Herpes Simplex Virus Infection and Genital Ulcer Disease Among Patients with Sexually Transmitted Infections in Dar es Salaam, Tanzania

Nilsen, Arvid; Kasubi, Mabula; Mohn, Stein Christian; Mwakagile, Davis; Langeland, Nina; Haarr, Lars

doi:10.2340/00015555-0241

Cited by 27 publications

(16 citation statements)

References 30 publications

(38 reference statements)

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“…Our study was limited by a lack of specific diagnostic testing for ulcer aetiology. Although we did culture material from atypical ulcers for chancroid, we identified no chancroid-related GUD; this is consistent with the current low incidence of chancroid in our cohort (no cases since 1999, unpublished data) and in East Africa in general 13 14. Although syphilis serology can be falsely negative among HIV-infected persons with advanced immunosuppression, available serological results from the quarterly testing of these women after the post-GUD visit reveal no cases of late seroconversion.…”

Section: Discussionsupporting

confidence: 87%

Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy

Graham

Masese

Gitau

et al. 2010

Sexually Transmitted Infections

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Objectives Genital ulcer disease (GUD) is associated with increased HIV-1 RNA shedding in antiretroviral therapy (ART)-naïve women. The effect of GUD on HIV-1 shedding among ART-treated women is not known. Our objective was to test the hypothesis that genital ulcerations increase genital HIV-1 RNA shedding in women receiving ART. Methods Eligible women initiated ART and attended monthly visits with inspection for genital lesions and collection of genital swabs. GUD cases diagnosed after ≥2 months on ART were included for analysis and served as their own controls. HIV-1 RNA was quantitated in specimens collected before, during, and after GUD for all cases. The lower limit of quantitation was 100 HIV-1 RNA copies/swab. Using the pre-GUD visit as the reference, we compared detection of genital HIV-1 RNA before versus during and after GUD episodes. Results Thirty-six women had GUD episodes after ART initiation. HIV-1 RNA was detected before, during, and after GUD in cervical secretions from 4 (11%), 1 (3%), and 6 (17%) women respectively, and in vaginal secretions from 3 (8%), 4 (11%) and 4 (11%) women respectively. After adjustment for time on ART, there was no difference in detection of cervical HIV-1 RNA before versus during GUD (aOR 0.22, 95% CI 0.04–1.23). Likewise, GUD did not increase HIV-1 detection in vaginal secretions (adjusted odds ratio [aOR] 1.32, 95% CI 0.29–5.92). Conclusions GUD did not significantly increase cervical or vaginal HIV-1 shedding. Our results suggest that ART maintains its effectiveness for genital HIV-1 suppression despite GUD episodes.

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Section: Discussionsupporting

confidence: 87%

Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy

Graham

Masese

Gitau

et al. 2010

Sexually Transmitted Infections

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“…While recent studies from Africa and South America report a HSV-2:HSV-1 ratio in the range of 10:1 -20:1 in favor for HSV-2 [34, 36,37], one from UK found a 1:1 ratio [33] as we did.…”

Section: Accepted Articlecontrasting

confidence: 61%

“…HSV-1/2 was detected in 22% of our patients, and the rate of HSV among ulcer patients reported by previous PCR studies varied between 12.5% and 63% [33][34][35][36][37]. In previous decades,…”

Section: Accepted Articlementioning

confidence: 63%

“…consuming subsequent electrophoresis to detect PCR products (for example [35][36][37][38][39] We sought to determine the rate of T. pallidum, HSV-1/2 and H. ducreyi in ulcers of our patients from Zurich, Switzerland and Graz, Austria. The proportion of 53% of T. pallidum-positive patients in the present study appeared higher than the rates of ulcers caused by syphilis reported from other European areas, for example 2% in the UK [33], 3% in The Netherlands [3] or 35% in France [1].…”

Section: Accepted Articlementioning

confidence: 99%

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A multicenter prospective trial to asses a new real-time polymerase chain reaction for detection of Treponema pallidum, herpes simplex-1/2 and Haemophilus ducreyi in genital, anal and oropharyngeal ulcers

Glatz

Juricevic

Altwegg

et al. 2014

Clinical Microbiology and Infection

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Treponema pallidum, herpes simplex virus types 1 or 2 (HSV-1/2) and Haemophilus ducreyi are sexually transmitted pathogens that can cause genital, anal and oropharyngeal ulcers. Laboratory evaluation of these pathogens in ulcers requires different types of specimens and tests, increasing the risk of improper specimen handling and time lapse until analysis. We sought to develop a new real-time PCR (TP-HD-HSV1/2 PCR) to facilitate the detection of T. pallidum, HSV-1/2 and H. ducreyi in ulcers. The TP-HD-HSV1/2 PCR was tested (i) in a retrospective study on 193 specimens of various clinical origin and (ii) in a prospective study on 36 patients with genital, anal or oropharyngeal ulcers (ClinicalTrials.gov # NCT01688258). The results of the TP-HD-HSV1/2 PCR were compared with standard diagnostic methods (T. pallidum: serology, dark field microscopy; HSV-1/2: PCR; H. ducreyi: cultivation). Sensitivity and specificity of the TP-HD-HSV1/2 PCR for T. pallidum were both 100%, for HSV-1 100% and 98%, and for HSV-2 100% and 98%, respectively. T. pallidum and HSV-1/2 were detected in 53% and 22% of patients in the prospective study; H. ducreyi was not detected. In the prospective study, 5/19 (26%) specimens were true positive for T. pallidum in the TP-HD-HSV1/2 PCR but non-reactive in the VDRL. The TP-HD-HSV1/2 PCR is sensitive and specific for the detection of T. pallidum and HSV-1/2 in routine clinical practice and it appears superior to serology in early T. pallidum infections.

