Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia, España: estudio observacional retrospectivo / Genital Infection With Herpes Simplex Virus Type 1 and Type 2 in Valencia, Spain: A Retrospective Observational Study

INTRODUCCIÓN Y OBJETIVO: Se ha constatado un cambio en la epidemiología del herpes genital en los últimos años con un aumento de la incidencia del virus herpes (VHS) tipo 1. El objetivo de nuestro estudio es analizar las características clínico-epidemiológicas de los pacientes diagnosticados de un herpes genital. MATERIAL Y MÉTODOS: Se diseñó un estudio observacional retrospectivo donde se incluyeron todos los pacientes diagnosticados de herpes genital entre enero de 2016 y enero de 2019 en una Unidad de Infecciones de Transmisión Sexual (ITS) en Valencia, España. RESULTADOS: Se diagnosticaron 895 ITS, de las cuales 126 fueron un herpes genital (14%), 68 (54%) en mujeres y 58 (46%) en hombres. En 110 de ellos (87,3%) se confirmó el herpes genital por la detección de ADN viral por técnicas moleculares. Se diagnosticaron 52 casos de VHS tipo 1 (47,3%) y 58 casos de VHS tipo 2 (52,7%). En el 69,5% de los hombres se detectó el VHS tipo 2, mientras que en el 59,3% de las mujeres se detectó el VHS tipo 1. La edad media de las mujeres diagnosticadas de VHS tipo 1 fue de 26 años, mientras que la de las mujeres diagnosticadas de VHS tipo 2 fue de 34 años (p = 0,015). Las recurrencias de las lesiones en los pacientes con VHS tipo 1 y VHS tipo 2 fue del 13% y del 40%, respectivamente. CONCLUSIÓN: Destacamos un aumento de la prevalencia del VHS tipo 1 en nuestro medio como agente causante de herpes genital, especialmente en mujeres jóvenes. Esto tiene un valor pronóstico importante dado el menor riesgo de recurrencias que tiene

INTRODUCTION AND OBJECTIVE: The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. MATERIAL AND METHODS: A retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included. RESULTS: We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P = .015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. CONCLUSIONS: There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur

Síndrome retroviral aguda en un adolescent amb herpes genital / Síndrome retroviral agudo en un adolescente con herpes genital / Acute retroviral syndrome in an adolescent with genital herpes

Introducció: La infecció aguda pel virus de la immunodeficiència humana (VIH) cursa amb clínica inespecífica i transitòria tipus síndrome mononucleòsica. És poc freqüent trobar un cas de VIH en l'edat pediàtrica i, a més, l'adolescent poques vegades expressa de forma espontània una exposició de risc. Per això és important considerar la infecció per VIH, sobretot si es detecten altres infeccions de transmissió sexual. Cas clínic: Adolescent de 13 anys amb discapacitat intel·lectual lleu, que consulta per febre, odinofàgia, astènia, miàlgies, anorèxia, vòmits i diarrea de 5 dies d'evolució. Després d'insistir en l'anamnesi, explica que els darrers dos dies apareix exantema a tronc i úlceres al penis, i que va tenir una única relació homosexual no consentida fa dos mesos. En l'exploració destaca exantema maculoeritematós al tronc, hiperèmia faríngia, adenopaties generalitzades i úlceres doloroses al gland i al prepuci. La reacció en cadena de la polimerasa al frotis de les lesions genitals és positiva per a virus herpes simple 1. El test ràpid d'anticossos pel VIH resulta indeterminat i el test confirmatori per immunocromatografia és negatiu. Presenta càrrega viral del VIH de 1.681.383 còpies/mL, test d'immunoassaig de 4a generació (inclou detecció anticossos VIH i antigen p24) positiu i recompte de limfòcits CD4 de 327 cèl·lules/μL. Rep tractament amb aciclovir i teràpia antiretroviral amb tenofovir, emtricitabina i darunavir/cobicistat, que després de l'alta hospitalària s'administra de forma supervisada al domicili. Comentaris: El pediatre ha d'estar alerta per reconèixer la infecció aguda per VIH i altres malalties de transmissió sexual en l'adolescent. El diagnòstic de la infecció evita la transmissió als altres, i l'inici precoç de la teràpia antiretroviral millora el pronòstic de la malaltia

