Genital Ulcer Disease: A Review of Pathogenesis and Clinical Features

Maliyar, Khalad; Mufti, Asfandyar; Syed, Maleeha; Selk, Amanda; Dutil, Maha; Bunce, Paul E.; Alavi, Afsáneh

doi:10.1177/1203475419858955

Cited by 15 publications

(18 citation statements)

References 86 publications

(120 reference statements)

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“…Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection (STI) worldwide. 1 , 2 Although it is usually asymptomatic, [3][4][5] its chronic nature, with persistent reactivations and subclinical shedding, increases its transmission potential, resulting in higher prevalence than other STIs in both the general and higher-risk populations. [6][7][8][9][10] HSV-2 infection manifests in the form of painful, itchy, and often recurrent ulcers in the genital tracts.…”

Section: Introductionmentioning

confidence: 99%

“…HSV-2 infection manifests in the form of painful, itchy, and often recurrent ulcers in the genital tracts. [3] , [4] , [5] , 11 It can also be transmitted vertically from mother to child, causing neonatal herpes, a disease condition associated with high morbidity and mortality. 12 , 13 HSV-2 infection has been linked to a nearly 3-fold increase in HIV acquisition and transmission, [14] , [15] , [16] indicating an epidemiological synergy between the two infections.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

AlMukdad

Harfouche

Wettstein

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection worldwide. This systematic review was conducted to characterize HSV-2 epidemiology in Asia, including the World Health Organization regions of Southeast Asia and the Western Pacific.Methods: Cochrane and PRISMA guidelines were followed to systematically review and report findings. Pooled mean seroprevalence and proportions of HSV-2 isolated in genital ulcer disease (GUD) and in genital herpes were calculated using random-effects meta-analyses. Meta-regressions were also conducted. Quality assessment was performed.Findings: HSV-2 measures extracted from 173 publications included 15 seroconversion rates, 11 seroincidence rates, 272 overall seroprevalence measures (678 stratified), 14 proportions of HSV-2 isolation in GUD (15 stratified), and 27 proportions of HSV-2 isolation in genital herpes (36 stratified). Pooled mean seroprevalence was 12.1% (95% confidence interval (CI): 11.0-13.2%) among general populations, 23.6% (95% CI: 20.9-26.3%) among men who have sex with men and transgender people, 46.0% (95% CI: 39.2-52.9%) among HIV-positive individuals and individuals in HIV-discordant couples, and 62.2% (95% CI: 58.9-65.6%) among female sex workers. Among general populations, pooled mean seroprevalence increased gradually from 4.7% (95% CI: 3.3-6.3%) in < 20-year-old individuals to 26.6% (95% CI: 19.2-34.7%) in > 60-year-old individuals. Compared to women and across all populations, men had 0.60-fold (95% CI: 54.0-67.0) lower seroprevalence, that is women had 70% higher seroprevalence. Seroprevalence declined by 0.98-fold (95% CI: 0.97-0.99) per year, that is a 2% decline per year in the last three decades. Pooled mean proportions of HSV-2 isolation in GUD and in genital herpes were 48.2% (95% CI: 34.9-61.6%) and 75.9% (95% CI: 68.3-82.8%), respectively.Interpretation: Over 1 in 10 individuals is infected with HSV-2, but seroprevalence is declining. HSV-2 accounts for half of GUD cases and three-quarters of genital herpes cases. These findings support the need for an HSV-2 vaccine and universal access to sexual and reproductive health services.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

AlMukdad

Harfouche

Wettstein

et al. 2021

The Lancet Regional Health - Western Pacific

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“…LGV, Epstein-Barr virus, cytomegalovirus, Behc ßet disease, Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum and neoplasia. 10 The treatment of LGV is the same irrespective of its presentation with oral doxycycline 100 mg twice daily for 21 days. 5 In conclusion, anogenital ulcer is an unusual clinical manifestation of LGV to be considered besides proctitis.…”

