Alta seroprevalencia de sífilis y herpes genital en migrantes en tránsito en Chiapas, México / High seroprevalence of syphilis and genital herpes in migrants in transit in Chiapas, Mexico / Alta soroprevalência de sífilis e herpes genital em migrantes em trânsito por Chiapas, México

RESUMEN Objetivos. Determinar la prevalencia de anticuerpos contra Treponema pallidum y virus herpes simple tipo 2 (VHS-2), así como identificar los factores asociados a dichas infecciones entre migrantes en tránsito en Chiapas, México. Métodos. Estudio transversal realizado durante 2021-2022, en tres albergues para migrantes en Chiapas, México. Las personas contestaron un cuestionario y proporcionaron una muestra de sangre para la detección de anticuerpos contra Treponema pallidum y VHS-2. Se calculó la seroprevalencia y se evaluaron los factores asociados mediante pruebas de χ2 y razones de momios. Resultados. Participaron 462 migrantes, con edad promedio de 31,2 años, 56,9 % eran mujeres, 41,1 % provenían de Honduras. La seroprevalencia de VHS-2 fue 29,9 % mientras que la de sífilis fue 4,5 %, siendo mayor en hombres (8,0 %) que en mujeres (1,9 %). El 15,4 % de las embarazadas presentaban anticuerpos contra sífilis. Entre las variables asociadas a sífilis destacan el ser hombre, antecedente de lesiones genitales, así como tener parejas del mismo sexo y la seropositividad a VHS-2. Con relación al VHS-2, factores como ser mujer, edad, escolaridad, dormir en la calle, antecedente de prueba de VIH, debut sexual temprano, número de parejas sexuales y sífilis estuvieron asociados a la infección. Conclusiones. Se encontró una prevalencia elevada de sífilis y VHS-2 entre la población migrante evaluada. La sífilis se confirma como una infección reemergente, incluso en las mujeres. Los migrantes presenta vulnerabilidades asociadas al comportamiento sexual, por lo que se deben enfocar medidas de prevención, diagnóstico y tratamiento para este grupo poblacional.

ABSTRACT Objectives. To determine the prevalence of antibodies against Treponema pallidum and herpes simplex virus type 2 (HSV-2), and to identify the factors associated with these infections among migrants in transit in Chiapas, Mexico. Methods. Cross-sectional study conducted during 2021-2022, in three migrant shelters in Chiapas, Mexico. Participants answered a questionnaire and provided a blood sample to detect antibodies against Treponema pallidum and HSV-2. The study calculated seroprevalence and assessed associated factors using Chi-square (χ2) tests and odds ratios. Results. A total of 462 migrants participated, with an average age of 31.2 years; 56.9% were women, and 41.1% came from Honduras. The seroprevalence of HSV-2 was 29.9%; for syphilis it was 4.5%, and it was higher in men (8.0%) than in women (1.9%). Among pregnant women, 15.4% had antibodies against syphilis. Notable variables associated with syphilis include being male, having a history of genital lesions, having same-sex partners, and seropositivity to HSV-2. Regarding HSV-2, factors associated with infection included being female, age, schooling, sleeping in the street, a history of HIV testing, early sexual debut, number of sexual partners, and syphilis. Conclusions. A high prevalence of syphilis and HSV-2 was found among the migrant population evaluated. Syphilis is confirmed as a re-emerging infection, even in women. Migrants have vulnerabilities associated with sexual behavior, so prevention, diagnosis, and treatment measures should be focused on this population group.