Introducción: La infección aguda por el virus de la inmunodeficiencia humana (VIH) cursa con clínica inespecífica y transitoria tipo síndrome mononucleósico. Es poco frecuente encontrarse con un caso de VIH en la edad pediátrica y, además, el adolescente pocas veces revela de forma espontánea una exposición de riesgo. Por ello es importante considerar la infección por VIH, sobre todo si se detectan otras infecciones de transmisión sexual. Caso clínico: Adolescente de 13 años con discapacidad intelectual leve, que consulta por fiebre, odinofagia, astenia, mialgias, anorexia, vómitos y diarrea de 5 días de evolución. Tras insistir en la anamnesis, explica que en los últimos dos días aparece exantema en tronco y úlceras en pene, y que tuvo una única relación homosexual no consentida hace dos meses. En la exploración destaca exantema maculoeritematoso en tronco, hiperemia faríngea, adenopatías generalizadas y úlceras dolorosas en glande y prepucio. La reacción en cadena de la polimerasa en frotis de las lesiones genitales es positiva para virus herpes simple 1. El test rápido de anticuerpos VIH resulta indeterminado y el test confirmatorio por inmunocromatografía es negativo. Presenta carga viral del VIH de 1.681.383 copias/ml, test de inmunoensayo de 4ª generación (incluye detección anticuerpos VIH y antígeno p24) positivo y recuento de linfocitos CD4 de 327 células/μl. Recibe tratamiento con aciclovir y terapia antirretroviral con tenofovir, emtricitabina y darunavir/cobicistat, que tras el alta hospitalaria se administra de forma supervisada en domicilio. Comentarios: El pediatra debe estar alerta para reconocer la infección aguda por VIH y otras enfermedades de transmisión sexual en el adolescente. El diagnóstico de la infección evita la transmisión a otros y el inicio precoz de la terapia antirretroviral mejora el pronóstico de la enfermedad

Introduction: Acute human immune deficiency virus (HIV) infection is typically described as a transient and non-specific mononucleosis like syndrome. This acute presentation is rare in pediatrics, and adolescents rarely report a risk exposure. Thus, it is important to consider HIV infection specially if other sexually transmitted diseases are diagnosed. Case report: A 13-year-old boy with mild intellectual disability, presented with a 5-day history of fever, sore throat, asthenia, myalgia, anorexia, vomiting and diarrhea. Upon questioning, the patient disclosed having a rash on the trunk and penis ulcers for the last two days, and that he had non-consensual sex with a man two months prior. Physical examination was notable for a macular rash on the trunk, pharyngitis, generalized lymphadenopathy and painful ulcers on the glans and prepuce. Herpes simplex type 1 was detected in genital lesions by Polymerase Chain Reaction. Rapid HIV test was indeterminate and confirmatory test by immunochromatography was negative. Plasma HIV viral load was 1.681.383 copies/ml, 4th generation immunoassay (including HIV antibodies and p24 antigen detection) was positive and CD4 lymphocyte count was 327 cells/μl. He was treated with acyclovir and started antiretroviral therapy regimen, consisting of tenofovir, emtricitabine and darunavir/cobicistat that was given under supervision at home after discharge. Comments: Pediatricians must be aware of the signs of acute HIV infection and other sexually transmitted diseases in adolescent patients. Prompt diagnosis helps to prevent further transmission and early antiretroviral therapy improves outcomes

Microbial Diversity of Genital Ulcers of HSV-2 Seropositive Women.

We measured the microbial community structure of genital ulcers in women. Swabs from clinically detected ulcers were tested for HSV-2 and Treponema pallidum by polymerase chain reaction (PCR). HSV-2 and T. pallidum were detected by serum antibody testing. Microbial community structure was characterized by high-throughput 16 s rRNA gene amplicon sequencing. Multiple group testing and Elastic net and Lasso regressions identified taxa associated with differences in factors of interest. Among 49 ulcer specimens from 49 HSV-2 seropositive women, by PCR HSV-2 was recovered from 28 (57%) specimens and T. pallidum from none; one woman showed serologic evidence of syphilis. Overall, 63% of women were HIV-positive and 49% had an uncircumcised male sex partner. By both multiple group testing and regression, Porphyromonas (FDR p-value = 0.02), Prevotella (FDR p-value = 0.03), Anaerococcus (FDR p-value = 0.07), and Dialister (FDR p-value = 0.09) were detected at higher relative abundance in HSV-2 PCR-positive than negative ulcers. The presence of HSV-2 in a lesion was associated with presumed bacterial agents of Bacterial vaginosis. Differences in bacterial communities may contribute to HSV-2 ulcer pathogenesis, severity, or prolonged healing. If these results are confirmed, future studies may consider the influence of BV treatment on women's GUD and HSV-2 incidence and recurrence.

