (n = 186) were tested by real time polymerase chain reaction (PCR) and serum samples (n = 70) by HSV-2 specific enzyme linked immunoassay (ELISA). RESULTS: Among 186 patients (median age 29 years), 104/186 (56%) were male and 176/186 (95%) heterosexual; ethnicity was predominantly black Caribbean (76/186, 41%), white (65/186, 35%), or black-African (41/186, 22%). The most common lesion sites were penis (85/104 men, 82%) and vulva (63/82 women, 77%); 114/186 (61%) patients were diagnosed clinically with first episode disease. Women were more likely to present <5 days of onset (p = 0.008). Black Caribbean patients were more likely to present > or = 5 days (p = 0.04) and decline HIV testing (p = 0.03). By PCR, 108/186 (58%) swabs tested positive for HSV-1 (7/108, 6.5%) or HSV-2 (101/108, 93.5%). Independent predictors of a positive PCR were heterosexual group, <5 days of onset, and visible genital ulceration on examination. HSV-2 was associated with black Caribbean and black African ethnicity; HSV-1 with white ethnicity (p = 0.006). By HSV-2 specific serology, 16/42 (38%) first episodes caused by HSV-2 were recurrent infections, and 7/19 (37%) patients with recurrent genital disease but negative PCR had genital herpes. CONCLUSIONS: Epidemiological trends in genital HSV-1 and HSV-2 infection appear to vary between ethnic groups in the United Kingdom. HSV-2 specific serology improves diagnostic accuracy in GUM populations where most genital infections are caused by HSV-2.     

Epstein-Barr virus-related persistent erythema multiforme in chronic fatigue syndrome.

BACKGROUND--Erythema multiforme (EM) has been rarely reported in Epstein-Barr virus (EBV)-associated diseases; this includes patients with chronic fatigue syndrome who have chronic or recurrent and disabling illness and an abnormal antibody reactivity to EBV. We describe a patient fulfilling the chronic fatigue syndrome diagnostic criteria who had developed an unusually persistent EM resistant to corticosteroids therapy. The EBV DNA was studied in skin EM lesions, throat washings, peripheral mononuclear cells, and plasma. The EBV antigens were studied in skin EM lesions and in mononuclear cells. The patient was followed up to 2 years. OBSERVATIONS--The patient had abnormal titers of antibodies against various EBV antigens and by immunofluorescence she disclosed the EBV nuclear antigen and the viral capsid antigen in the blood vessels of the affected skin. The dot blot hybridization assay detected viral DNA in throat washings and mononuclear cells, but not in plasma. The presence of the viral genomic content in lesional skin is suggested by the autoradiographic signal and by the difference from appropriate control specimens. Skin lesions and constitutional symptoms cleared after acyclovir sodium therapy and recurred after discontinuation of this therapy. CONCLUSIONS--This is the first EM case in which evidence of the EBV causal role has been provided. The association with chronic fatigue syndrome suggests the EBV role in selected cases of this syndrome.     

不同预后尖锐湿疣组织中Toll样受体3、9的表达

目的探讨不同预后尖锐湿疣(CA)患者皮损局部Toll样受体3(TLR3)和Toll样受体9(TLR9)表达定位及TLR3 mRNA、TLR9 mRNA的表达情况.方法免疫组化SP法及反转录聚合酶链反应(RT-PCR)法检测10例CA复发者、14例CA无复发者及10例包皮组织中TLR3及TLR9表达情况.结果 TLR3、TLR9在无复发CA皮损中表达以棘层、颗粒层为主;在复发组CA皮损中表达以基底层、棘层为主.无复发组CA组织中TLR3mRNA表达较对照组及复发组均明显升高(P<0.01、P<0.05),TLR9mRNA较对照组明显升高(P<0.05),较复发组差异无统计学意义.结论表皮TLR3及TLR9的表达部位和表达量的改变可能与CA预后有关,TLR3的影响可能更大.     

不同预后尖锐湿疣组织中Toll样受体3、9的表达

目的探讨不同预后尖锐湿疣(CA)患者皮损局部Toll样受体3(TLR3)和Toll样受体9(TLR9)表达定位及TLR3 mRNA、TLR9 mRNA的表达情况.方法免疫组化SP法及反转录聚合酶链反应(RT-PCR)法检测10例CA复发者、14例CA无复发者及10例包皮组织中TLR3及TLR9表达情况.结果 TLR3、TLR9在无复发CA皮损中表达以棘层、颗粒层为主;在复发组CA皮损中表达以基底层、棘层为主.无复发组CA组织中TLR3mRNA表达较对照组及复发组均明显升高(P<0.01、P<0.05),TLR9mRNA较对照组明显升高(P<0.05),较复发组差异无统计学意义.结论表皮TLR3及TLR9的表达部位和表达量的改变可能与CA预后有关,TLR3的影响可能更大.     

Virostatics in dermatology

Many antiviral substances are known, but only a few are clinically effective in certain disease resulting from herpes virus infections. Early diagnosis is essential. Antiviral chemotherapy is discussed in respect to herpes infections in immunocompetent patients, and in patients with primary genital herpes, eczema herpeticum, genital and gluteal recurrent herpes and herpes zoster.     

Oral zinc therapy in geriatric patients with selected skin manifestations and a low plasma zinc level.

A geriatric population comprising 585 inhabitants of an institution for the aged was studied. Twenty-six persons with a mean age of 82 years were selected because of skin manifestations suggestive of chronic zinc deficiency. In 10 of the patients a subnormal plasma zinc level was found. This hypozincaemic group underwent a 4 week trial with zinc sulphate tablets, 0.6 g daily. The therapy failed to alleviate the skin condition in any of the patients, thus indicating that the changes were not caused by zinc deficiency. In the hypozincaemic group, plasma albumin was subnormal in all patients and significantly lower than in the normozincaemic subjects. The correlation between plasma zinc and plasma albumin levels in all 34 patients studied was highly significant (rs = 0.69, p less than 0.001). As plasma albumin tends to fall to subnormal concentrations with age, this explains why plasma zinc may be low in the elderly without indicating a state of zinc deficiency. After 2 and 4 weeks' zinc therapy, the mean plasma zinc concentration of the hypozincaemic group rose significantly from 9.5 to 17.6 and 23.4 mumol/1. This increase is higher than the rise observed in younger patients receiving an identical zinc sulphate dosage.