RESUMO Objetivos. Determinar a prevalência de anticorpos contra Treponema pallidum e vírus herpes simples tipo 2 (HSV-2) e identificar os fatores associados a essas infecções entre migrantes em trânsito por Chiapas, México. Métodos. Estudo transversal realizado nos anos de 2021 e 2022 em três abrigos de migrantes em Chiapas, México. Os participantes preencheram um questionário e forneceram uma amostra de sangue para a detecção de anticorpos contra Treponema pallidum e HSV-2. Calculou-se a soroprevalência e avaliaram-se os fatores associados usando testes de χ2 e razões de chances. Resultados. O estudou incluiu 462 migrantes com idade média de 31,2 anos, dos quais 56,9% eram mulheres e 41,1% vinham de Honduras. A soroprevalência do HSV-2 foi de 29,9%. A soroprevalência de sífilis, por sua vez, foi de 4,5%, sendo mais alta nos homens (8,0%) do que nas mulheres (1,9%). Os anticorpos contra a sífilis estavam presentes em 15,4% das mulheres grávidas. As principais variáveis associadas à sífilis foram sexo masculino e história de lesões genitais, além de parceiros do mesmo sexo e soropositividade para HSV-2. Com relação ao HSV-2, fatores como sexo feminino, idade, escolaridade, dormir na rua, história de teste de HIV, iniciação sexual precoce, número de parceiros sexuais e sífilis estavam associados a infecção. Conclusões. A população migrante avaliada apresenta alta prevalência de sífilis e HSV-2. Confirmou-se que a sífilis é uma infecção reemergente, inclusive em mulheres. Os migrantes apresentam vulnerabilidades associadas ao comportamento sexual; portanto, é preciso concentrar medidas de prevenção, diagnóstico e tratamento nesse grupo populacional.

Epidemiological features and trends of genital herpes in Zhejiang province from 2011 to 2020 / 中华皮肤科杂志

Objective:To investigate epidemiological features and trends of genital herpes in Zhejiang province, and to provide scientific evidence for developing control strategies.Methods:Data on reported cases of genital herpes in Zhejiang province between 2011 and 2020 were collected from national notifiable infectious disease surveillance system in China Disease Control and Prevention Information System, and a descriptive epidemiological study was conducted.Results:The reported incidence rate of genital herpes in Zhejiang province between 2011 and 2020 ranged from 4.92 per 100 000 to 6.19 per 100 000, without a significant upward or downward trend (trend χ2 = 0.03, P = 0.959) ; the reported incidence rate in females showed an increasing trend (from 4.50 per 100 000 to 6.02 per 100 000, trend χ2 = 5.13, P = 0.034) , with an average annual increase rate of 3.27%; among all the age groups, the sexually active population aged 20 - 39 years showed a high reported incidence rate of genital herpes, but the incidence rate increased significantly in the groups aged 15 - 19 years and over 50 years, with the average annual increase rates being 8.10%, 9.24%,7.81% and 4.27% in the groups aged 15 - 19 years, 50 - 54 years, 55 - 59 years and over 60 years respectively. The largest proportion of cases was found in farmers (28.38%, 8 779/30 931) , and high average annual increase rates in proportions were observed in healthcare workers, retirees, students, unemployed population and cadres (13.71%, 13.14%, 10.74%, 9.36% and 7.00%, respectively) . The reported incidence rates were high (over 5 per 100 000) in Eastern coastal areas such as Ningbo, Wenzhou, Taizhou, as well as Jinhua city with relatively developed industrial economies in central Zhejiang; the reported incidence rate markedly increased in Hangzhou city, with an average annual increase rate of 5.39%. Conclusions:There was no obvious downward trend in the prevalence of genital herpes in Zhejiang province from 2011 to 2020. Attention should be paid to the prevention and treatment of genital herpes in females, adolescents and the elderly, and the monitoring of herpes simplex virus infections and investigation of infection routes and exposure history should be strengthened.

Chronic mucocutaneous anogenital herpes: series of ten cases and literature review

Abstract Anogenital herpes is one of the most prevalent sexually transmitted infections worldwide. It has several clinical manifestations, from cases of primary herpes infection to recurrent forms, among them chronic mucocutaneous herpes. This presentation is rare, characterized by a duration of more than four weeks, usually associated with immunosuppression and resistance to classic anti-herpetic treatment. The present study presents a series of ten cases of chronic mucocutaneous herpes with a discussion about its clinical, laboratory, and therapeutic aspects.

Tumor-like herpes simplex infection in an HIV patient

Abstract A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam úlcera genital / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause genital ulcers / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan úlcera genital

As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.

Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.