Detección de infecciones de transmisión sexual por técnicas de biología molecular / Detection of sexually transmitted infections using molecular biology techniques

Las infecciones de transmisión sexual precisan para su control de pruebas diagnósticas rápidas, fiables y que permitan su realización en situaciones de cribado. Las técnicas de biología molecular han supuesto una verdadera revolución diagnóstica. Debido a su elevada sensibilidad, no solo detectan más infecciones, sino que permiten la obtención de muestras poco invasivas que facilitan los programas de cribado y evitan el rechazo de los pacientes a la realización de toma de muestras. La mejora de su especificidad evita en muchos casos la realización de pruebas de confirmación, bajo la premisa del cumplimiento de normas de calidad. También permiten diagnosticar patógenos que las técnicas de cultivo son incapaces de recuperar, y cada vez tenemos plataformas diagnósticas más sencillas, versátiles y en formato múltiple que agilizan el trabajo en el laboratorio e incluso fuera de él (AU)

Sexually transmitted infections (STI) require rapid, reliable diagnostic tests that can be performed in screening situations. Molecular biology techniques have been a true diagnostic revolution. Due to their high sensitivity, they detect more infections and allow non-invasive sample collection, simplifying screening programs and minimising patient refusal to have samples taken. Improvements in specificity have reduced the need for confirmation tests in many cases, under the premise of compliance with quality standards. They also allow to identify pathogens that culture techniques are unable to recover. Moreover, diagnostic platforms are increasingly simple, versatile and available in multiplex format, facilitating work inside and outside the laboratory (AU)

Pseudoepitheliomatous hyperplasia causing a painful plaque in a HIV-infected female.

Dermatological conditions are more common and can present atypically, in human immunodeficiency virus-infected individuals. This case report describes a 22-year-old human immunodeficiency virus-positive Caucasian female who presented with a vulval lesion eight weeks after starting antiretroviral treatment. Clinical examination revealed a 2 cm well-demarcated plaque on the outer aspect of the left labium minus. The lesion was tender, no contact bleeding or ulceration present. She was presumptively treated for chancroid and herpes simplex with 500 mg ceftriaxone IM stat, 1 g azithromycin PO stat, and valacyclovir 500 mg BD for five days. The lesion persisted despite treatment, and during follow-up, a punch biopsy was carried out. She was diagnosed with pseudoepitheliomatous hyperplasia of the epidermis. In addition to highlighting this condition that has been previously reported in human immunodeficiency virus/herpes simplex virus co-infection, this case demonstrates that unusual skin presentations must be considered in human immunodeficiency virus-infected individuals and illustrates the importance of biopsy for any non-healing lesions.

Distinct Effects of the Cervicovaginal Microbiota and Herpes Simplex Type 2 Infection on Female Genital Tract Immunology.

Background: Genital inflammation is a key determinant of human immunodeficiency virus (HIV) transmission, and may increase HIV-susceptible target cells and alter epithelial integrity. Several genital conditions that increase HIV risk are more prevalent in African, Caribbean, and other black (ACB) women, including bacterial vaginosis and herpes simplex virus type-2 (HSV-2) infection. Therefore, we assessed the impact of the genital microbiota on mucosal immunology in ACB women and microbiome-HSV-2 interactions. Methods: Cervicovaginal secretions and endocervical cells were collected by cytobrush and Instead Softcup, respectively. T cells and dendritic cells were assessed by flow cytometry, cytokines by multiplex enzyme-linked immunosorbent assay (ELISA), and the microbiota by 16S ribosomal ribonucleic acid gene sequencing. Results: The cervicovaginal microbiota of 51 participants were composed of community state types (CSTs) showing diversity (20/51; 39%) or predominated by Lactobacillus iners (22/51; 42%), L. crispatus (7/51; 14%), or L. gasseri (2/51; 4%). High-diversity CSTs and specific bacterial phyla (Gardnerella vaginalis and Prevotella bivia) were strongly associated with cervicovaginal inflammatory cytokines, but not with altered endocervical immune cells. However, cervical CD4+ T-cell number was associated with HSV-2 infection and a distinct cytokine profile. Conclusions: This suggests that the genital microbiota and HSV-2 infection may influence HIV susceptibility through independent biological mechanisms.

