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Synopsis: Valacyclovir use in 10% of pregnancies with cytomegalovirus infection in this US cohort was likely for genital herpes treatment. [ABSTRACT FROM AUTHOR]

Vaccine development for herpes simplex virus 2 (HSV‐2) has been attempted, but no vaccines are yet available. A plasmid‐based reverse genetics system for Rotavirus (RV), which can cause gastroenteritis, allows the generation of recombinant RV containing foreign genes. In this study, we sought to develop simian RV (SA11) as a vector to express HSV‐2 glycoprotein D (gD2) and evaluated its immunogenicity in mice. We generated the recombinant SA11‐gD2 virus (rSA11‐gD2) and confirmed its ability to express gD2 in vitro. The virus was orally inoculated into suckling BALB/c mice and into 8‐week‐old mice. Serum IgG and IgA titers against RV and gD2 were measured by ELISA. In the 8‐week‐old mice inoculated with rSA11‐gD2, significant increases in not only antibodies against RV but also IgG against gD2 were demonstrated. In the suckling mice, antibodies against RV were induced, but gD2 antibody was not detected. Diarrhea observed after the first inoculation of rSA11‐gD2 in suckling mice was similar to that induced by the parent virus. A gD2 expressing simian RV recombinant, which was orally inoculated, induced IgG against gD2. This strategy holds possibility for genital herpes vaccine development. [ABSTRACT FROM AUTHOR]

Introduction: Prostate cancer (PCa) is by far the most common type of cancer among men in western countries. However, relatively little is known about its etiology despite the high morbidity and mortality. It has been suggested that chronic inflammation may be involved in prostate carcinogenesis. We investigated the role of sexually and non-sexually transmitted infections in prostate cancer risk with a specific interest in the aggressive types. Methods: We used data from epidemiological study of prostate cancer (EPICAP), a population-based case–control study. A total of 819 incident cases and 879 controls were interviewed face-to-face using a standardized questionnaire gathering information on known or suspected risk factors of prostate cancer and personal history of specific sexually and non-sexually transmitted infections: gonorrhea, syphilis, trichomonas, herpes, mononucleosis, Epstein–Barr virus, varicellazoster, and dengue. Odds ratios (OR) and their 95% confidence interval were estimated using multivariate unconditional logistic regression. Results: There was no significant association between gonorrhea (OR: 0.90, 95% CI: 0.61–1.33), trichomonas (OR: 0.74, 95% CI: 0.27–2.07), genital herpes (OR: 0.69, 95% CI: 0.38–1.27), and the risk of prostate cancer. No association emerged for overall sexually transmitted bacterial and viral infections (OR 1.05, 95% CI: 0.86–1.29) and overall non-sexually transmitted viral infections (OR 1.11, 95% CI: 0.90–1.35) and the risk of prostate cancer. Conclusion: Our results showed that sexually or non-sexually transmitted infections, either bacterial or viral, were not associated to prostate cancer. Therefore, further investigation is needed to help advance our understanding of the role of chronic inflammation in the etiology of prostate cancer, with a particular focus on its most aggressive types. [ABSTRACT FROM AUTHOR]

Background: This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy. Objective: The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions. Methods: The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence. Results: The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN). Conclusion: Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described. [ABSTRACT FROM AUTHOR]

Herpes simplex virus type 2 (HSV‐2) is the most common cause of genital disease worldwide. The development of an effective HSV‐2 vaccine would significantly impact global health based on the psychological distress caused by genital herpes for some individuals, the risk transmitting the infection from mother to infant, and the elevated risk of acquiring HIV‐1. Five nonclinical safety studies were conducted with the replication defective HSV529 vaccine, alone or adjuvanted with GLA‐SE, and the G103 subunit vaccine containing GLA‐SE. A biodistribution study was conducted in guinea pigs to evaluate distribution, persistence, and shedding of HSV529. A preliminary immunogenicity study was conducted in rabbits to demonstrate HSV529‐specific humoral response and its enhancement by GLA‐SE. Three repeated‐dose toxicity studies, one in guinea pigs and two in rabbits, were conducted to assess systemic toxicity and local tolerance of HSV529, alone or adjuvanted with GLA‐SE, or G103 containing GLA‐SE. Data from these studies show that both vaccines are safe and well tolerated and support the ongoing HSV‐2 clinical trial in which the two vaccine candidates will be given either sequentially or concomitantly to explore their potential synergistic and incremental effects. Herpes simplex virus type 2 (HSV‐2) is the most common cause of genital disease worldwide, with no preventive or curative vaccine available. Five nonclinical safety studies were conducted with the replication defective HSV529 vaccine, alone or adjuvanted with GLA‐SE, and the G103 subunit vaccine containing GLA‐SE. The two vaccine candidates were found safe and well tolerated supporting the ongoing HSV‐2 clinical trial in which they will be given either sequentially or concomitantly to explore their potential synergistic and incremental effects. [ABSTRACT FROM AUTHOR]