El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam úlcera genital / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause genital ulcers / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan úlcera genital

Resumo As infecções que causam úlcera genital são um dos temas que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Este artigo aborda a síndrome clínica de úlcera genital causada por infecções sexualmente transmissíveis e seus agentes etiológicos mais comuns: Treponema pallidum (sífilis), vírus herpes simples 2 (herpes genital) e vírus herpes simples 1 (herpes perioral), Haemophilus ducreyi (cancroide), Chlamydia trachomatis sorotipos L1, L2 e L3 (linfogranuloma venéreo) e Klebsiella granulomatis (donovanose). São apresentados aspectos epidemiológicos e clínicos dessas infecções, bem como orientações para seu diagnóstico e tratamento, além de estratégias para as ações de vigilância, prevenção e controle, com a finalidade de subsidiar gestores e profissionais de saúde na qualificação da assistência.

Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.

Resumen El tema de las infecciones que causan úlcera genital hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento fue elaborado con base en evidencias científicas y validado en discusiones con especialistas. Este artículo trata del síndrome de úlcera genital clínica provocada por infecciones de transmisión sexual, con sus agentes etiológicos más comunes: Treponema pallidum (sífilis), virus del herpes simple-1 (herpes genital) y virus del herpes simple-2 (herpes perioral), Haemophilus ducreyi (chancro blando), Chlamydia trachomatis, serotipos L1, L2 y L3 (linfogranuloma venéreo), y Klebsiella granulomatis (donovanosis). Se presentan aspectos epidemiológicos y clínicos de esas infecciones, bien como pautas para su diagnóstico y tratamiento, además de estrategias para acciones de monitoreo epidemiológico, prevención y control, a fin de contribuir con gestores y personal de salud en la cualificación de la asistencia.

Prevalence of Sexually Transmitted Infections (STIs) among Adolescents Attending Genitourinary Medicine Clinic Hospital Kuala Lumpur between 2014 and 2018

Background@#Adolescents, who aged between 10 and 19 years old, comprise about 20% of the world’s population. They are vulnerable to acquisition of sexually transmitted infections (STIs). Here, we aim to determine the demography and pattern of STIs among adolescents attending Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur (HKL).@*Methods@#This is a retrospective study on all adolescents attending GUM clinic between 2014 and 2018. Data was obtained from case notes and further analysed.@*Results@#A total of 111 adolescents attended GUM clinic between 2014 and 2018. The mean age was 18 years (range 12-19). The male to female ratio was 2.26:1. All patients were Malaysian. Only 2 were foreign nationals. The majority were Malays (85.3%) followed by Indians (11%) and Chinese (3.7%). About 46.8% were still schooling, 28.8% were employed and 23.4% were unemployed. About 8.3% had a history of substance abuse. The majority (67.6%) were heterosexual, about 17.1% were homosexual and 3.6% were bisexual. Nearly 95% engaged in unprotected sex. Majority (46%) had casual sex. The most frequent presenting symptoms for male and female adolescents were discharge (43.2%) followed by swelling/growth (23.4%). About 83% had confirmed STIs. The most common STIs among the male were gonorrhoea (44.1%), genital warts (23.4%) and non-gonococcal urethritis (14.7%). The most common STIs among the female were herpes genitalis (50%), genital warts (33.3%) and syphilis (8.3%). Six patients were infected with the human immunodeficiency virus (HIV).@*Conclusion@#The most common STI among adolescents between 2014 and 2018 was gonorrhoea for male and herpes genitalis for female.

Presentación atípica anogenital de virus herpes simple en un adulto VIH positivo, manejo exitoso con foscarnet: reporte de caso / Atypical anogenital herpes simple virus infection in an hiv patient, successfully treatment with foscarnet: a case report

Las lesiones anogenitales hipertróficas, pseudotumorales y similares a placas, son presentaciones atípicas del virus herpes simple (VHS). Estas lesiones desarrollan resistencia a los tratamientos y se presentan en inmunocomprometidos, especialmente aquellos con infección por el virus de inmunodeficiencia humana (VIH). Presentamos el caso de un paciente masculino de 38 años de edad, VIH/SIDA, con antecedente de carcinoma escamocelular infiltrante de canal anal, con lesiones múltiples hipertróficas anogenitales y exudativas, a quien se le confirma infección por VHS-1, sin respuesta a aciclovir ni valaciclovir a dosis óptimas, el cual resuelve con 21 días de foscarnet intravenoso. Nuestro caso muestra la importancia de considerar el uso de foscarnet en adultos con infección de VIH y del VHS, que no respondan a tratamiento de primera línea, en un país donde no hay esquemas establecidos de manejo para este tipo de presentaciones y donde existe la limitante de no haber disponibilidad en pruebas para resistencia a antivirales.