Association of HPV infection and clearance with cervicovaginal immunology and the vaginal microbiota.

Cervical human papillomavirus (HPV) infection may increase HIV risk. Since other genital infections enhance HIV susceptibility by inducing inflammation, we assessed the impact of HPV infection and clearance on genital immunology and the cervico-vaginal microbiome. Genital samples were collected from 65 women for HPV testing, immune studies and microbiota assessment; repeat HPV testing was performed after 6 months. All participants were HIV-uninfected and free of bacterial STIs. Cytobrush-derived T cell and dendritic cell subsets were assessed by multiparameter flow cytometry. Undiluted cervico-vaginal secretions were used to determine cytokine levels by multiplex ELISA, and to assess bacterial community composition and structure by 16S rRNA gene sequence analysis. Neither HPV infection nor clearance were associated with broad differences in cervical T cell subsets or cytokines, although HPV clearance was associated with increased Langerhans cells and HPV infection with elevated IP-10 and MIG. Individuals with HPV more frequently had a high diversity cervico-vaginal microbiome (community state type IV) and were less likely to have an L. gasseri predominant microbiome. In summary, HPV infection and/or subsequent clearance was not associated with inflammation or altered cervical T cell subsets, but associations with increased Langerhans cells and the composition of the vaginal microbiome warrant further exploration.

Chlamydial Pre-Infection Protects from Subsequent Herpes Simplex Virus-2 Challenge in a Murine Vaginal Super-Infection Model.

Chlamydia trachomatis and Herpes Simplex Virus-2 (HSV-2) genital tract co-infections have been reported in humans and studied in vitro but the clinical consequences are unknown. Limited epidemiologic evidence suggests that these co-infections could be more severe than single infections of either pathogen, but the host-pathogen interactions during co-infection remain uncharacterized. To determine whether disease progression and/or pathogen shedding differs between singly-infected and super-infected animals, we developed an in vivo super-infection model in which female BALB/c mice were vaginally infected with Chlamydia muridarum (Cm) followed later by HSV-2. Pre-infection with Chlamydia 3 or 9 days prior to HSV-2 super-infection conferred significant protection from HSV-2-induced neurologic disease and significantly reduced viral recovery compared to HSV-2 singly-infected controls. Neither protection from mortality nor reduced viral recovery were observed when mice were i) super-infected with HSV-2 on day 27 post Cm; ii) infected with UV-irradiated Cm and super-infected with HSV-2; or iii) azithromycin-treated prior to HSV-2 super-infection. Therefore, protection from HSV-2-induced disease requires active infection with viable chlamydiae and is not observed after chlamydial shedding ceases, either naturally or due to antibiotic treatment. Thus, Chlamydia-induced protection is transient and requires the continued presence of chlamydiae or their components. These data demonstrate that chlamydial pre-infection can alter progression of subsequent HSV-2 infection, with implications for HSV-2 transmission from co-infected humans.

[IS A NONBACTERIAL PROSTATITIS NONBACTERIAL?].

The study involved 287 patients with chronic recurrent urethroprostatitis. In 83 (28.9%) of them the bacterial microflora in prostatic secretions was detected. The remaining 204 patients with nonbacterial prostatitis underwent in-depth laboratory testing. Cytological and immunological methods, electron microscopy, PCR, McCoy cell culture and developed by the authors the pre-culture pathogen accumulation technique were used to investigate urethral and prostatic smears. As a result C. trachomatis was detected in 84.8% of patients, T. vaginalis--75.5%, and viruses of the Herpesviridae family--in 68.6%. Co-infection was diagnosed in 82.4% of patients, no infection was found in 6.9% of patients. The highest diagnostic sensitivity and specificity were observed in the pre-culture pathogen accumulation technique. According to electron microscopy, T. vaginalis was presented in several morphological shapes: flagellated, spherical and amoeboid. Thus, in 93.1% of patients who had previously been diagnosed with nonbacterial prostatitis by standard bacterial culture, the in-depth microbiological examination identified atypical infections (chlamydia, herpes virus, trichomonas), revealing that the rate of real nonbacterial (non-infectious) prostatitis did not exceed 6.9%.