Herpes simplex virus type 2 (HSV‐2) infection is a prevalent, sexually transmitted infection with poorly characterized prevalence in the Middle East and North Africa (MENA) region. This study characterized HSV‐2 epidemiology in MENA. HSV‐2 reports were systematically reviewed as guided by the Cochrane Collaboration Handbook and findings were reported following PRISMA guidelines. Random‐effects meta‐analyses and meta‐regressions were performed to estimate pooled mean outcome measures and to assess predictors of HSV‐2 antibody prevalence (seroprevalence), trends in seroprevalence, and between‐study heterogeneity. In total, sixty‐one overall (133 stratified) HSV‐2 seroprevalence measures and two overall (four stratified) proportion measures of HSV‐2 detection in laboratory‐confirmed genital herpes were extracted from 37 relevant publications. Pooled mean seroprevalence was 5.1% (95% confidence interval [CI]: 3.6%–6.8%) among general populations, 13.3% (95% CI: 8.6%–18.7%) among intermediate‐risk populations, 20.6% (95% CI: 5.3%–42.3%) among female sex workers, and 18.3% (95% CI: 3.9%–39.4%) among male sex workers. Compared to Fertile Crescent countries, seroprevalence was 3.39‐fold (95% CI: 1.86–6.20) and 3.90‐fold (95% CI: 1.78–8.57) higher in Maghreb and Horn of Africa countries, respectively. Compared to studies published before 2010, seroprevalence was 1.73‐fold (95% CI: 1.00–2.99) higher in studies published after 2015. Pooled mean proportion of HSV‐2 detection in genital herpes was 73.8% (95% CI: 42.2%–95.9%). In conclusion, MENA has a lower HSV‐2 seroprevalence than other world regions. Yet, 1 in 20 adults is chronically infected, despite conservative prevailing sexual norms. Seroprevalence may also be increasing, unlike other world regions. Findings support the need for expansion of surveillance and monitoring of HSV‐2 infection in MENA. [ABSTRACT FROM AUTHOR]

Mucus is a self‐healing gel that lubricates the moist epithelium and provides protection against viruses by binding to viruses smaller than the gel's mesh size and removing them from the mucosal surface by active mucus turnover. As the primary nonaqueous components of mucus (≈0.2%–5%, wt/v), mucins are critical to this function because the dense arrangement of mucin glycans allows multivalence of binding. Following nature's example, bovine submaxillary mucins (BSMs) are assembled into "mucus‐like" gels (5%, wt/v) by dynamic covalent crosslinking reactions. The gels exhibit transient liquefaction under high shear strain and immediate self‐healing behavior. This study shows that these material properties are essential to provide lubricity. The gels efficiently reduce human immunodeficiency virus type 1 (HIV‐1) and genital herpes virus type 2 (HSV‐2) infectivity for various types of cells. In contrast, simple mucin solutions, which lack the structural makeup, inhibit HIV‐1 significantly less and do not inhibit HSV‐2. Mechanistically, the prophylaxis of HIV‐1 infection by BSM gels is found to be that the gels trap HIV‐1 by binding to the envelope glycoprotein gp120 and suppress cytokine production during viral exposure. Therefore, the authors believe the gels are promising for further development as personal lubricants that can limit viral transmission. [ABSTRACT FROM AUTHOR]

First case of toxoplasmosis following small bowel transplantation and systematic review of tissue-invasive toxoplasmosis following noncardiac solid organ transplantation. Keywords: Kidney transplantation; space occupying lesion; toxoplasmosis EN Kidney transplantation space occupying lesion toxoplasmosis 1 3 3 08/12/22 20220801 NES 220801 "This case of toxoplasmosis 17 years after transplant highlights the importance of exploring the broad differential diagnosis for a ring-enhancing lesion in a solid organ transplant recipient, regardless of transplant vintage.". [Extracted from the article]

An incisional biopsy from the edge of the lesion showed exuberant hyperkeratosis, parakeratosis, and pronounced epithelial hyperplasia, with sprinkling of lymphohistiocytic infiltrates in superficial dermis; no cellular atypia was appreciated (Fig. Nail-like presentation of pseudoepitheliomatous keratotic and micaceous balanitis successfully treated with topical 5% 5-fluorouracil: a case report and review of the literature Dear Editor, Penile tumors at any age invariably cause alarm and concern and warrant early clinicopathological assessment to establish the diagnosis. [Extracted from the article]

HSV-1 was isolated from NAATs of the oral ulcers and a vesicular lesion on the phalanx, thus confirming the clinical diagnosis of primary herpetic gingivostomatitis and herpetic whitlow. Herpetic gingivostomatitis and herpetic whitlow are common clinical manifestations of Herpes Simplex Virus-1 (HSV-1). This was demonstrated in a recent report where an HIV-positive individual with herpetic geometric glossitis with a co-existing fissured tongue demonstrated a rapid response to acyclovir.[4] Herpetic whitlow usually occurs on the fingertip. [Extracted from the article]

Genital herpes is one of the sexually transmitted diseases that is reported with a greater incidence of primary and secondary recurrence. In this study, olive leaf extract was used for its antiviral properties to treat the infection. The randomized‐clinical trials using such a therapeutic approach are required in this field. [ABSTRACT FROM AUTHOR]