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“…Obwohl ca. 50-80 % der genitalen Ulzera durch HSV verursacht werden [30,35], sind ca. 75-90 % der infizierten Personen sich dieser Infektion nicht bewusst [13,48].…”

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Herpes genitalis

Mylonas

2015

Gynäkologe

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Die Infektion mit dem Herpes-simplexVirus (HSV) ist weltweit eine der am häu-figsten auftretenden Viruserkrankungen [18,40,51]. Die Hauptursache des Genitalherpes ist Herpes-simplex-Virus Typ 2 (HSV-2), wobei mittlerweile auch das HSV-1 vermehrt beobachtet wird [5,51]. Obwohl ca. 50-80 % der genitalen Ulzera durch HSV verursacht werden [30,35], sind ca. 75-90 % der infizierten Personen sich dieser Infektion nicht bewusst [13,48].Diese sexuell übertragene Erkrankung verursacht bei den Betroffenen ausgeprägte und schmerzhafte genitale Ulzerationen, den Herpes genitalis. Entscheidend ist dabei, dass das Virus reaktiviert werden kann und es dadurch zu erneuten klinischen Rezidiven kommt. Neben der klinischen Erkrankung kann das Virus auch während der Schwangerschaft auf den Feten bzw. dem Neugeborenen mit teils schweren klinischen Komplikationen und Spätfolgen übertragen werden [14,32,48]. EpidemiologieDie HSV-Seroprävalenz variiert sehr stark aufgrund von Alter, Geschlecht, Ethnizität, Bildungsstand, sozioökono-mischem Status, Region oder sexuellem Risikoprofil [38, 13, 39]. Die Viruspräva-lenz von HSV-2 in der Normalbevölke-rung in einer älteren Untersuchung lag bei 0,25-5 %, während diese bei Frauen mit anderen genitalen Infektionen (z. B. sexuell übertragene Erkrankungen) auf ca. 7 % geschätzt wurde [13]. Mittlerweile zeigt sich in den USA eine Seroprävalenz von ca. 58 % für HSV-1 und 16 % für HSV-2 [38, 51]. Wenngleich HSV-2 die Hauptursache eines genitalen Herpes ist, kommen mittlerweile auch vermehrt genitale Infektionen mit HSV-1 vor [5]. Die Rate einerprimären HSV-1-Infektion ist mittlerweile doppelt so hoch wie von HSV-2 und manifestiert sich häufiger im genitalen als im orofaszialen Bereich [5]. » Die Rate einer primären HSV-1-Infektion ist mittlerweile doppelt so hoch wie von HSV-2 Obwohl die HSV-2-Seroprävalenz zwischen 1970 und 1990 in den USA zunahm [13], zeigte sich ein Rückgang Anfang der 2000er-Jahre (von 21 % in den Jahren 1988 bis 1994 auf 17 % in den Jahren 1999 bis 2004) [51]. Im Gegensatz dazu wurde in den letzten JahrTab. 1 Symptome der Herpes-genitalis-Infektion [33, 34] Mukokutane Manifestation Herpes labialis, Herpes facialis, Herpes integumentalis (vorwiegend durch HSV-1 verursacht) Heilung nach 10 bis 20 Tagen Häufigste Form eines Herpes recurrens oder recidivans Gingivostomatitis und Stomatitis herpetica (primär HSV-1) Herpes genitalis (Vulvovaginitis, Balanitis) Häufigste genital übertragene Kontaktinfektion Tritt nach Primärinfektion und als rekurrierender Herpes auf ZNS-Infektionen Herpes-Enzephalitis ist in Mitteleuropa die häufigste nekrotisierende Enzephalitis (ca. 50 %) 30 % nach Primärinfektionen Bis zu 70 % als rekurrierender Herpes Hohe Letalität (bis zu 70 %), wobei viele überlebende Patienten Residuen behalten Disseminierte Infektionen Disseminierter Herpes simplex mit Streuung des Virus Eczema herpeticatum Beteiligung des Auges (primär HSV-1) Ösophagitis Hepatitis Beteiligung von weiteren inneren Organen (HSV-1 und HSV-2) mit oft tödlichem Verlauf zehnten eine ansteigende In...

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Herpes Simplex Virus Infection and Genital Ulcer Disease Among Patients with Sexually Transmitted Infections in Dar es Salaam, Tanzania

Cited by 27 publications

References 30 publications

Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy

Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy

A multicenter prospective trial to asses a new real-time polymerase chain reaction for detection of Treponema pallidum, herpes simplex-1/2 and Haemophilus ducreyi in genital, anal and oropharyngeal ulcers

Herpes genitalis

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