CD18 deficiency evolving to megakaryocytic (M7) acute myeloid leukemia: case report.

Leukocyte adhesion deficiency type 1 (LAD 1 - CD18 deficiency) is a rare disease characterized by disturbance of phagocyte function associated with less severe cellular and humoral dysfunction. The main features are bacterial and fungal infections predominantly in the skin and mucosal surfaces, impaired wound healing and delayed umbilical cord separation. The infections are indolent, necrotic and recurrent. In contrast to the striking difficulties in defense against bacterial and fungal microorganisms, LAD 1 patients do not exhibit susceptibility to viral infections and neoplasias. The severity of clinical manifestations is directly related to the degree of CD18 deficiency. Here, a 20 year-old female presenting a partial CD18 deficiency that developed a megakaryocytic (M7) acute myeloid leukemia is described for the first time. The clinical features of the patient included relapsing oral thrush due to Candida, cutaneous infections and upper and lower respiratory tract infections, followed by a locally severe necrotic genital herpetic lesion. The patient's clinical features improved for a period of approximately two years, followed by severe bacterial infections. At that time, the investigation showed a megakaryocytic acute myeloid leukemia, treated with MEC without clinical improvement. The highly aggressive evolution of the leukemia in this patient suggests that adhesion molecules could be involved in the protection against the spread of neoplastic cells.

Vulvar pseudoepitheliomatous hyperplasia associated with herpes simplex virus type II mimicking cancer in an immunocompromised patient.

We report an exaggerated dermatological inflammatory condition in an immunocompromised patient. The patient was a 51-year-old woman who had HIV infection and a history of cervical cancer. Three years after highly active antiretroviral therapy with an improved immune status, and 2 years after remission of cervical cancer, she developed verrucous perineal masses. Provisional diagnosis was recurrent cervical cancer or primary vulvar cancer. Pathological features revealed pseudoepitheliomatous hyperplasia associated with herpes viral infection. After minimal response to systemic oral antiviral drugs and topical imiquimod, she had clinical resolution with the addition of systemic oral corticosteroid.

Optical coherence tomography for assessment of microbicide safety in a small animal model.

Sensitive imaging techniques for small animals are needed to assess drug toxicity in preclinical studies. Optical coherence tomography (OCT) provides a noninvasive tool for high-resolution, depth-resolved visualization of drug-induced changes in tissue morphology. In a mouse model, we utilize OCT to assess vaginal tissue integrity following the application of topical microbicides (drugs used to prevent infection). Mice are challenged with herpes simplex virus-2 (HSV-2) to determine the correlation of tissue damage as quantified by OCT to increased susceptibility. The microbicide benzalkonium chloride (BZK) (0.02, 0.2, or 2%) or phosphate buffered saline control is administered intravaginally. In vivo OCT imaging and collection of tissue samples are performed after treatment. A quantitative OCT scoring system is applied to assess epithelial damage, and the results are compared with those of histology. A separate group of mice are treated similarly then challenged with HSV-2. Epithelial morphology quantified noninvasively by OCT and histology are dose-dependent (p<0.0001). The OCT scoring system detected a significant increase in epithelial damage with increasing BZK concentration (p<0.0001). These results paralleled an increase in HSV-2 susceptibility (p<0.005). OCT can be used as a noninvasive tool to assess topical drug toxicity in a small animal model with potential to predict increased susceptibility to vaginal infection.

Recalcitrance of bacterial vaginosis among herpes-simplex-virus-type-2-seropositive women.

AIM: The multifactorial etiology of bacterial vaginosis (BV) impedes development of effective treatment and prevention strategies. Herein, we evaluated the effects of herpes simplex virus type 2 (HSV-2), a suspected BV risk factor, on vaginal flora composition. MATERIALS AND METHODS: Correlations between HSV-2 infection and BV were prospectively explored among 12 HSV-2-seropositive women with asymptomatic BV who were asked to collect daily vaginal swab specimens for Gram stain analysis of vaginal flora and determination of HSV-2 shedding frequencies during the 1month before and after metronidazole therapy. RESULTS: Unlike prior longitudinal studies that reported rapid fluctuations in vaginal flora composition and frequent episodes of spontaneously resolving BV, we found that 99.4% (310/312) of vaginal smears collected before initiation of metronidazole were consistent with a diagnosis of BV. Effectiveness of metronidazole therapy was also much lower than previously reported in studies not restricting enrollment to HSV-2-seropositive women; we observed a BV recurrence rate of 89% in the first month after completion of therapy while the median time to this recurrence occurred only 14days after treatment. CONCLUSIONS: Our study demonstrates BV recalcitrance among HSV-2-infected women and provides additional evidence for a linkage between this chronic viral infection and abnormal vaginal flora. Additional work will be needed to define mechanisms responsible for this correlation and to determine if vaginal flora health of HSV-2-infected women is improved by medications that suppress HSV-2 shedding.