Summary Recurrent infections with herpes simplex virus (HSV) in the orofacial (cold sores), ocular or genital region are common and sometimes disabling, calling for an effective preventive intervention. The bacillus Calmette‐Guérin (BCG) vaccine has beneficial off‐target effects that might impact recurrence of HSV infections. In this systematic review, Medline, EMBASE, and PubMed were searched in June 2020; 16 articles were deemed relevant comprising eight animal and eight human studies (301 patients). In animals, BCG administration led to a 1.9 to 5.5‐fold increase in survival rate following HSV challenge (vaginal, corneal, or intraperitoneal inoculation). This beneficial effect was influenced by the dose of BCG (higher better), mode of administration (intradermal better than intraperitoneal), and the interval between vaccination and viral challenge (at least 6 days required). In nonrandomized human studies (that failed to control for a placebo effect), BCG vaccination appeared beneficial in 78% of adults with recurrent herpes genitalis or labialis, with 37% being recurrence‐free for an extended period, 41% experiencing less frequent or severe episodes, and only 22% reporting no change. This clinical benefit is consistent with the findings of immunological sub‐studies. In the two studies restricted to recurrent herpes labialis, 94% appeared to benefit from BCG. The one randomized controlled trial used an intervention in the control group that has immunomodulatory effects thus limiting interpretation. In conclusion, BCG vaccine is a potential, safe, affordable and readily available candidate intervention to decrease the high burden of disease associated with HSV infection and recurrences, but properly controlled randomized trials are required. [ABSTRACT FROM AUTHOR]

Background: The affecting factors of mucocutaneous manifestations in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients remain unclear in China. Methods: A retrospective analysis was conducted among HIV/AIDS patients in Yunnan, China. The demographic data, mucocutaneous manifestations, CD4 cell counts, and antiretroviral therapy (ART) regimens were collected. The effects of CD4 cell count and ART on the spectrum of mucocutaneous manifestations were evaluated. Results: Among 508 HIV/AIDS patients, 86.0% of cases showed mucocutaneous manifestations. The average CD4 cell count (176 cells/μl) of the patients with manifestations was significantly lower than those without manifestations (328 cells/μl) (P < 0.001). Diseases such as herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, cryptococcosis, and HIV‐PPE (pruritic papular eruption) were represented quite frequently in patients with CD4 cell count <200 cells/μl (P < 0.05), but eczema was suffered by those with CD4 cell count ≥200 cells/μl (P < 0.05). ART could decline the incidence of herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, and cryptococcosis (P < 0.05). Conclusions: Mucocutaneous manifestations are closely related to the CD4 cell count and can be used as early predictors of HIV/AIDS and immune status in clinic. ART could reduce the incidence of certain mucocutaneous manifestations. [ABSTRACT FROM AUTHOR]

Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor‐like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions. [ABSTRACT FROM AUTHOR]

We suggest that IV cidofovir can treat drug-resistant herpetic pseudotumoral lesions in HIV-infected patients after a positive genotypic resistance test or a clinical failure of acyclovir treatment. Penile lesion in first patient (a), and perianal lesion in second patient (b) gl The second patient was a 58-year-old HIV-infected man, with CD4 at 190/mm SP 3 sp (nadir at 6/mm SP 3 sp ) and multiple opportunistic infections. We report two cases of persons living with human immunodeficiency virus (PLHIV) presenting with drug-resistant pseudotumoral genital herpes infection successfully treated after intravenous (IV) cidofovir. [Extracted from the article]

An editorial discusses Chédiak–Higashi syndrome (CHS), a rare autosomal recessive disorder characterized by immunodeficiency, neurological dysfunction, oculocutaneous albinism, and platelet dysfunction. It is caused by a variant in the LYST gene. It highlights a study by Oh et al. that used induced pluripotent stem cells (iPSCs) derived from CHS patients to model the disease.

Lipschütz ulcers are uncommon acute, painful genital ulcerations occurring in adolescent or young adult females, with rare reports in children. Behcet's disease is a chronic condition that presents with recurrent oral and genital ulcers, associated with systemic manifestations.[3] Pyoderma gangrenosum manifests as large, tender, chronic ulcers that rarely involve the vulva.[5] Histology is usually non-diagnostic. Six patients presented with a single ulcer and four patients with multiple ulcers varying between 0.5 and 2 centimeters in diameter (Figs. [Extracted from the article]

This study shows the relative quantification of HSV‐2 by qPCR, using the MIQE Guidelines. The reaction efficiency was evaluated, and the relative quantification used the R = 2−ΔCq method. The relative quantification of HSV‐2 was conducted with anal and genital samples from men who have sex with men (MSM), living with HIV. The presence of a single amplification product was validated with a dissociation curves profile and the determination of the melting temperature. The limit of detection for β‐globin was determined as 3.3 × 10−5 ng/μL, and for HSV‐2 at 6.0 × 10−6 ng/μL. The efficiency for β‐globin was 100.2% and for HSV‐2 was 106.8%. From 336 MSM, 2.1% and 3.9% individuals presented anal or genital HSV‐2 shedding, respectively. The HSV‐2 viral load was 9.2 RU, individuals with fewer CD4+ presented higher HSV‐2 viral load. The qPCR method is reproducible and has optimal reaction efficiency. [ABSTRACT FROM AUTHOR]