Pseudotumoral, hypertrophic, plaque-like anogenital ulcers are atypical features of herpes simplex infection. These ulcers develop treatment resistance and they appear in immunocompromised mainly those infected by human immunodeficiency virus. We present a 38 years-old man with AIDS and personal history of infiltrative squamous carcinoma of anal canal with multiple hypertrophic and exudative ulcers secondary to VHS-1 etiology without response to acyclovir neither valacyclovir at optimal doses but complete answer with 21 days of foscarnet treatment. Our case highlights the role of foscarnet in adults with HIV-HSV coinfection that don't respond to frst line treatment in a country that doesn't have clear treatment recommendations in these cases and with the limitations of absence of antiviral resistance test.

Vegetative chronic genital herpes with satisfactory response to imiquimod

Abstract Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.

Clinicoepidemiological profile of sexually transmitted disease (STD) patients presenting in a tertiary care center

Background: Sexually transmitted infections (STIs) constitute a major health problem in the developing countries and prevalence of STIs varies from region to region in our country. Aim: To study the pattern and prevalence of sexually transmitted infections and HIV seropositivity among patients presenting in a tertiary care center. Materials and methods: A retrospective data was collected in the department of Dermatology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIHMS), Shri Mahant Indiresh Hospital (SMIH), a tertiary care center in Dehradun, Uttarakhand, India, from January 2011 to December 2018. A total of 525 patients were analyzed in this study. Results: A total of 525 patients were enrolled in our study. STIs were more common in men, with male (365): female (160) ratio of 2.2:1. Maximum numbers of patients were in the age group of 25 to 34 years. Unskilled workers (22.28%) and housewives (20.00%) constituted major proportion. Majority of the cases presented with warts (38.09%) followed by molluscum contagiosum (20.95%) and herpes genitalis (19.61%). But herpes genitalis (27.39%) was found to be the most common STD seen among males and warts (68.75%) among the females. HIV seropositivity was seen among 20 (3.80%) patients and was most commonly associated with herpes genitalis infection (60.00%). Gunjan Gupta, Jitendra Singh Bist, Rahul Sudan, Kewal Krishan, Neeti Kumari. Clinicoepidemiological profile of sexually transmitted disease (STD) patients presenting in a tertiary care center. IAIM, 2019; 6(2): 7-12. Page 8 Conclusion: Increased prevalence of viral STDs like herpes genitalis, genital warts and mollascum contagiosum was seen in our study. Widespread use of antibacterial lead to falling trend of bacterial STDs.

The situation of sexual transmitted diseases among acquired immune deficiency syndrome patients and its influence on the risk of human immunodeficiency virus transmission between couples / 中华传染病杂志

Objective To investigate the situation of sexual transmitted diseases (STD) prevalence among human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS ) patients and to analyze its impact on HIV transmission between couples .Methods Under voluntary counseling and testing ,1871 clinically confirmed HIV/AIDS patients underwent common STD testing , with synchronous test of HIV infection on their couples .Continuous variables were compared using t-test , and categorical variables were compared using variance analysis .Chi-square test was used for comparison between groups .Results Among 1871 HIV/AIDS patients ,571 patients (30 .5％ ) were co-infected with STD .The HIV transmission rates between couples in STD co-infection group and non-STD co-infection group were 49 .2％ (281/571) and 23 .6％ (307/1300) ,respectively ,which was statistically different (χ2 =120 .6 ,P<0 .01) .Among the 571 HIV/STD co-infection patients ,HIV transmission rates between couples with genital herpes ,condyloma acuminatum ,gonorrhoea or nongonococcal urethritis and syphilis were 84 .2％ (80/95) ,72 .2％ (78/108) ,45 .0％ (27/60) and 31 .2％ (96/308) ,respectively .There was statistically significant among multiple groups comparisons (χ2 =110 .0 , P<0 .01) .Among the comparison between two groups , there were statistically significant differences between genital herpes group and condyloma acuminatum group (χ2 =4 .210 ,P=0 .040) ,between pointed condyloma group and gonorrhoea or nongonococcal urethritis group (χ2 =12 .196 , P< 0 .01) ,between gonorrhoea or nongonococcal urethritis group and syphilis group (χ2 = 4 .317 , P=0 .038) .Conclusions STD co-infection rate is high among HIV/AIDS patients .STD can facilitate the HIV transmission between couples ,and different STD has different impact on the transmission .