[Comprehensive examination of the female urogenital tract infection by polymerase chain reaction using multiplex test systems].

The results of the polymerase chain reaction studies performed in 2006-2008 were used to make a retrospective analysis of the detection of urogenital herpesvirus infections in reproductive-aged women constituting the urban population of the central region of Russia. The study used both monotarget and mutiplex test systems to detect herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus types 6 and 7. A total of about 7.500 referrals; the detection rate for HSV was about 1%; that for CMV was from 0.3 in 2006 to 1% in 2008; that for EBV was from 0.1% in 2006 to 0.3% in 2008. More than a half of HSV-, CMV-, or EBY-positive samples also contained DNA of other causative agents and some samples did two pathogens or more. Multiplex test systems for herpesviruses considerably enhance the efficiency of diagnostic studies and reduce the material and time costs of diagnosis.

Risk factors for herpes simplex virus type 2 and its association with HIV among pregnant teenagers in Zimbabwe.

Herpes simplex virus type 2 (HSV-2) causes a chronic infection that is recognised as the leading cause of genital ulcer disease worldwide and is known to increase the risk of HIV infection. In a cross-sectional study we examined risk factors for HSV-2 among 176 pregnant teenagers recruited from three primary health care clinics in Zimbabwe. The prevalence of HSV-2 and HIV were 41.6% and 29.2% respectively. HIV-infected teenagers were more likely to be HSV-2 seropositive compared with the HIV uninfected teenagers, odds ratio (OR) 7.9 (95% confidence interval (CI) 3.7-16.9). In multivariate analysis having an older partner remained independently associated with HSV-2 seropositivity, OR 2.9 (95% CI 1.2-6.9) suggesting that risk factors for HSV-2 seropositivity among pregnant teenagers depend primarily on the behaviour of the male partners.

Utilidad de las técnicas de biología molecular en el diagnóstico de las infecciones de transmisión sexual y otras infecciones genitales / Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections

Históricamente, el diagnóstico de las infecciones detransmisión sexual ha sido difícil. La introducción en eldiagnóstico microbiológico de las técnicas de biologíamolecular y su aplicación a muestras no invasivas hapermitido importantes avances en su diagnóstico. Engeneral, la detección de Neisseria gonorrhoeae mediantetécnicas de biología molecular proporciona un diagnósticopresuntivo y requiere confirmación por cultivo en zonas de baja prevalencia. Para Chlamydia trachomatis, estastécnicas se consideran como las más sensibles yespecíficas, tanto para estudios de cribado poblacional,como para el diagnóstico de pacientes sintomáticos. Eldiagnóstico de Mycoplasma genitalium por cultivo es muylento, por ello, las técnicas moleculares son las únicas que pueden aportar información diagnóstica relevante. Para Treponema pallidum, las técnicas moleculares puedenaportar ventajas en el diagnóstico directo de la infección. Respecto a la donovaniosis, las técnicas moleculares no están establecidas para el diagnóstico sistemático, aunque se recomiendan en manos expertas. En el caso de Haemophilus ducreyi, las dificultades del cultivo y su baja sensibilidad aconsejan el uso de métodos moleculares. En el herpes genital, las técnicas moleculares han comenzado a recomendarse para el diagnóstico sistemático y pueden convertirse en la técnica de referencia en poco tiempo. Para otras infecciones genitales, como vaginosis bacteriana, vulvovaginitis candidiásica y tricomoniasis, losmétodos moleculares para el diagnóstico están pocoestablecidos. Respecto a las verrugas genitales, lastécnicas de cribado y genotipado disponibles paramuestras endocervicales podrían utilizarse para ciertaspoblaciones, aunque no se han validado para estecometido

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose

Herpes simplex virus type 2 and Chlamydia trachomatis in adenocarcinoma of the uterine cervix.