Although there is no curative treatment for genital herpes, antiviral therapy can reduce the duration of symptoms and the frequency and severity of recurrences. This article discusses the diagnosis of genital herpes, the treatment options available and the GP's role in management. [ABSTRACT FROM AUTHOR]

publisher‐imprint‐name Springer volume‐issue‐count 1 issue‐article‐count 46 issue‐toc‐levels 0 issue‐pricelist‐year 2016 issue‐copyright‐holder The Author(s) issue‐copyright‐year 2016 article‐contains‐esm No article‐numbering‐style Unnumbered article‐registration‐date‐year 2016 article‐registration‐date‐month 9 article‐registration‐date‐day 17 article‐toc‐levels 0 toc‐levels 0 volume‐type Regular journal‐product ArchiveJournal numbering‐style Unnumbered article‐grants‐type OpenChoice metadata‐grant OpenAccess abstract‐grant OpenAccess bodypdf‐grant OpenAccess bodyhtml‐grant OpenAccess bibliography‐grant OpenAccess esm‐grant OpenAccess online‐first false pdf‐file‐reference BodyRef/PDF/40169_2016_Article_121.pdf target‐type OnlinePDF issue‐type Regular article‐type OriginalPaper journal‐subject‐primary Medicine & Public Health journal‐subject‐secondary Medicine/Public Health, general journal‐subject‐collection Medicine --> Background: We conducted a clinical study that tested the effect of suppressive treatment with the botanical product Gene‐Eden‐VIR/Novirin on genital herpes. Our previous paper showed that the treatment decreased the number of genital herpes outbreaks without any side effects. It also showed that the clinical effects of Gene‐Eden‐VIR/Novirin are mostly better than those reported in the studies that tested acyclovir, valacyclovir, and famciclovir. The current paper reports the effect of suppressive treatment with Gene‐Eden‐VIR/Novirin on the duration of outbreaks, in severe and mild genital herpes cases. Methods: The framework was a retrospective chart review. The population included 137 participants. The treatment was 1–4 capsules per day. The duration of treatment was 2–48 months. The study included three controls: baseline, no‐treatment, and dose–response. Results: The treatment decreased the duration of outbreaks in 87 % of participants and decreased the mean duration of outbreaks from 8.77 days and 6.7 days in the control groups to 2.87 days in the treatment group (P < 0.001, both groups). All participants reported no adverse experiences. Conclusions: This paper shows that suppressive treatment with Gene‐Eden‐VIR/Novirin decreased the duration of genital herpes outbreaks, in both severe and mild cases, without any side effects. Based on the results reported in this and our previous paper, we recommend suppressive treatment with Gene‐Eden‐VIR/Novirin as a natural alternative to both suppressive and episodic treatments with current drugs, in both severe and mild genital herpes cases. Trial registration ClinicalTrials.gov NCT02715752 Registered 17 March 2016 Retrospectively Registered [ABSTRACT FROM AUTHOR]

We aimed to (i) develop a new VZV PCR referring to guidelines for the development of new diagnostic tests,4 (ii) combine it with the already existing HSV assay to a vesicular rash PCR for simultaneous detection of VZV, HSV-1 and HSV-25 and (iii) perform a diagnostic evaluation study in which results are compared with commercially available PCRs. Moreover, our new VZV PCR has shown lower Ct values compared with the commercial VZV PCR, which might suggest an enhanced sensitivity for low concentration samples. Varicella zoster virus (VZV) typically infects the skin leading to chickenpox (varicella) and herpes zoster, whereas herpes simplex virus 1 and 2 (HSV-1/-2) often affect the mucosa forming herpes labialis and genital herpes. [Extracted from the article]

Amenamevir is the international non-proprietary name for ASP2151 synthesized by Astellas Pharma, Inc. It is a structurally novel class of helicase-primase inhibitor and demonstrated more potency in vitro anti-viral activity with low cytotoxicity against varicella-zoster virus (VZV), herpes simplex virus type 1 (HSV-1), and herpes simplex virus type 2 (HSV-2) than acyclovir (ACV). Phase II randomized trial assessed the safety and efficacy of ASP2151 for episodic therapy of recurrent genital herpes was conducted. Participants self-initiated with ASP2151 (100, 200, or 400 mg daily for 3 days), ASP2151 (1,200 mg as a single dose), placebo for 3 days, or Valacyclovir (500 mg twice daily for 3 days). We present a first population pharmacokinetic (PPK) modeling analysis of Amenamevir for genital herpes patients. The final model retained the effect of Weight and Albumin on CL. Statistical analysis between pharmacokinetics and clinical efficacies was done by using the time above 200 ng/mL (T200). T200 derived from the final PPK model to consider the correlation with Time to lesion healing and viral shedding. This finding suggested that it could be necessary to maintain the Amenamevir concentration above the threshold level to prevent the virus replication. [ABSTRACT FROM AUTHOR]

We report an exaggerated dermatological inflammatory condition in an immunocompromised patient. The patient was a 51-year-old woman who had HIV infection and a history of cervical cancer. Three years after highly active antiretroviral therapy with an improved immune status, and 2 years after remission of cervical cancer, she developed verrucous perineal masses. Provisional diagnosis was recurrent cervical cancer or primary vulvar cancer. Pathological features revealed pseudoepitheliomatous hyperplasia associated with herpes viral infection. After minimal response to systemic oral antiviral drugs and topical imiquimod, she had clinical resolution with the addition of systemic oral corticosteroid. [ABSTRACT FROM AUTHOR]

