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.

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.

Atuação do enfermeiro no diagnóstico e no tratamento do herpes genital, na atenção primária à saúde / The nurse's role in the diagnosis and treatment of genital herpes in primary health care

O Herpes Genital é uma Doença Sexualmente Trans- missível (DST), que acomete milhares de pessoas, sendo considerada um problema de saúde pública, no Brasil. A Abordagem Sindrômica é uma ferramenta importan- te para a realização do diagnóstico precoce e tratamen- to, sendo utilizada pelo enfermeiro, durante a Consulta de Enfermagem, na Atenção Primária à Saúde (APS). Os objetivos foram destacar a atuação do enfermeiro no diag- nóstico e no tratamento do Herpes Genital, enfatizar o uso da Abordagem Sindrômica e destacar a importância da Consulta de Enfermagem para a aplicação dessa Abor- dagem. Trata-se de uma pesquisa de revisão bibliográfica. Concluiu-se que interromper a cadeia de transmissão, as- sim como desenvolver estratégias de prevenção, tratamen- to e aconselhamento é essencial no acompanhamento do portador do Herpes Genital.

Genital herpes is a sexually transmitted disease (STD) that afflicts thousands of people, and is considered a public health problem in Brazil. The syndromic approach is an important tool for conducting early diagnosis and treatment, being used by the nurse during nursing consultation in Primary Health Care (PHC). The objectives were to highlight the nurse's role in the diagnosis and treatment of genital herpes, emphasize the use of the syndromic approach, and highlight the importance of nursing consultation for the application of this approach. This study is a literature review. It concludes that interrupting the chain of transmission, as well as developing strategies for prevention, treatment, and counseling is essential in monitoring the patient with genital herpes.

Cytological versus serological diagnosis of Herpes Simplex Virus type 2 infection among women with cervicitis without external genital ulcer or blistering lesions in Hawler Maternity Teaching Hospital

Herpes simplex virus type 2 linked to the genital tract infection may produce significant acute or chronic cervicitis. Identification of the virus is important due to its association with genital tract disease and sexual transmission. The virus establishes lifelong latency with periodic reactivation. Therefore, it causes significant physical and psychological morbidity. The aim of this study was to assess and compare cytological examination with serological test in the diagnosis of genital herpes simplex virus type 2. This study included 104 women. Pap smear was collected from 24 healthy women as a control group [group A], 40 patients with severe cervicitis on cytological examination [group B] and 40 patients with atypical cervicitis [group C]. Blood sample was obtained from the patients and the control group and tested for Herpes simplex virus type 2 specific serology. The ages of the studied groups ranged from 21-53 years. They were referred to the Maternity Teaching Hospital and private laboratories in Erbil city, Kurdistan region, Iraq during the period from December 2011 to December 2012. Herpes simplex virus type 2 IgG antibodies were found in 10 sera from patients with nonspecific cervicitis [group-B] and only in three patients with atypical cervicitis [group-C]. No positive serological test was identified in the control group. All Pap smear results showed features suggestive of cervicitis but without viral cytopathic herpetic changes. The serological test was superior to cytology for the diagnosis of Herpes simplex virus type 2 infection in women presented with cervicitis with no clinically apparent genital ulcer or blisters

Prevalence of hrrpes simplex virus type 2 and rsk factors associated with thiss infection in women in southern Brazil / Prevalencia do herpes virus tipo 2 e fatores de risco associados a sua infeccao em mulheres do sul do Brasil

SUMMARY The herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2. .

RESUMO O vírus herpes simplex tipo 2 (HVS-2) é uma das infecções mais prevalentes em todo o mundo. Considera-se um co-factor na aquisição do vírus da imunodeficiência humana (HIV) e na persistência do papilomavirus humano (HPV). Este estudo tem como objetivo avaliar a prevalência de HSV-2 usando a reação em cadeia da polimerase (PCR) e fatores associados em pacientes atendidos na Universidade Federal do Rio Grande e em Unidades Básicas de Saúde (UBS) do Rio Grande, Brasil. A prevalência de HSV-2 encontrada neste estudo foi de 15,6%. Entre as 302 mulheres estudadas, 158 haviam recebido assistência na UBS e 144 foram atendidos na FURG. A prevalência de HSV-2 nestes grupos foi de 10,8 e 20,8%, respectivamente, com RR: 1,9 e p = 0,012. Conhecer o exame de Papanicolaou, e presença de lesão não teve associação com infecção HSV-2. A análise multivariada mostrou que a variável que influencia no risco de infecção HSV-2 foi o paciente ter HIV, com risco relativo 1,9 e p = 0,04. Discussão: As úlceras genitais são importante porta de entrada para o vírus HIV e o uso do preservativo é estratégia importante para reduzir a transmissão do HIV e do HSV-2. .

