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 >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. G enital herpes is increasingly common in the United Kingdom.1 Although the infection has traditionally been associated with herpes simplex virus type 2 (HSV-2), HSV-1 accounts for 22% to 71% of cases in several genitourinary medicine (GUM) populations in England and Scotland.2 As genital infection with HSV-1 has a relatively mild natural history compared to infection with HSV-2, 3 determining the HSV type provides important information for management and counselling.In recent years, polymerase chain reaction (PCR) has increased HSV detection rates in genital swabs by up to 71% compared to virus culture. 4 HSV type specific antibody assays with high sensitivity and specificity have also been developed. Using these new diagnostic tools, this study investigated an ethnically diverse cohort of GUM attendees presenting with symptoms suggestive of genital herpes. METHODSThe clinical diagnosis of genital herpes and of first or recurrent episode was left to the treating physician. HSV was detected and typed in genital swabs by LightCycler PCR (Roche Diagnostics, Germany).4 HSV type was confirmed by sequencing (n = 14) and by immunofluorescence staining of virus isolates (n = 66) (data not shown). In 70 patients, sera collected for HIV or syphilis screening were labelled as first/ recurrent episode and HSV PCR posit...
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