Reactivation of Genital Herpes Simplex Virus Type 2 Infection in Asymptomatic Seropositive Persons

Wald, Anna; Zeh, Judith; Selke, Stacy; Warren, Terri; Ryncarz, Alexander J.; Ashley, Rhoda; Krieger, John N.; Corey, Lawrence

doi:10.1056/nejm200003233421203

Cited by 531 publications

(391 citation statements)

References 39 publications

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“…4,[7][8][9][10] Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease. 5 In the absence of symptoms, HSV-2 can be detected in the genital tract, by viral culture, on 3% of days for the first year after initial infection, then on 1% of days for the next 2 years. HSV-2 DNA can be detected by polymerase chain reaction testing 15-20% of days.…”

Section: Epidemiology Of Genital Herpesmentioning

confidence: 99%

“…Between 75% and 90% of HSV-2-infected people are not aware of having the infection. [3][4][5][6] This is important because most sexual transmission of HSV occurs during episodes of subclinical reactivation among persons with unrecognized infection. 4,[7][8][9][10] Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease.…”

Section: Epidemiology Of Genital Herpesmentioning

confidence: 99%

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Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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Neonatal herpes can occur when the neonate is exposed to herpes simplex virus in the maternal genital tract during labour. Attack rates are highest when the mother has a newly acquired infection and, therefore, does not have antibodies to protect the neonate. Even with early therapy, there is significant morbidity and mortality associated with neonatal herpes, suggesting that preventing neonatal herpes simplex virus exposure or early recognition of exposure is important. The incidence of neonatal herpes has not declined despite national guidelines for prevention. This suggests that the prevention guidelines need to be re-addressed.Keywords Herpes, neonate, prevention.Please cite this paper as: Gardella C, Brown Z. Prevention of neonatal herpes. BJOG 2011;118:187-192. Epidemiology of genital herpesBased on serological data from a large National Health and Nutrition Examination Survey (NHANES), 22% of pregnant women in the USA are infected with herpes simplex virus 2 (HSV-2), 63% are HSV-1 seropositive, 13% have both HSV-1 and HSV-2, and 28% are seronegative. 1 In the general population, for the first time since the 1976 inception of NHANES, the seroprevalence of HSV-2 has decreased; overall, the age-adjusted HSV-2 seroprevalence was 17% in 1999-2004, compared with 21% in 1988-94, a relative decrease of 19% between the two study periods. Among those infected with HSV-2, the percentage who reported being diagnosed was 14.3% in 1999-2004 and 9.9% in 1988-94, suggesting that more providers are aware of genital herpes, and able to make appropriate diagnoses. 2 However, the vast majority of people infected with HSV-2 remain undiagnosed and, therefore, untreated and able to spread the infection. Between 75% and 90% of HSV-2-infected people are not aware of having the infection. [3][4][5][6] This is important because most sexual transmission of HSV occurs during episodes of subclinical reactivation among persons with unrecognized infection. 4,7-10 Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease. 5 In the absence of symptoms, HSV-2 can be detected in the genital tract, by viral culture, on 3% of days for the first year after initial infection, then on 1% of days for the next 2 years. HSV-2 DNA can be detected by polymerase chain reaction testing 15-20% of days. 11,12 Recent data suggest that HSV reactivation may occur much more frequently than previously understood, and may be characterised by frequent short bursts of viral shedding that do not correlate with symptoms. 13 As HSV-2 seroprevalence decreased, HSV-1 seroprevalence in the USA increased to 62% in 1988-94 from 57.7% in 1999-2004. 2 Among persons infected with HSV-1 but not HSV-2, a higher percentage reported a diagnosis of genital herpes in 1999-2004 compared with 1988-94 (1.8% versus 0.4%). 2 HSV-1 has emerged as a major cause of genital herpes among college-age populations, in which up to 80% of new cases of genital HSV were caused by HSV-1. [14][1...

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Section: Epidemiology Of Genital Herpesmentioning

confidence: 99%

Section: Epidemiology Of Genital Herpesmentioning

confidence: 99%

Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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“…В целом гуморальный иммунитет, как полагают, обе-спечивает системное присутствие в различных слизистых оболочках и висцеральных тканях антител, циркулирую-щих в периферической крови [15]. Однако в эксперимен-те было показано, что у обезьян, иммунизированных ва-гинально против обезьяньего-HIV, вирусоспецифические вагинальные IgA и IgG, но не плазменные IgG, коррели-руют с защитой от инфекции [19].…”

Section: Discussionunclassified

“…Комбинированное использование химиопрепа-ратов с различными механизмами противовирусного дей-ствия препятствует появлению резистентных штаммов ВПГ [15].…”

Section: лечение пациенток с рецидивирующим впг-2unclassified

Impact of immunomodulatory therapy on prolongation of remission duration in patients with recurrent genital herpes

Minaev¹,

Bugrimov²,

Климович³

2015

Ross. vestn. akush.-ginekol.