Epidemiologic features of genital herpes in China from 2008 to 2017 / 中华皮肤科杂志

Objective To investigate epidemiological features of genital herpes in China from 2008 to 2017,and to provide scientific evidences for developing control strategies.Methods A descriptive epidemiological study was conducted to analyze personal,spatial and temporal distribution of genital herpes cases reported from 105 sexually transmitted disease (STD) surveillance sites between 2008 and 2017.Results The reported incidence of genital herpes decreased from 8.30 per 100 000 in 2008 to 6.14 per 100 000 in 2017,with an average annual decline rate of 3.29％.There was marked variation in the reported incidence of genital herpes among different STD surveillance sites,with a range from ＜ 1 per 100 000 to 113.51 per 100 000.The reported incidence was relatively high in Guangdong,Guangxi,Hainan,Zhejiang,Fujian,Chongqing and Hubei,but low in north China and central China.In addition,no cases were reported at a few sites in rural areas.The reported annual incidence was higher in females than in males in 2016,but higher in males than in females in the other years.The ratio of male to female cases decreased from 1.77 ∶ 1 in 2008 to 1.03:1 in 2017.Among all the age groups,the sexually active population aged 20-39 years showed high reported incidence of genital herpes,with the highest reported incidence observed in the group aged 25-34 years (range,17.84/100 000-26.89/100 000).Among all kinds of medical institutions,general hospitals had the largest number of reported cases of genital herpes (range,58.13％-76.52％),followed by specialized dermatovenereology hospitals,gynecology hospitals and maternal and child health (MCH) hospitals.Conclusions Although the overall reported incidence of genital herpes shows a downward trend,the reported incidence is high in Guangdong,Guangxi,Hainan,Zhejiang,Fujian,Chongqing and Hubei.Therefore,different prevention strategies are needed to be developed according to the epidemiological features.

A Case of Candida Balanitis Masquerading as Herpes Genitalis / 대한의진균학회지

A 46-year-old male presented with skin lesion on the tip of penis, occurring a month ago. Erythematous macules and grouped vesicles on the glans penis and upper side of prepuce area were noticed. In addition, scales were noticed on the tip of glans penis. The lesion was first diagnosed as herpes genitalis based on the clinical manifestation, but had failed to improve with systemic and topical antiviral and topical antibiotics. KOH examinations were performed on his upper glans penis, and we detected pseudo hyphae and spores. Fungal culture and polymerase chain reaction (PCR) study were revealed as Candida albicans. He was successfully treated with topical isoconazole cream twice a day. Candida balanitis refers to candida infections of glans penis. Infectious balanitis presented various clinical presentations, it is not easy to diagnose with clinical presentation only. Therefore, it is essential to include other examination such as KOH examination, microorganism exam, and/or biopsy in the differential diagnosis when cutaneous lesions are noticed in patients. Herein, we present a candida balanitis with atypical features that clinically mimicked herpes genitalis.

Value of detection of anti-herpes simplex virus type 2 antibodies in the diagnosis of genital herpes before in vitro fertilization / 中华皮肤科杂志

