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PubMedDate not supplied

Recurrent genital herpes: what helps adjustment?

Psychosocial adjustment to recurrent genital infections with herpes simplex virus (HSV) varies greatly among individuals. To identify the factors predictive of psychosocial adjustment to recurrent genital HSV infections, we analyzed data from interviews and psychological tests conducted with infected individuals. We found that avoidant coping strategies such as denial and social support from a counselor were negatively correlated with adjustment to genital HSV, whereas cognitive coping strategies and social support from one's spouse or lover were positively correlated with adjustment. We conclude that psychosocial adjustment to recurrent genital HSV infections might be facilitated by sharing one's diagnosis with supportive intimate others and avoiding denial as a defense mechanism.

Adaptation, Psychological↗
PubMedDate not supplied

Treatment of genital HPV infection with carbon dioxide laser and systemic interferon alpha-2b.

BACKGROUND AND OBJECTIVES: Treatment of genital warts is problematic. Numerous treatment modalities are available, but response to any therapy often is unsatisfactory. Recently, studies have suggested that interferons would be effective in the treatment of some genital warts. GOAL OF THIS STUDY: To compare carbon dioxide laser with or without adjuvant subcutaneously administered interferon alpha-2b in the treatment of genital human papillomavirus infection. STUDY DESIGN: One hundred randomized women with genital HPV infection were treated with carbon dioxide laser and adjuvant systemic interferon alpha-2b or carbon dioxide laser and placebo. Patients were followed colposcopically, cytologically, and by HPV DNA testing for 6 months. RESULTS: Complete response was seen in 62% patients who received adjuvant interferon, and in 68% patients who received placebo. However, recurrence was less common in patients treated with interferon who were infected with HPV 16/18. CONCLUSION: Only a subgroup of patients, women infected with HPV DNA 16/18, benefited from adjuvant systemic interferon treatment.

Adolescent↗
PubMedDate not supplied

Spectrum of genital human papillomavirus infection in a female adolescent population.

BACKGROUND: Human papillomavirus infection is a sexually transmitted disease associated with cervical dysplasia and carcinoma. GOAL OF THIS STUDY: To determine prevalence rates of cervical human papillomavirus infection compared with other sexually transmitted diseases and risk factors associated with human papillomavirus infection among adolescent women, we evaluated 634 patients attending three urban adolescent clinics. STUDY DESIGN: Patient evaluation included Pap smears; screening for chlamydia, gonorrhea, and trichomoniasis; and testing of cervical swab samples for human papillomavirus DNA. RESULTS: Cervical human papillomavirus was the most common STD in our population (15.6%), followed by infection with Chlamydia trachomatis (11.0%), Neisseria gonorrhoeae (7.1%), and Trichomonas vaginalis (5.4%). The most prevalent human papillomavirus types were 16/18 (7.3%), followed by 31/33/35 (4.7%) and 6/11 (3.5%). When genital warts on exam, low-grade squamous intraepithelial lesions on cytology, or cervical human papillomavirus DNA were considered as indicators of genital human papillomavirus infection, 24% of patients had any manifestation of infection, including 15% with clinically apparent infection (genital warts), 36% with cytologically apparent infection without warts, and 49% with subclinical infection only (cervical human papillomavirus DNA without low-grade squamous intraepithelial lesions or warts). Factors associated with detection of cervical human papillomavirus DNA by multivariate analysis included number of lifetime sexual partners and genital warts on exam. CONCLUSION: Cervical human papillomavirus infection was the most prevalent sexually transmitted disease among an ethnically diverse group of urban adolescent females, with a large proportion of infections neither clinically nor cytologically apparent. The strong association with lifetime sexual partners substantiates that cervical human papillomavirus is acquired predominantly by sexual contact and often soon after the onset of sexual activity.

Adolescent↗
PubMed1997

Interferon-gamma and interleukin-5 production by mice in response to genital infection by the mouse pneumonitis agent of Chlamydia trachomatis.