Herpes Simplex Virus 2 Infection Rate and Necessity of Screening during Pregnancy: A Clinical and Seroepidemiologic Study

PURPOSE: This study determined the seroprevalence of herpes virus 2 in gravidas and the differences between herpes virus 2-infected and healthy gravidas. The need to screen gravidas for herpes virus 2 was also evaluated. MATERIALS AND METHODS: A retrospective analysis involving 500 gravidas who underwent herpes virus 2 serologic testing and delivery in our hospital between January 2009 and August 2010 was performed. All patients in the study group were classified as herpes simplex virus 2 (HSV2) positive, and all cases were analyzed with respect to the clinical course of the pregnancy, pregnancy outcome, obstetric complications, and neonatal outcomes. SPSS software (version 14.0) was used for statistical analysis. A chi-square test and Student's t-test were used for statistical analysis. RESULTS: In the current study, the herpes virus 2 seroprevalence rate in gravidas was 17%. There was no significant difference in the rates of preterm delivery, premature rupture of membranes, preterm labor, and intrauterine growth restriction between the herpes virus 2-infected gravidas and the healthy control group. The rates of spontaneous abortion and sexually transmitted disease were higher in the herpes virus 2 infection group than the healthy control group. CONCLUSION: After educating gravidas on genital herpes and, if gravidas thereafter consent to herpes virus 2 screening, the risk of neonatal herpes virus 2 infections can be reduced. In addition, examination of gravidas for sexually transmitted diseases would increase as would appropriate treatment.

Herpes genital vulvar e uso tópico de uncaria tomentosa: relato de caso / Uncaria tomentosa and topical use in genital herpes in vulva: case report

Introdução: herpes genital é uma doença infectocontagiosa de transmissão sexual que acomete pessoas das mais diversas camadas sociais. Herpes genital está disseminado em todo o mundo e é uma causa frequente de lesões genitais dolorosas em homens e em mulheres. Objetivo e Métodos: descrever caso de mulher adulta com quadro clínico e citológico de primomanifestação de herpes genital vulvar, no qual foi usado, na lesão, gel com 50 mg/g de Uncaria tomentosa três vezes ao dia, durante 4 dias. Resultados: os sintomas de dor e ardor tiveram rápida remissão. Ainda na consulta, cerca de 25 minutos apósaplicação tópica do fitoterápico, a paciente relatou grande melhora do quadro doloroso genital. A evolução clínica foi satisfatória e após 6 dias a paciente, já sem lesão, informou ter tido coito vaginal sem incômodos. Conclusão: a aplicação tópica de gel de Uncaria tomentosa em primomanifestação de herpes genital vulvar foi bem tolerada, não apresentou efeitos colaterais e melhorou rápida e sensivelmente o quadro clínico da doença.

Introduction: genital herpes is a sexually transmitted infectious disease that affects people from many different social strata. Genital herpes is spreadb worldwide and is a frequent cause of painful genital sores in men and women. Objective and Methods: to describe the case of adult women with clinical and cytologic clinical picture of a vulvar initial outbreak of genital herpes in which the lesion was treated with Uncaria tomentosa gel 50 mg/g three times a day for four days. Results: the symptoms of pain and burning had rapid remission. During the consultation, about 25 minutes after topical application of theherbal medicine, the patient reported great improvement in genital pain. The clinical outcome was satisfactory and after six days the patient, whose lesion had already healed, reported having had vaginal intercourse without discomfort. Conclusion: application of Uncaria tomentosa topical gel in a vulvar initial outbreak of genital herpes was well tolerated, showed no side effects, and rapidly and significantly improved the clinical symptoms of disease.

Herpes genital et grossesse: mesures efficaces en prevention de l'herpes neonatal

L'herpes genital est une infection virale due a Herpes Simplex 1 ou 2. Chez la femme enceinte; elle peut avoir des consequences redoutables chez l'enfant a naitre. Nous rapportons 2 observations qui ont souleve le probleme de diagnostic et de prise en charge. La premiere concernait une primipare de 29 ans dont le diagnostic est etabli vers 38 semaines d'amenorrhee devant une notion d'eruptions peniennes chez le conjoint et des leucorrhees rebelles. La deuxieme concernait une primipare de 22 ans de diagnostic etabli vers 36 semaines d'amenorrhee pour des eruptions vesiculo-suintantes vulvo-vaginales. Les particularites de la prise en charge sont discutees pour prevenir l'herpes neonatal. L'evolution favorable confirme que la cesarienne en urgence associee a un traitement anti-viral pour la mere et l'enfant reste le traitement de choix

Seroepidemiological study of herpes simplex virus type 2 in patients with the acquired immunodeficiency syndrome in the city of Niterói, Rio de Janeiro, Brazil