Objective To determine the prevalent herpes simplex virus (HSV) strain in patients with genital herpes (GH),and to evaluate the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of anti-herpes simplex virus type 2 (HSV2) IgG and IgM antibodies in the diagnosis of genital herpes (GH) before in vitro fertilization (IVF).Methods Totally,193 HSV2 clinical strains isolated in cell culture from the lesions of patients with GH in the Department of Dermatology,First Affiliated Hospital,Sun Yat-sen University between 2009 and 2011 were typed by using type-specific fluorescein isothiocyanate (FITC)-labelled anti-HSV monoclonal antibodies.Serum samples were obtained from 57 anti-HSV2 IgM/IgG antibody-positive females with suspected GH as well as their husbands (clinical observation group),68 HSV culture-positive patients diagnosed with GH (positive control group),and 120 children aged 8-12 years (negative control group).Enzyme-linked immunosorbent assay (ELISA) was performed to detect anti-HSV1/HSV2 IgG/IgM antibodies in these serum samples.Statistical analysis was carried out using chi-square test.Results There was a significant difference between the positive control group and negative control group in the positivity rate of anti-HSV1 IgG (89.71％ (61/68) vs.40.80％ (49/120),P ＜ 0.01) and anti-HSV2 IgG (91.18％ (62/68) vs.0,P ＜ 0.01),but not in that of anti-HSV1 IgM (20.59％ (14/68) vs.21.70％ (26/120),P ＞ 0.05) or anti-HSV2 lgM (13.24％ (9/68)vs.13.30％ (16/120),P ＞ 0.05).In the clinical observation group,the positivity rate of anti-HSV1 and anti-HSV2 IgM antibodies,anti-HSV1 and anti-HSV2 IgG antibodies was 80.70％ (46/57),91.23％ (52/57),84.21％ (48/57) and 14.04％ (8/57) respectively in the females,19.30％ (11/57),8.77％ (5/57),87.71％ (50/57),12.28％ (7/57)respectively in the males,with significant differences in the positivity rate of anti-HSV1 and-HSV2 IgM antibodies (both P ＜ 0.01),but not in that of anti-HSV 1 or-HSV2 IgG antibodies (both P ＞ 0.05).The sensitivity,specificity,PPV and NPV were 13.24％ (9/68),86.67％ (104/120),36.00％ (9/25) and 63.80％ (104/163) respectively for anti-HSV2 IgM antibody in the diagnosis of GH,91.18％ (62/68),100.00％ (120/120),100.00％ (62/62),and 95.24％ (120/126) respectively for anti-HSV2 IgG antibody.Conclusions HSV2 prevails in the patients with GH in this region,while HSV1 only amounts to 5.18％.The type-specific anti-HSV2 IgG antibody shows a higher specificity,sensitivity,PPV and NPV in the diagnosis of GH than anti-HSV2 IgM antibody,hence,the type-specific anti-HSV2 IgG antibody is superior to anti-HSV2 IgM antibody in diagnosing GH before assisted reproduction.

Adaptación cultural de la escala para medir conocimiento sobre herpes simple genital en adultos jóvenes cubanos / Cross cultural adaptation of the scale to assess knowledge about genital herpes

Objetivo: Adaptar culturalmente al contexto cubano la escala para medir conocimiento sobre herpes simple genital. Material y métodos: El proceso de adaptación cultural de la escala incluyó la realización de traducción, retro-traducción, revisión por un comité de expertos, preprueba y envío de la escala adaptada a los autores originales. El estudio fue realizado de junio a noviembre del año 2008 con 38 estudiantes de licenciatura en enfermería matriculados en la Escuela de Enfermería de San Antonio de los Baños, Habana, Cuba. Los permisos de la institución y el comité de ética de la facultad fueron obtenidos antes de comenzar el estudio. Resultados: El 53 por ciento fueron mujeres (n=17) y el 47 por ciento fueron hombres (n=18). El 84 por ciento de la muestra estaba soltero (n=32), 13 por ciento casados (n=5) y 2,6 por ciento estaban divorciados (n=1). Todos los integrantes de la muestra estaban estudiando licenciatura en enfermería (n=38). La estabilidad interna del instrumento con el coeficiente de Alfa de Cronbach fue de 0.82 y el Coeficiente de Correlación Interclase (ICC) fue de 0.84. Conclusiones: La escala es confiable en su uso para medir conocimiento sobre herpes simple genital en el contexto cubano. Por lo tanto la escala para medir conocimiento sobre herpes simple genital es un instrumento apropiado para realizar investigaciones en el área de las infecciones de transmisión sexual en adultos jóvenes.