Background Previous studies examining the teratogenic effects of antiherpetic medications have found no associations for birth defects overall but have not examined the risk of specific birth defects. Methods The National Birth Defects Prevention Study ascertains population-based cases with birth defects and live-born controls without birth defects in 10 states across the United States for the purpose of identifying potential teratogenic risk factors. Mothers of cases and controls are interviewed within 2 years of their estimated date of delivery about demographic, medical and behavioural factors before and during pregnancy. This analysis examined the possible association between use of antiherpetic medications (acyclovir, valacyclovir or famciclovir) during early pregnancy and gastroschisis, a birth defect of the abdominal wall. Results The mothers of 1.1% ( n = 10) of 941 gastroschisis cases and 0.3% ( n = 27) of 8339 controls reported antiherpetic medication use during the month before conception through the third month of pregnancy. The adjusted odds ratios for such use in relation to gastroschisis were 4.7 [95% confidence interval 1.7, 13.3] and 4.7 [95% CI 1.2, 19.0] among women with and without self-reported genital herpes, respectively, when compared with women without antiherpetic use or herpes. Among women reporting no antiherpetic medication use, the odds ratio for self-reported genital herpes in relation to gastroschisis was 3.0 [95% CI 1.6, 5.7]. Conclusions Our study raises the possibility of an increased risk of gastroschisis because of either antiherpetic medication use during early pregnancy or the underlying genital herpes infection for which it was indicated. [ABSTRACT FROM AUTHOR]

HSV triggers intracellular calcium release to promote viral entry. We hypothesized that Akt signaling induces the calcium responses and contributes to HSV entry. Exposure of human cervical and primary genital tract epithelial, neuronal, or keratinocyte cells to HSV serotype 2 resulted in rapid phosphorylation of Akt. Silencing of Akt with small interfering RNA prevented the calcium responses, blocked viral entry, and inhibited plaque formation by 90% compared to control siRNA. Susceptibility to infection was partially restored if Akt was reintroduced into silenced cells with an Akt-expressing plasmid. HSV-2 variants deleted in glycoproteins B or D failed to induce Akt phosphorylation, and coimmunoprecipitation studies indicated that Akt interacts with glycoprotein B. Cell-surface expression of Akt was rapidly induced in response to HSV exposure. Miltefosine (50 µM), a licensed drug that blocks Akt phosphorylation, inhibited HSV-induced calcium release, viral entry, and plaque formation following infection with acyclovir-sensitive and resistant clinical isolates. Miltefosine blocked amplification of HSV from explanted ganglia to epithelial cells; viral yields were significantly less in miltefosine compared to control-treated cocultures (P<0.01). Together, these findings identify a novel role for Akt in viral entry, link Akt and calcium signaling, and suggest a new target for HSV treatment and suppression. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of counseling for patients undergoing screening for type 2 herpes simplex virus (HSV-2). Using pre- and post-screening questionnaires, we evaluated correlations between demographic factors, measures of self-efficacy and follow-through with the screening test, and willingness to take antiviral medication and share results with sexual partners. Data sources: Subjects ( N= 115) were recruited as part of usual care at a private, urban family practice. A total of 111 subjects completed pre-screening questionnaires, and 38 completed post-screening questionnaires. Conclusions: The overwhelming majority of participants were (a) willing to undergo screening; (b) take suppressive antiviral medication if necessary; (c) share their results with sexual partners; and (d) consider safer sexual practices as a consequence of screening. Older patients were less willing to consider daily antiviral medication. Men who have sex with men (MSM) had lower perceived susceptibility to HSV-2 but were more likely to undergo and report screening. Implications for practice: Future research should include predictive models for determining the most appropriate patients to screen for HSV-2 and best practices for those who test positive. Shared decision making between patients and advanced practice nurses regarding the risks and benefits of screening for HSV-2 should be a component visits that include sexually transmitted disease screening. Particular attention should be paid to those at higher risk for contracting the virus, including patients with HIV and MSM. [ABSTRACT FROM AUTHOR]

The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection. Boyd AS, Zwerner JP, Miller JL. Herpes simplex virus-induced plasmacytic atypia. [ABSTRACT FROM AUTHOR]

Summary Objectives To assess the extent to which sexually transmitted infections (STIs) have contributed to the spread of HIV in South Africa and to estimate the extent to which improvements in STI treatment have reduced HIV incidence. Methods A mathematical model was used to simulate interactions between HIV and six other STIs (genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection and trichomoniasis) as well as bacterial vaginosis and vaginal candidiasis. The effects of STIs on HIV transmission probabilities were assumed to be consistent with meta-analytic reviews of observational studies, and the model was fitted to South African HIV prevalence data. Results The proportion of new HIV infections in adults that were attributable to curable STIs reduced from 39% (uncertainty range: 24-50%) in 1990 to 14% (8-18%) in 2010, while the proportion of new infections attributable to genital herpes increased. Syndromic management programmes are estimated to have reduced adult HIV incidence by 6.6% (3.3-10.3%) between 1994 and 2004, by which time syndromic management coverage was 52%. Had syndromic management been introduced in 1986, with immediate achievement of 100% coverage and a doubling of the rate of health seeking, HIV incidence would have reduced by 64% (36-82%) over the next decade, but had the same intervention been delayed until 2004, HIV incidence would have reduced by only 5.5% (2.8-9.0%). Conclusions Sexually transmitted infections have contributed significantly to the spread of HIV in South Africa, but STI control efforts have had limited impact on HIV incidence because of their late introduction and suboptimal coverage. [ABSTRACT FROM AUTHOR]