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Вирус простого герпеса 2 (ВПГ-2) классифицируется вместе с ВПГ-1 в подсемействе Alphaherpesvirinae и являет-ся одной из весьма распространенных инфекций, переда-ваемых половым путем, во всем мире. Уровень распро-страненности этого вируса от 15 до 20% в Европе и Соеди-e-mail: klimovich@gmail.com ненных Штатах и до 90% в некоторых африканских по-пуляциях Субсахары [1].Вирус простого герпеса (ВПГ) -это повсеместно распространенный оболочечный с двухнитевой ДНК ви-рус, принадлежащий к семейству герпесвирусов, переда- Цель исследования -изучение влияния агониста толл-подобных рецепторов 9 (TLR-9 рецепторов) иммуномодулирую-щего, противовирусного препарата Ферровир на частоту рецидивов и длительность периода ремиссии у пациенток, инфи-цированных вирусом простого герпеса 2-го типа (ВПГ-2). Материал и методы. Была обследована 101 пациентка репро-дуктивного возраста от 25 лет до 31 года с первичным, или рецидивирующим, или с единственным эпизодом генитального герпеса. Для определения уровня серопозитивности больным был проведен серологический анализ крови с измерением уровня содержания типоспецифических IgG и степени их авидности. По показаниям им были выполнены ультразвуковое исследование органов малого таза, кольпоскопия, а также у всех пациенток были взяты мазки из цервикального канала на онкоцитологию и патогенную (условно патогенную) микрофлору. Результаты. Была отмечена четкая взаимосвязь между сниженным содержанием в плазме высокоавидных IgG и рецидивами ВПГ-2 инфекции с клиническими проявлениями в виде язвенного поражения слизистых оболочек половых путей. Наоборот, повышенное содержание в плазме пациенток высокоавидных типоспецифических антител к ВПГ-2 при применении агониста толл-подобных рецепторов 9 (TLR-9) пре-парата Ферровир, коррелирует у них с длительным, до 6-9-12 мес, периодом клинической ремиссии в течении забо-левания. Заключение. Введение в схему профилактики рецидивов инфекции ВПГ-2 Ферровир приводит к существенному удлинению периода клинической ремиссии у пациенток с рецидивирующей герпесвирусной инфекцией.Авторы информируют об отсутствии конфликта интересов. Ключевые слова: рецидивирующая инфекция ВПГ-2, врожденный иммунный ответ, адаптивный иммунный ответ, авидность антител.Objective -to investigate the effect of ferrovir, a toll-like receptor 9 (TLR-9) agonist with immunomodulatory and antiviral properties, on the frequency of recurrences and the duration of remission in patients infected with herpes simplex virus type 2 (HSV-2). Subject and methods. A total of 101 patients of reproductive age from 25 to 31 years with primary, or recurrent, or with a single episode of genital herpes were examined. To determine the seropositivity, blood serology test and measurement of the level of type-specific IgGs and the degree of their avidity were done in the patients. They underwent small pelvic ultrasonography, colposcopy, as indicated; smears were taken from the cervical canal of all the patients for oncocytology and pathogenic (opportunistic) microflora. Results. There was a clear correlation between pla...

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“…Epidemiological studies consistently demonstrate that mucosal HIV-1 shedding is more frequent and in greater amounts during mucosal and subclinical reactivations (Corey et al, 2004;Nagot et al, 2007;Watson-Jones et al, 2008). HSV-2 can be detected in swabs obtained from the cervix from seropositive subjects by culture on 3% of days and by sensitive DNA PCR on about 20% of days, illustrating the high frequency of asymptomatic shedding (Wald et al, 2000). Being sero-positive for HSV-2 is associated with a 3-to 10-fold increased risk of HIV-1 acquisition in women, based on longitudinal cohort studies showing HSV-2 infection preceding HIV-1 acquisition and adjusted for sexual behavior Celum, 2004;Freeman et al, 2006).…”

Section: The Cotton Rat Model Of Hsv Infectionmentioning

confidence: 93%