Objective: The aim of this manuscript is to adapt culturally to the Cuban context the scale to measure knowledge about genital herpes simplex. Methods: A cross-sectional design was used with an exploratory survey methodology from June 2008 to November 2008 with nursing students from the school in San Antonio de los Baños, Havana Cuba. Institutional and ethical approval was obtained before starting the study. Results: The mean age of the participants was 23.34 years with (SD 7.01), and 53 percent (n=17) were female and 47 percent were male (n=18). 84 percent of student were unmarried (n=32), 13 percent were married (n=5) and 2,6 percent were divorced (n=1). All subjects were involved in the bachelor's program in nursing (n=38). The Alpha Coefficient for the total scale was 0,82. Te interclass correlation coefficient to measure scale's stability over time was 0,84 (test-retest two weeks). Conclusions: Findings support that genital herpes knowledge scale is a reliable and valid in measuring knowledge young adults. Thus, genital herpes knowledge scale is an appropriate instrument to conduct the research on sexual transmitted disease in young adults in the Cuban contexts.

Herpes hipertrófico perianal tratado eficazmente com imiquimod / Hypertrophic perianal herpes successfully treated with imiquimod

A infecção pelo vírus herpes simples tipo 2 (HSV-2) é frequente em pacientes infetados pelo vírus de imunodeficiência adquirida (VIH). Nestes casos, o herpes genital pode ter uma apresentação clínica atípica. As variantes hipertróficas e vegetantes são pouco habituais. Os autores relatam um caso de herpes hipertrófico perianal em paciente infetada pelo VIH, com resposta insatisfatória ao aciclovir e valaciclovir, tratado eficazmente com imiquimod tópico. O herpes genital hipertrófico é, frequentemente, refratário aos tratamentos antivirais. Na nossa experiência, o imiquimod é um tratamento eficaz, seguro e bem tolerado que deverá ser considerado na abordagem terapêutica destes pacientes.

Herpes simplex virus type 2 (HSV-2) infections are frequent in HIV (human immunodeficiency virus) infected patients. In those cases, genital herpes may have an atypical clinical presentation. Hypertrophic and vegetating variants are unusual. The authors describe a case of hypertrophic perianal herpes in an HIV patient with unsatisfactory response to acyclovir and valacyclovir, successfully treated with imiquimod. Hypertrophic genital herpes cases are frequently refractory to antiviral treatments. In our experience, imiquimod is an efficient, safe and well tolerated treatment that should be considered in therapeutic approach of these patients.

Associação de aciclovir oral e imiquimode no tratamento de herpes simples genital hipertrófico em paciente com sida: relato de dois casos / Association of oral acyclovir and imiquimod for the treatment of hypertrophic genital herpes simplex in HIV positive patients: report of two cases

Herpes simples crônico é doença capaz de gerar apresentações exuberantes, principalmente em pacientes com sida. O provável mecanismo da formação dessas lesões hiperplásicas consiste na invasão viral dos linfócitos T CD4 situados na epiderme. Diante das dificuldades terapêuticas e da grande taxa de insucesso do tratamento nesses pacientes, novas terapias têm sido citadas na literatura atualmente. O conhecimento da imunopatologia ratificou o mecanismo pelo qual o imiquimode poderia ser eficaz como terapia adjuvante aos antivirais. Relatamos aqui dois casos de pacientes tratados com aciclovir associado ao imiquimode tópico que obtiveram resposta clínica excepcional.

Chronic herpes simplex can present as exuberant clinical lesions, especially in HIV patients. The most probable mechanism of formation of these lesions is the invasion of the epidermal CD4 T cells by the herpes simplex virus. Due to the therapeutic difficulties and the high rates of treatment failure amongst these patients, new drugs are currently being discussed on the literature. Studies based on the immunophatology of these lesions have suggested that imiquimod might work as an adjuvant therapy to the antiviral drugs. Here we present two cases of excellent response to treatment with topical imiquimod as an adjuvant drug to acyclovir.