Herpes simplex infection is responsible for substantial morbidity in patients with HIV infection. Data from less-developed countries analyzing risk factors within this population are largely unavailable. Investigate the incidence and seroprevalence of HSV-1 and HSV-2 infection in populations at high and low risk for HIV infection. A prospective cohort study was performed in a population at high risk for STDs composed of 170 HIV seronegative male homosexuals and bisexuals (group A). The population at low risk for STDs was composed of 155 volunteer male blood donors (group B). All blood samples were screened using a type specific ELISA to HSV-1 and HSV-2 glycoprotein G (gG). The prevalence of HSV-1 and HSV-2 infection among all the 325 patients was 83.5% and 63.4%, respectively. Annual incidence of HSV-1 and 2 among group A were 0.053% and 0.08%, respectively. Among group B, the incidence for HSV-1 was 0.04% and for HSV-2 was 0.02%. Educational parameters (P<0.001), irregular use of condoms (P<0.001), and percentage of previous receptive anal intercourse (P<0,012) were significantly associated with seropositivity to HSV-2. About 8.4% of the HSV-1 seronegative subjects presented recurrence episodes of herpes labialis as well as 7.6% of the HSV-2 seronegative patients had genital herpes in the past. The high seroprevalence detected suggests that routine screening for HSV should be performed in populations at high risk for STDs, especially in HIV-infected patients. Educational campaigns, with particular focus on the transmission of HSV, and the regular use of condoms are important measures to reduce the HSV dissemination among patients with less advanced educations and at high risk for STDs. [ABSTRACT FROM AUTHOR]

Citation Gillgrass A, Chege D, Bhavanam S, Kaushic C. Estradiol limits viral replication following intravaginal immunization leading to diminished mucosal IgG response and non-sterile protection against genital herpes challenge. Am J Reprod Immunol 2010; 63: 299–309 Problem Previously we reported that ovariectomized (OVX) mice receiving estradiol (E) prior to immunization with an attenuated strain of HSV-2 (TK-HSV-2) were not protected. Lack of protection in the E group was because of the inability of TK-HSV-2 to penetrate the thick keratinized epithelium. In this study, we determined the outcome of immunization after the thickening of vaginal epithelium following E-treatment waned. OVX, C57BL/6 mice were given Progesterone (P), E or saline (S) for 3 days and immunized with IVAG TK-HSV-2. Method of study To determine the time point at which E-treated mice could be successfully immunized, the mice were inoculated with TK-HSV-2 between days 1 and 7 (ED1–ED7) post-E-treatment and challenged with IVAG HSV-2 three weeks later. Results The level of infection post-immunization correlated with HSV-2-specific IgG antibody level, which correlated with sterile protection. No viral infection was observed in ED1–ED3 groups and no specific antibodies were detected, resulting in no protection. Moderate infection was seen in ED5 group, resulting in low antibody production and non-sterile protection in 87.5% of mice. High antibody titers and sterile protection were observed in all groups that experienced robust infection post-immunization. Conclusion The results show that estradiol leads to limited viral replication and diminished mucosal IgG response, resulting in non-sterile immune protection against genital herpes infection. [ABSTRACT FROM AUTHOR]

summary. Among the family of herpes viruses, only cytomegalovirus (CMV) and, to a lesser extent, human herpes virus 8 (HHV-8) are of relevance in transfusion medicine. Due to neutropism, herpes simplex viruses (HSV) types 1 and 2 are considered to be of minor relevance. However, several reports gave evidence that a HSV DNAemia might occur and HSV could therefore be transmissible by blood products. The aim of our study was to collect data about prevalence of HSV antibodies among blood donors and to clarify whether HSV DNAemia is possible. HSV antibody states of 653 blood donors were investigated. Blood specimens of 46 patients with primary and recurrent HSV infection were tested for HSV-1 and HSV-2 DNA using TaqMan polymerase chain reaction. In 505 of the 653 blood donors HSV antibodies were detectable, most of which were HSV-1 antibodies. HSV DNA was detected in plasma, but not in peripheral blood mononuclear cells (PBMCs) of seven rather seriously ill patients with primary herpes genitalis. No HSV viraemia was detectable in otherwise healthy patients with recurrent herpes labialis. Thus, HSV DNAemia is possible, but seems to be limited to primary infections and could not be detected in the recurrent infection. Therefore, blood donors with primary herpes infection should be deferred from donation. Blood donors with recurrent HSV infection are probably not at risk of transmitting HSV, but further studies are necessary to prove this hypothesis. Detection of HSV DNA in PBMCs as described formerly could not be confirmed by this study. [ABSTRACT FROM AUTHOR]