INTRODUCTION: Adenocarcinoma of the uterine cervix (AC) occurs in 15-20% of primary cervical neoplasias. Although some etiologic factors for squamous cell carcinoma are well defined, and its relationship with sexually transmitted disease as human papillomavirus (HPV) is established, we still do not know about the causative factors of most of AC besides HPV infection. OBJECTIVES: To determine the presence of herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis (CT) DNA in AC specimens, and its correlation with HPV infection. METHODS: 206 paraffin-embedded cases of AC were selected to DNA extraction. The specimens and the DNA were isolated. Samples were first screened for beta-globin DNA sequences, and 67 cases were considered adequate to further analysis. In a previous analysis, DNA of HPV was identified in 79.4% of specimens included in this series (51% HPV 18 and 34% HPV 16). The local ethical committee approved the study. RESULTS: All samples were negative for HSV-2 DNA and CT DNA. CONCLUSIONS: In our series HSV-2 DNA and CT DNA were not found to be integrated to the genome of adenocarcinoma of the uterine cervix and do not seem to be a co-factor for HPV on the etiology of this histologic subtype.

The microenvironment of vulvar skin in women with symptomatic and asymptomatic herpes simplex virus type 2 (HSV-2) infection.

BACKGROUND: It is not known why some individuals infected with herpes simplex virus type 2 (HSV-2), experience frequent recurrences, while most of those infected have a completely silent infection. OBJECTIVE: We wanted to study if local factors in the skin could explain this difference. DESIGn 21 HSV-2 seropositive patients, 10 with history of >8 clinical recurrences a year (symptomatics) and 11 without symptoms of genital herpes (asymptomatics) were included. All had to answer a questionnaire. With standardised methods, the skin temperature, pH, and the skin barrier function, expressed as transepidermal water loss (TEWL) and skin capacitance, were measured on labium majus and perineum. Culture for bacteria was performed from the same regions. RESULTS AND CONCLUSION: No significant differences in terms of pH and skin barrier function were registered between symptomatic and asymptomatic patients. Asymptomatic patients had a tendency (0.06) to a higher colonisation with lactobacilli on labium majus than symptomatic patients.

Poor correlation between genital lesions and detection of herpes simplex virus in women in labor.

OBJECTIVE: To estimate the accuracy of clinical diagnosis of genital herpes for herpes simplex virus (HSV) detection among women in labor. METHODS: Viral detection by culture and HSV DNA polymerase chain reaction (PCR) among women who underwent cesarean delivery for genital herpes was compared with women without HSV symptoms in labor who had genital swabs collected for HSV culture and to a subset of these women who had genital specimens available for PCR analysis, regardless of culture results. RESULTS: From 1989 to 1999, 126 of 19,568 (0.6%) women underwent cesarean delivery for HSV. Twenty-six percent of 110 of these women had HSV detected by culture from at least 1 genital specimen and 46% of 70 of these women had HSV detected by PCR. During the same period, 61 of 12,623 (0.5%) asymptomatic women had HSV detected by culture. Between 1995 and 1996, 57 of 2,109 (2.7%) asymptomatic women had HSV detected by PCR. Thus, the presence of genital lesions had a sensitivity for HSV detection of 37% by culture and 41% by PCR. The amount of HSV present in asymptomatic women with HSV detected in genital secretions by PCR was often as high as those with genital lesions, although the median amount of HSV DNA detected was greater in women with lesions. CONCLUSION: Clinical diagnosis of genital herpes at the time of labor correlates relatively poorly with HSV detection from genital sites or lesions by culture or PCR and fails to identify asymptomatic women who have HSV in their genital secretions at the time of labor.

Induction of secretory aspartyl proteinase of Candida albicans by HIV-1 but not HSV-2 or some other microorganisms associated with vaginal environment.

The most common type of candidiasis involves mucosal sites such as the oral cavity, the gastrointestinal tract and the vagina. Among many of virulence factors, the production of secretory aspartyl proteinase (Sap) by Candida albicans (C. albicans) has gained much attention, and factors leading to Sap induction are thus under intense study. The aim of this study was to examine whether some microorganisms such as Lactobacillus, Gardnerella vaginalis (G. vaginalis), human immunodeficiency virus type-1 (HIV-1) and human herpes simplex virus type-2 (HSV-2) had any Sap inducing effect on C. albicans. Here we showed that among the microorganisms tested in vitro only HIV-1 induced Sap production from C. albicans.