Infecção por vírus herpes simples na gestação: aspectos epidemiológicos, diagnósticos e profiláticos / Herpes simplex virus infection in pregnancy: epidemiological, diagnostic, and prophylactic aspects

A infecção por vírus herpes simples (HSV) é uma das mais frequentes doenças sexualmente transmissíveis (DST) e, quando presente no período gestacional, pode determinar uma de suas complicações de maior morbidade, o herpes neonatal. Características epidemiológicas de tal doença foram estudadas pela literatura em diversas instâncias, mas não foram produzidos dados definitivos a respeito do real impacto que tal doença determina. Estratégias diagnósticas e profiláticas também foram sugeridas e testadas, porém diretrizes universalmente aceitas, capazes de reduzir a morbimortalidade de tal complicação, ainda não se encontram em uso. Há muitas controvérsias acerca da abordagem ideal de um caso de infecção herpética que se manifesta na gravidez, seja ela uma primoinfecção ou um caso de recorrência. Sabe-se que a entidade é potencialmente prevenível, porém ainda não existe evidência definitiva de que o custo de tal prevenção seja proporcional ao impacto da infecção

Herpes simplex virus infection is one of the most common sexually transmitted diseases (STD) and when it affects pregnancy, one of its most morbid complications, neonatal herpes, can ensue. Epidemiological information on this disease has already been studied by literature, but definitive data regarding the real burden of disease have not been produced. Diagnostic and prophylactic strategies have already been suggested and tested, but universally accepted guidelines, capable of diminishing the consequences of disease, are still not in use. There is much controversy on the optimal management of herpes in pregnancy, whether a primo-infection or a reactivation. It is known that the disease is potentially preventable, but there is still no absolute evidence that the cost of such prevention is proportional to the impact of such disease

Does circumcision influence recurrences in herpes genitalis.

Background and Aims: The effect of therapeutic circumcision in men for preventing recurrences of herpes genitalis remains largely unelucidated despite its well documented albeit conflicting role in reducing the risk of acquiring sexually transmitted infections, including genital herpes. Methods: Twenty volunteer adult males with a history of recurrent herpes genitalis were included in the study after informed consent and circumcision was carried out. Twenty more adult males having recurrent herpes genitalis and registered in the clinic during the same period were selected as controls. All patients and controls were followed-up for recurrences of herpes genitalis. Results and Conclusions: Six patients and six controls did not follow-up. Seven patients reported no recurrences during 3-18 years, seven patients had two to six recurrences during 11-27 years of postcircumcision follow-up, 0.0080 (average) recurrences per person per year as compared with 0.20 (average) recurrences per person per year recorded before the circumcision. Two patients had first recurrence 11 years after the circumcision. In comparison, 14 controls had 0.17 (average) recurrences per person per year, comparable with the number of recurrences in uncircumcised patients, and frequently at shorter intervals. Despite being a small study, the circumcision appears to reduce the number of recurrences on an average and evidently prolongs the disease-free period in between two recurrences.

Expression of activating and inhibitory receptors as well as costimulatory molecules on peripheral blood natural killer cells in patients with recurrent genital herpes / 中华皮肤科杂志

Objective To investigate the expression of activating receptors (NKG2D and NKp46), inhibitory receptors (NKG2A and KIR) as well as costimulatory molecules (OX40, 4-1BB and ICOS) on peripheral blood natural killer (NK) cells from patients with recurrent genital herpes (RGH). Methods Four-color immunofluorescence staining with flow cytometry was used to detect the expression of NKG2D, NKG2A, KIR and NKp46 in 44 patients with RGH and 40 normal human controls, and to detect the expression of OX40, 4-1BB and ICOS in 29 patients with RGH and 29 normal human controls. Results The proportions of NKG2D-positive and NKp46-positive NK cells significantly decreased in patients with RGH than those in the normal human controls [(93.3 ± 5.4)% vs (96.9 ± 2.5)%, (88.9 ± 8.7)% vs(93.4 ± 4.1)%, respectively, both P < 0.01]. Between the patients and controls, no significant difference was observed in the expression of NK cell inhibitory receptors, NKG2A [(41.8 ± 14.4)% vs (46.0 ± 14.7)%, P > 0.05] or KIR [(68.3 ± 19.1)% vs (69.1 ± 17.6)%, P > 0.05]. A lower expression of costimulatory molecule OX40 was noted in NK cells from patients with RGH compared with those in normal controls [(1.0 ± 1.1)% vs (1.8 ± 1.7)%, P < 0.05]. Conclusions Herpes simplex virus infection could down-regulate the expression of NK cell activating receptors and costimulatory molecules, subsequently suppress the activation of NK cells, and lead to the escape of virus-infected cells from the killing of NK cells.