Citation Shust GF, Cho S, Kim M, Madan RP, Guzman EM, Pollack M, Epstein J, Cohen HW, Keller MJ, Herold BC. Female genital tract secretions inhibit herpes simplex virus infection: correlation with soluble mucosal immune mediators and impact of hormonal contraception. Am J Reprod Immunol 2010; 63: 110–119 Problem Female genital tract secretions inhibit herpes simplex virus (HSV) infection, however, the intra- and inter-subject variability, contribution of specific mediators, and impact of reproductive hormones have not been defined. Method of study Cervicovaginal lavage (CVL) ( n = 89) obtained from nine cyclers and seven women on hormonal contraception (HC), who completed between three and eight weekly visits, were examined for anti-herpes simplex virus activity and concentrations of mediators. Results The CVL inhibited HSV infection by a mean value of approximately 57% during the follicular or luteal phase, but only by 36% in hormonal contraceptive users. Human neutrophil peptides 1–3 (HNP1-3) ( P = 0.03), IL-8 ( P = 0.003), lactoferrin ( P = 0.005), lysozyme ( P = 0.003), IgA ( P = 0.002), and IgG ( P = 0.02) correlated with antiviral activity. Intra-subject and inter-subject variability was observed, suggesting that factors other than hormones contribute to innate defense. Conclusion Endogenous antimicrobial activity may provide a biomarker of healthy mucosal immunity and may be reduced in the setting of HC. However, larger prospective studies are needed. [ABSTRACT FROM AUTHOR]

Herpes simplex virus type 1 (HSV-1) latent persistence in human trigeminal ganglia (TG) is accompanied by a chronic CD8 T-cell infiltration. Thus far, during HSV-1 latency only a single transcript, namely the latency-associated transcript (LAT), has been identified to be synthesized but not translated into a protein. In contrast, the chronic CD8 T-cell infiltration suggests that an antigen trigger must be present. The focus of the current work was to look for HSV-1 transcription activity as a potential trigger of the immune response and to demonstrate whether the immune cells are clonally expanded and have a phenotype that suggests that they have been triggered by viral antigen. By combining in situ hybridization, laser cutting microscopy, and single-cell real time RT-PCR, we demonstrated expression of the HSV-1 immediate early (IE) genes ICP0 and ICP4 in human trigeminal neurons. Using CDR3 spectratyping, we showed that the infiltrating T cells are clonally expanded, indicating an antigen-driven immune response. Moreover, the persisting CD8+ T cells had prominent features of the memory effector phenotype. Chemokines CCL5 and CXCL10 were expressed by a subpopulation of infiltrating cells and the corresponding chemokine receptors CCR5 and CXCR3 were co-expressed on virtually all T cells bearing the CD8 phenotype. Thus, HSV-1 IE genes are expressed in human TG, and the infiltrating T cells bear several characteristics that suggest viral antigenic stimulation. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the sexual health and behaviour of older Australians attending a sexual health clinic. Methods: A retrospective patient record of people aged 50 years and over attending the clinic. Results: 2438 people aged 50 years and over attending. The main reasons for attending were assessment of genital symptoms (40%), testing for sexually transmitted infections (STIs) (23%), and HIV testing/care (13%); more than 50% of the clients had a previous sexual health problem and more than 50% had not been tested for HIV. Men reported more lifetime sexual partners than women and were significantly more likely to report using condoms (P <  0.05), although condom use was variable. Genital herpes (10% women, 6% men) and non-gonococcal urethritis (9% men) were the most commonly diagnosed STIs. Conclusions: High levels of unsafe sex and many important sexual health problems were identified which provide direction for public health interventions for older sexually active Australians. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this guideline is to provide recommendations to gynaecology health care providers on optimal management of genital herpes.Outcomes: More effective prevention of complications and transmission of genital herpes.Evidence: Medline was searched for articles published in French and English related to genital herpes and gynaecology. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. [ABSTRACT FROM AUTHOR]

Objective: To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant.Outcomes: More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant.Evidence: Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed.Values: Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. [ABSTRACT FROM AUTHOR]

Background Herpes is a prevalent, infectious disease that can occur anywhere on the body; it is found primarily on the face and genitalia. Herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) are the DNA viruses that cause human herpes. Clinically, HSV-1 and HSV-2 infections produce lesions generally located on the mucocutaneous junctions of the face and genitalia. At times, vesicular lesions may ulcerate, leaving recalcitrant wounds that are challenging to treat. Until now, the basis of treatment has been related to the eradication of the viral infection. Little attention has focused on the consequence of the viral infection and the resulting wounds, specifically whether this represents an epidermal or dermal injury. Methods Using 10 herpetic lesions from different individuals, we studied the depth of the injury via routine hematoxylin and eosin stains, as well as periodic acid–Schiff (PAS) and type IV collagen stains, which demonstrate the presence of the basement membrane. Results In all cases, we found an inflammatory infiltrate in the dermis and selective disruption of the basement membrane. Conclusion This suggests that herpetic lesions involve the dermis and are best classified as partial-thickness wounds. [ABSTRACT FROM AUTHOR]

Purpose: To present an overview of the prevalence of genital herpes in older women and to present case studies of older women diagnosed with genital herpes in a geriatric practice in the southeastern United States. Data sources: Review of current scientific literature and treatment/practice guidelines. Specific descriptive cases are reviewed to illustrate the clinical problem. Conclusions: Genital herpes is an important differential diagnosis to include when assessing and treating older women for recurrent genital symptoms. Implications for practice: Given the large numbers of older individuals potentially infected with genital herpes, the nurse practitioner (NP) is well positioned to accurately diagnose and initiate treatment that can improve quality of life. The NP’s skill in education and counseling is essential to the ongoing management of genital herpes infections. [ABSTRACT FROM AUTHOR]