This study was designed to determine the seroprevalence of herpes simplex virus type 2 (HSV-2) and to evaluate its association with age, sex as well as other demographic and behavioural factors in 150 human immunodeficiency virus (HIV) positive adults patients attending the general medical outpatient ward for routine care of Niterói, state of Rio de Janeiro, Brazil. Serum samples were screened for HSV-2 antibodies using an indirect ELISA. Eighty-three patients were men (mean age: 38.8) and 67 were women (mean age: 35.4). The estimated prevalence of HSV-2 was 52 percent (95 percent CI: 44-60 percent) and it was higher among men (53 percent) than among women (50.7 percent). Overall, the age of first sexual intercourse and past history of genital herpes were associated with HSV-2 seropositivity. Analysis by gender disclosed significant association of number of lifetime sex partners only among men. Although HSV-2 antibodies were frequent in the study group, genital herpes was reported by 21.8 percent of the HSV-2 positive subjects, indicating low awareness of the HSV-2 infection. These results may have public health importance for Brazil as the high rate of HSV-2 infection may act as a cofactor of HIV transmission.

Prevalência e fatores de risco para a infecção pelo herpes simples vírus tipo-2 em uma coorte de homens que fazem sexo com homens no Rio de Janeiro / Prevalence and risk factors for herpes simplex type-2 virus in a cohort of men who have sex with men in Rio de Janeiro

O HSV-2 é a principal causa de herpes genital, sendo a maior parte destas infecções assintomática. A infecção pelo HSV-2 pode ser um fator de risco para a aquisição e transmissão de outras DST, inclusive da infecção causada pelo HIV. Objetivo: Estimar a prevalência e identificar os fatores de risco associados à infecção pelo HSV-2 em uma coorte de homens que fazem sexo com homens da Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. Métodos: Estudo transversal, com avaliação de dados sócio-demográficos, comportamentais e laboratoriais referentes à linha de base de 403 voluntários incluídos na referida coorte, no período de 1994-1998. As amostras foram testadas através do ELISA para detecção de anticorpos tipo-específicos contra a gG2 do HSV-2 (HerpeSelect - Focus Technologies)Resultados: A prevalência para anticorpos anti-HSV-2 encontrada nesta população foi de 65,2 por cento. Após análise multivariada, os fatores que se mostraram independentemente associados à infecção pelo HSV-2 foram idade mais elevada (maior ou igual a 26 anos), raça não branca, ter sorologia positiva para sífilis (TPHA), ter feito sexo desprotegido com parceria sexual masculina e ter feito sexo desprotegido com parceria sexual feminina nos seis meses que antecederam a visita. Conclusão: Este estudo mostra uma elevada prevalência da infecção pelo HSV-2 neste grupo e associação dessa infecção com outras DST, em concordância com outros estudos. Estes dados podem ter uma importante contribuição no sentido de avaliar estratégias que possam contribuir para a prevenção desta infecção na população de homens que fazem sexo com homens, que é tida como uma população vulnerável e central à dinâmica da disseminação do HSV-2 em todo o mundo...

HSV-2 is the primary cause of genital herpes and most of the infections are asymptomatic. The infection by HSV-2 may be a risk factor to acquisition and transmission of other sexually transmitted diseases (STD), including infection by HIV virus. Objective: Estimate the prevalence and identify the risk factors associated of infection by HSV-2 in a cohort of men who have sex with men (MSM) in Fundação Oswaldo Cruz [Oswaldo Cruz Foundation], Rio de Janeiro, Brazil.Methods: Cross-sectional study, evaluating sociodemographic, behavioral, and laboratorialdata from baseline of 403 volunteers included in this cohort, in the period of 1994-1998. The samples were tested by ELISA to detect type-specific antibodies against HSV-2 gG2 (HerpeSelect - Focus Technologies). Results: The prevalence to antibodies anti-HV2-2 observed in this population was 65.2 percent.After multivariate analysis, the factors independently associated to HSV-2 infection were older age (> 26 years), non-white race, positive serology for syphilis (TPHA), history of unprotected sex with male partners and history of unprotected sex with female partners inthe last six months before the visit.Conclusion: This study shows a high prevalence of HSV-2 infection in this group and association with other STD, consistent with other studies. This data may have a significant contribution to evaluate strategies that may contribute to prevent this infection amongMSM, as this is considered a vulnerable core-population to the dynamics of HSV-2 spreading all over the world...

Increase of genital HSV-1 and mixed HSV-1 and HSV-2 infection in Bangkok, Thailand.

