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Biomedical subjects

L Corey

Publications and source records attributed to L Corey.

421 records · Page 24Linked to original sources
PubMedDate not supplied

Frequency of acquisition of first-episode genital infection with herpes simplex virus from symptomatic and asymptomatic source contacts.

Sixty-six source contacts of index patients with first-episode genital infection caused by herpes simplex virus (HSV) were evaluated for evidence of current or past HSV infections. Forty-three source contacts (65%) reported a history consistent with previous recurrent HSV infection or were experiencing a first episode of genital herpes when initially examined. However, 60% of these 43 contacts were not aware that they had transmissible HSV infection. Twenty-nine (67%) of the 43 individuals had had recent sexual contact with an index patient when lesions were present. All of the remaining 23 source contacts, who were without a history of symptoms consistent with HSV infection, had detectable neutralizing antibody to HSV; HSV type 2 was isolated from the cervix of two of these asymptomatic source contacts. Efforts to identify individuals with undiagnosed genital herpes and to instruct these individuals concerning the risk of disease transmission in the presence of lesions are needed if the rate of transmission is to be decreased; however, methods designed to decrease the rate of transmission by asymptomatic individuals must also be evaluated.

Adult↗
PubMedDate not supplied

Risk of recurrence after treatment of first-episode genital herpes with intravenous acyclovir.

To determine whether intravenous acyclovir treatment for a first episode of genital herpes could prevent or reduce subsequent recurrences, we combined and analyzed the results of two independently conducted, randomized, double-blind, placebo-controlled studies. Sixty-one patients were enrolled in the two trials; 30 received the drug, and 31 received placebo. At entry the demographic, epidemiologic, and clinical features of acyclovir- and placebo-treated patients from the two centers showed no significant differences. The median time to the first recurrence and the frequency of recurrences showed no significant differences when acyclovir and placebo recipients infected with either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2) were compared. However, irrespective of treatment, the median time to the first recurrence was significantly longer (293 days vs. 69 days; P less than .02) and the frequency of recurrence significantly less (0.11 recurrences per month vs. 0.43 recurrences per month; P less than .01) among patients with HSV-1 infection as compared with those who had HSV-2. It is concluded that in patients with first-attack genital herpes, the type of HSV is the most important determinant of subsequent recurrences and that intravenous acyclovir has little effect on subsequent recurrences.

Acyclovir↗
PubMedDate not supplied

The frequency of unrecognized type 2 herpes simplex virus infection among women. Implications for the control of genital herpes.

To evaluate the prevalence of symptomatic versus asymptomatic or unrecognized type 2 herpes simplex virus (HSV-2) infection, the authors performed physical examination, viral cultures, and type-specific serologic assays in 776 randomly selected women attending an STD clinic and 636 female university students. Forty-six percent of women attending the STD clinic compared with 8.8% of the university students had serologic evidence of HSV-2 infection. Clinical or historical evidence of genital herpes was present in only 34% of the HSV-2 seropositive women attending the STD clinic and in 29% of the HSV-2 seropositive women attending the university clinic. Among women attending the STD clinic, the prevalence of recognized genital infection was more common among those with HSV-2 antibodies only versus those with HSV-1 and -2 antibodies (odds ratio = 2.39; 95% confidence interval = 1.30-4.37), suggesting that HSV-1 infection reduces the likelihood of recognizing HSV-2 infection. In view of the high proportion of seropositive individuals with unrecognized HSV-2 infection in both high and low prevalence HSV-2 seropositive populations, newly developed HSV type-specific serologic methods should be evaluated for detecting carriers of HSV-2 infection and counseling these individuals about strategies for avoiding sexual and perinatal transmission of HSV-2.

Adolescent↗
PubMedDate not supplied

Underestimation of HSV-2 seroprevalence in a high-risk population by microneutralization assay.

BACKGROUND: Complement independent neutralizing antibody assays (CINA) have been used in seroepidemiologic studies and in diagnostic laboratories to distinguish between antibodies to herpes simplex virus types 1 (HSV-1) and 2 (HSV-2). The accuracy of CINA has not been rigorously tested against protein-specific typing assays, such as Western blot. GOAL OF THIS STUDY: To determine the ability of CINA to identify HSV-2 antibodies alone or in the presence of HSV-1 antibodies. STUDY DESIGN: Sera from randomly selected women at the Seattle King County Sexually Transmitted Disease Clinic were tested by CINA and Western blot. RESULTS: Of 521 women tested, 81% had HSV antibodies by Western blot and 76% had neutralizing antibodies. Of 220 sera with HSV-2 antibodies by Western blot, 106 (48%) were serotyped correctly by CINA. Of the women studied, 140 (27%) had type-indeterminate neutralizing antibodies; 55 of these sera (39%) had antibody only to HSV-1 by Western blot. CONCLUSION: The seroprevalence of HSV-2 in an STD clinic population was seriously underestimated by CINA.

Antibodies, Viral↗
PubMedDate not supplied

Therapeutic efficacy and complications of excisional biopsy of condyloma acuminatum.

BACKGROUND AND OBJECTIVES: Among the various treatment modalities for condyloma acuminatum, excisional cold-blade surgery appears excellent but it has been little studied and little used, particularly for lesions not located in the perianal area. GOALS: To examine the efficacy and complications of scissors excision of single anogenital warts. STUDY DESIGN: Retrospective analysis of single warts completely excised with scissors for the purpose of biopsy before patient entry in a randomized, placebo-controlled study of the efficacy and safety of various parenteral interferons in combination with cryotherapy. RESULTS: Of 152 patients entered in the main study, 85 patients were available for analysis. At 4 and 16 weeks after excision, 16 of 85 (19%) and 14 of 68 (21%) of the excised lesions recurred. After at 6 least months of follow-up, 2 of 11 (18%) of the excision sites demonstrated some evidence of pigmentation changes. CONCLUSIONS: Scissors excision of single anogenital warts has a high rate of success and acceptable long-term side-effects.

Adult↗
PubMedDate not supplied

The current trend in genital herpes. Progress in prevention.

Recent serosurveys indicate that the prevalence of genital herpes has continued to increase even during the decade of HIV. Much of this continued transmission is due to the difficulty of identifying the subclinical carrier of HSV-2. The development of serologic assays that accurately distinguish HSV-1 from HSV-2 infection now allow such persons to be identified, and recent studies indicate almost all HSV-2 seropositives have symptoms and signs of reactivation HSV-2. Moreover, over 50% will shed virus subclinically in the genital tract. This underestimation of this reactivation rate appears to be another factor in the continued spread of the virus throughout the population. The development of an HSV vaccine is imperative if we are to control this rapidly increasing infection.

Adolescent↗