Objective. To study the possible links between recurrent symptomatic genital herpes during pregnancy and risk for congenital abnormalities (CAs). Method. The occurrence of prospectively and medically-recorded recurrent genital herpes during pregnancy in the mothers of cases with different congenital abnormalities and in the mothers of matched controls without CAs was compared in the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities. Results. Of 22,843 cases with CAs, 59 (0.26%) were born to mothers with recurrent symptomatic genital herpes, while of 38,151 control newborns without CAs, 86 (0.23%) were born to mothers with recurrent genital herpes during the study pregnancy (adjusted OR: 1.1, 95% CI: 0.8-1.6). Pregnant women with clinically recognised recurrent genital herpes in the first trimester of pregnancy are not linked with a higher risk for any CAs. Conclusion. Recurrent genital herpes during pregnancy does not associate with a higher risk of CAs. [ABSTRACT FROM AUTHOR]

Background Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait. Methods All patients seen over a 1-year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients. Results One thousand and ninety-six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21–40-year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%. Conclusions Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus, genital herpes, and other sexually transmitted infections are a critical national and global health priority requiring the rapid development of safe and effective control methods. Topical microbicides, self-administered agents designed for vaginal use, that block transmission at the mucosal surface may provide a realistic method of intervention that could be distributed worldwide. An optimal microbicide should protect against infection but must also be safe, without adversely affecting the mucosal environment, including mediators of host defense. Thus, a critical component in microbicides development is to identify optimal assays that could serve as surrogate markers to predict safety of microbicides prior to embarking on large-scale clinical trials. This will require a greater understanding of the mediators of mucosal immunity in the female genital tract. [ABSTRACT FROM AUTHOR]

Objective: To search for an association between delivery by vacuum extraction and an increased neonatal risk for herpes simplex virus (HSV) infection.Methods: In a cross-sectional, descriptive, controlled study, the study (vacuum extraction) and control (spontaneous delivery) groups each included 50 consecutive women with no history of HSV infection. Cultures for HSV were obtained from the genital tracts of all parturient women and the scalps of their newborns.Results: Following operative vaginal delivery, two newborns (4%) had scalp vesicles and cultures were positive for HSV for both mothers and newborns; two newborns (4%) had scalp vesicles and cultures were negative for HSV; and two newborns (4%) without scalp vesicles had cultures positive for HSV. Following spontaneous delivery, cultures were positive for HSV for four women and their newborns (8%).Conclusion: Herpes simplex virus isolated from the scalps of newborns may often result from colonization rather than infection. [ABSTRACT FROM AUTHOR]

The article presents abstracts of research papers on HIV. Evidence suggests high rates of sexually transmitted infections in HIV positive men. In a study a clinic was utilized mainly by 125 HIV positive men, who were mainly white and homosexual. It informs that a study was conducted to determine the clinical presentation and management of female genitourinary medicine clinic attendees with Trichomonas vaginalis infection. HIV associated Kaposi's sarcoma is rarer in women. It presents description of 3 cases of Hypertrophic Herpes Simplex Genitalis in HIV 1 infected patients.

Genital herpes (GH) causes genital ulcer disease, severe transient pain, and often paresthesias. Whether or not GH can cause urinary retention or chronic neuropathic pain is not well known.We present two immunocompetent patients with GH associated with neuropathic symptoms. We also review the literature on GH and associated neurologic problems.Patient 1 had primary herpes simplex virus (HSV)-2 infection with transient urinary retention and chronic bilateral neuropathic pain in the sacral area. Patient 2 had recurrent HSV-1 associated with unitaleral chronic neuropathic pain in the sacral area. Although transient urinary retention associated with GH is not uncommon, chronic neuropathic pain has not been reported previously.Our cases show that chronic neuropathic pain, that is“pain initiated or caused by a primary lesion or dysfunction in the nervous system,” can follow genital HSV infection. [ABSTRACT FROM AUTHOR]

ABSTRACT A European panel of physicians reviewed the current treatments and perceptions of recurrent genital herpes (GH) across the continent. The panel consisted of specialists in dermatology and venereology from France, Finland, Germany, Italy, Norway, Spain, Sweden and the UK. A wide variety of factors that influence GH management were considered, including different health delivery systems, funding and cultural differences. The poor awareness of GH among both the general public and physicians was highlighted. The effectiveness of GH management was then examined from a patient's viewpoint, including the confirmation of the diagnosis, information and counselling about GH, as well as prescriptions for treatment. It was agreed that both physicians and patients often feel uncomfortable about discussing the disease, and that a European-wide effort is needed to re-educate patients and physicians about GH. The panel identified clear and unmet needs to manage a patient with clinical recurrences and to attempt to reduce the risk of GH transmission. Finally, resiquimod, an immune response modifier, was considered as a potential treatment option for GH. [ABSTRACT FROM AUTHOR]

Abstract We report a case of a 28-year-old human immunodeficiency virus-positive man. He presented with confluent verrucous papules and nodules on his scrotum that were due to herpes simplex infection. [ABSTRACT FROM AUTHOR]