Section: Casementioning

confidence: 99%

Primary genital lymphogranuloma venereum in the HIV pre‐exposure prophylaxis era

Arandes-Marcocci

Collgros

Serra-Pladevall

et al. 2020

Acad Dermatol Venereol

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Primary genital lymphogranuloma venereum in the HIV pre-exposure prophylaxis era Editor Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis (CT) serovars L1-L3. 1 In Europe, it is endemic among men who have sex with men (MSM) causing proctitis, mainly co-infected with HIV, since 2003. 2 Its presentation as a genital lesion has been rarely described and accounts for around 5% of cases in the United Kingdom and France. 3,4 Increasing STIs rates in MSM have been reported during the last decade in several Western countries, 5 and it is plausible that HIV pre-exposure prophylaxis (PrEP) might contribute to maintaining this trend. 6 We report 2 cases with genital primary LGV mimicking primary syphilis seen at in our clinic in Barcelona. Case 1. A 43-year-old HIV-negative man on PrEP presented with a one-week history of a painful penile ulcer. He reported unprotected anal sex with three men in previous month. Clinically, there was a red ulcer on the dorsal side of the penis with an inguinal adenopathy on the left groin (Fig. 1). Because of a negative dark-field examination and the large size of the adenopathy, we initiated empirical treatment with doxycycline 100 mg orally twice daily. Swabs from the penile ulcer were collected for bacterial culture and multiplex PCR testing. Only CT was detected. The patient was instructed to continue up to 3 weeks of treatment. Three weeks after treatment, the penile ulcer and the inguinal mass almost disappeared.

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“…[ 3 ] The infection is lifelong and usually asymptomatic, with persistent reactivation and subclinical shedding, that increase its transmission potential, resulting in higher prevalence than other STIs in both the general and higher-risk population. [ 4 – 7 ] Prevalence of HSV-2 among men who have sex with men (MSM) in China is very high. In this population, the prevalence was 7.8% in Jiangsu Province, 14% in Shenzhen ,24.7% in Chengdu city and up to 48.6% in HIV-positive MSM population.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of herpes simplex virus 2 among MSM in Mainland China: a systematic review and meta-synthesis

2022

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Background As one of the most prolific sexually transmitted infections (STIs) in the world, Herpes Simplex Virus Type 2 (HSV-2) is one of the primary causes of genital ulcers. In addition, HSV-2 infection multiplies the risk of acquiring HIV. Men who have sex with men (MSM) are at particularly high risk of contracting both diseases. Unfortunately, little information is available with regarding to the comprehensive prevalence of HSV-2 among MSM in mainland China. The objective of this manuscript was to determine the composite prevalence of HSV-2 among MSM in mainland China via systematic review and meta-synthesis. Methods We systematically searched PubMed, Embase, Chinese National Knowledge Infrastructure, WanFang Database for Chinese Periodicals, and the VIP Database for Chinese Technical Periodicals for relevant articles published from the database’s inception to 28 April 2022 that reported data on the prevalence of HSV-2 within the MSM population in mainland China. We considered publications to be eligible for inclusion if they satisfied these conditions: (1) publication participants were MSM in China mainland. Studies were excluded if participants were exclusively all HIV-positive MSM, all HIV-negative MSM, injection-drug users, or MSM sex workers. These studies would have introduced selection bias and skewed pooled prevalence estimates higher or lower; (2) proportion of HSV-2 virus among MSM in China mainland were reported; (3) HSV-2 diagnosis was conducted in a laboratory based on a strict type-specific glycoprotein-G based assays diagnostic method or PCR method; and (4) had a sample size over 20. Exclusion criteria included: (1) not being an original manuscript, such as a review article; (2) being a guideline, correspondence, and/or conference abstract; (3) the publication population did not reside in China mainland when the study was carried out; and (4) if the same epidemiological data were printed in both English and Chinese journals, English articles were preferred. We assessed the risk of bias in each individual publication using the modified quality assessment tool for systematic reviews of observational publications (QATSO). This meta-analysis was conducted by using R software. Due to extensive heterogeneity between various publications, we employed a random effect model to calculate the composite prevalence and corresponding 95% confidence intervals. We then conducted meta-regression to investigate the potential causes of observed heterogeneity. Lastly, we employed subgroup analysis based on characteristics of studies to compare the prevalence estimates across the groups. Publication bias was evaluated by funnel plot, Begg’s test and Egger’s test. Sensitivity analysis was also performed by removing each single study separately. Results This study included 31 articles (9 published in English and 22 in Chinese) in our meta-synthesis. The pooled prevalence of HSV-2 among MSM in China mainland was 0.094 (95%CI:0.074 to 0.116). Prevalence of HSV-2 among MSM in Southwest China was higher than other regions, prevalence of HSV-2 among MSM that recruited from VCT (Voluntary Counseling and Testing) was lower than other ways, respectively. Compared to 2000–2010, the prevalence of HSV-2 among MSM in mainland China showed a downward trend during 2011–2020, however, the difference was not statistically significant . Conclusion Prevalence of HSV-2 among MSM in China mainland is high, around 0.094. It indicated HSV-2 needed to be screening for MSM population among China mainland and proper actions should be taken to curve the trend of HSV-2 among MSM in China. Trial registration CRD42020180361.

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Genital Ulcer Disease: A Review of Pathogenesis and Clinical Features

Cited by 15 publications

References 86 publications

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

Primary genital lymphogranuloma venereum in the HIV pre‐exposure prophylaxis era

Prevalence of herpes simplex virus 2 among MSM in Mainland China: a systematic review and meta-synthesis

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