From January 1998 to December 2004, 207 out of 1125 samples were HSV isolation positive and typed. Two groups of patients, Thai and foreigner, as well as site of infection, non-genital and genital area, were identified. The prevalence of non-genital HSV-1 infection from 27 samples of Thai patients was 81.84%. Out of 180 genital samples, 39.02% HSV-1 and 43.09% HSV-2 from 123 Thai patients and 36.84% HSV-1 and 49.12% HSV-2 of 57 foreigner patients were determined. Moreover mixed infection of HSV-1 and HSV-2 was found in both Thai and foreigner groups, 17.89% and 14.04%, respectively. The prevalence of genital HSV-1 infection in Thai patients chronologically increases from 1.6% to 56.91% from of 1985 to 2004. Increase of HSV-1 genital infection and mixed HSV-1 and HSV-2 infection in Thai people might probably be due to changing of sexual behavior in the AIDS era.

Sexually-transmitted viral diseases in women: clinical and epidemiological aspects and advances in laboratory diagnosis

Sexually transmitted diseases (STDs) have long been known, but they have only recently been recognized as causes of significant long-term morbidity, mainly as a result of increased knowledge concerning viral STDs. The relationship of these diseases with conditions such as anogenital cancer and acquired immunodeficiency syndrome (AIDS) has made viral STDs an important issue in the healthcare of women and infants, and in reproductive health. The evolution of the AIDS pandemic is now characterized by growing differences between rich and poor nations. New diagnostic tools include rapid tests of blood, urine and saliva samples. New techniques, such as computerized cytology, have been developed for the diagnosis of human papillomavirus (HPV). Women infected with HIV are at a greater risk of being co-infected with HPV, and they are also more prone to the progression and persistence of HPV lesions. The herpes simplex virus presents high rates of co-infection with HIV, and it plays a particularly important role in increasing transmission rates of this virus.

High seroprevalence of HSV-1 and HSV-2 in STD clinic attendees and non-high risk controls: a case control study at a referral hospital in south India.

BACKGROUND: In Asia, HSV seroprevalence studies are sparse and they have recorded lower prevalence of HSV infection, especially HSV-2. AIMS: To ascertain the seroprevalence of HSV-1 and HSV-2 in patients attending a STD clinic in a referral hospital in south India and to compare it with a control group. METHODS: The study included 135 consecutive STD cases having history of ulcerative or non-ulcerative STD in the present or in the past 5 years and 135 age and sex-matched controls. Diagnostic serology was done for HSV-1 and HSV-2 using type specific IgG by indirect immunoassay using ELISA. The results were analyzed utilizing Chi- square test. RESULTS: Amongst 135 STD clinic cases, 106 cases were males and 29 cases were females with male to female ratio of 3.65:1. The mean age was 32.2 years (range 16-65 years). Among study group cases, 112 (82.9%) cases were co-infected with HSV-1 and HSV-2, 11 (8.1%) cases were seropositive for HSV-1 alone and 3 (2.2%) cases were seropositive for HSV-2 alone. In the control group, 112 (82.9%) cases were co-infected with HSV-1 and 2, 12 (9.6%) for HSV-1 alone and 1(0.8%) for HSV-2 alone. Correlation of HSV-1 and HSV-2 serology with various demographic and behavioral factors was statistically insignificant. CONCLUSIONS: Seroprevalence of HSV-1 and HSV-2 in STD clinic cases and control group is high, similar to that recorded in sub-Saharan Africa. Thus, serological studies for HSV-1 and HSV-2 cannot be taken as a marker of sexual behavior in our set of population.

Prevalence of Chlamydia trachomatis & herpes simplex virus in males with urethritis & females with cervicitis attending STD clinic.

BACKGROUND & OBJECTIVES: Cervicitis and urethritis due to Chlamydia trachomatis are common sexually transmitted diseases. However, there is a paucity of information on urethritis and mucopurulent cervicitis due to herpes simplex virus (HSV) from India. We used polymerase chain reaction (PCR) to find out the prevalence of C. trachomatis and HSV associated urethritis in males and mucopurulent cervicitis in females attending a sexually transmitted diseases (STD) clinic. METHODS: Twenty five endocervical swabs from 25 women with mucopurulent cervicitis and 75 urethral swabs from 72 males with urethritis were processed for the detection of C. trachomatis and HSV by antigen detection by fluorescent antibody test (FAT), culture and PCR. RESULTS: Among the 25 women, one (4.0%) was positive for C. trachomatis and 3 (12.0%) were positive for HSV by PCR. FAT and culture were negative. Nine (12.0%) of the 75 urethral swabs were positive for C. trachomatis and 5 (6.6%) were positive for HSV by PCR. Among the 9 positive by PCR for C. trachomatis, 3 (4.0%) were positive by FAT. Cultures for both organisms were negative. INTERPRETATION & CONCLUSION: Endocervicitis and male urethritis due to C. trachomatis and HSV are not uncommon among high-risk individuals. The diagnosis could be established mainly by PCR.