BACKGROUND AND OBJECTIVES: Mice sensitized with a chlamydial detergent extract and then genitally infected by Chlamydia trachomatis have increased genital inflammation characterized by elevated eosinophils, but do not have increased protective immunity. In contrast, mice infected previously by C. trachomatis show strong protective immunity. The authors studied interferon-gamma levels (associated with protective immunity) and interleukin-5 levels (the major cytokine responsible for eosinophilia). GOALS: To evaluate protective and nonprotective immune responses to chlamydial infection. STUDY DESIGN: The authors examined interferon-gamma and interleukin-5 levels in the genitalia during chlamydial genital infection among three groups of mice: extract-sensitized, sham-sensitized, and infected previously. RESULTS: Interferon-gamma levels peaked between 24 and 72 hours after chlamydial infection and then declined among all groups of mice. Overall, interleukin-5 levels increased throughout infection. Interleukin-5 levels apparently continued to increase over the 5-week period after primary infection. CONCLUSIONS: Increased interferon-gamma levels were associated with an early response to chlamydial genital infection. Increased interleukin-5 levels were associated with a more persistent immune response.

Animals↗
PubMed1997

Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Study Group.

BACKGROUND AND OBJECTIVES: Valaciclovir, the L-valine ester prodrug of acyclovir, is much better absorbed than acyclovir and produces acyclovir exposures three to five times those attainable with the parent drug. GOALS: To determine whether the improved bioavailability of valaciclovir and a more convenient, less frequent dose regimen can maintain the clinical efficacy previously demonstrated for acyclovir. STUDY DESIGN: This was an international, multicenter, randomized, double-blind clinical trial comparing 10-day regimens of valaciclovir (1000 mg, twice daily) and acyclovir (200 mg, 5 times daily) in the treatment of 643 otherwise healthy adults (> or = 18 years of age) with first-episode genital herpes. Patients were evaluated clinically and lesions were staged and cultured on days 1, 2, 3, 5, 7, 10, 14, and then twice weekly until healed. Blood for herpes serology tests was obtained on days 1 and 14; hematology and chemistry toxicity screening was done on days 1 and 7. RESULTS: Valaciclovir and acyclovir did not differ significantly in efficacy with respect to duration of viral shedding (hazard ratio, 1.00; 95% confidence interval [CI], 0.84-1.18), time to healing (hazard ratio, 1.08; 95% CI, 0.92-1.27), duration of pain (hazard ratio, 1.0; 95% CI, 0.85-1.18), and time to loss of all symptoms (hazard ratio, 1.02; 95% CI, 0.85-1.22). Patients with primary genital herpes (no preexisting antibody to either herpes simplex virus type at enrollment with seroconversion at day 14) had longer times to healing and longer duration of viral shedding and pain than patients with nonprimary first genital episodes. Adverse experiences were generally infrequent and mild and were comparable in the two treatment groups. CONCLUSIONS: Twice-daily valaciclovir proved as effective and well tolerated in the treatment of first-episode genital herpes as five-times-daily acyclovir. Valaciclovir provides a useful alternative to acyclovir with the advantage of a more convenient dosing regimen and the potential for improved compliance.

Acyclovir↗
PubMed1999

An interactive, computer-based program to educate patients about genital herpes.

BACKGROUND AND OBJECTIVES: Education and counseling constitute a substantial portion of management of patients with genital herpes. Innovative methods for education about genital herpes are needed. GOAL: To test the ability of an interactive, computer-based program to educate patients about genital herpes. STUDY DESIGN: Persons seeking care at five urban offices were asked to participate. A knowledge test about genital herpes was administered before and after participation. Participants' satisfaction was assessed with a questionnaire. RESULTS: Four hundred thirty-five participants enrolled, and 428 completed the herpes knowledge test. Of six questions evaluated, a statistically significant increase in the proportion of correct answers was noted on five of six questions. Fifty-one percent of participants answered all the questions correctly after the program, compared with 39% before the program. Satisfaction with the program was very high. CONCLUSIONS: Innovative, computer-based programs can provide education and assist in the management of chronic sexually transmitted infections.

Adolescent↗
PubMed2000

Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions: systematic review and data synthesis.

OBJECTIVE: To determine whether coinfection with sexually transmitted diseases (STD) increases HIV shedding in genital-tract secretions, and whether STD treatment reduces this shedding. DESIGN: Systematic review and data synthesis of cross-sectional and cohort studies meeting predefined quality criteria. MAIN OUTCOME MEASURES: Proportion of patients with and without a STD who had detectable HIV in genital secretions, HIV load in genital secretions, or change following STD treatment. RESULTS: Of 48 identified studies, three cross-sectional and three cohort studies were included. HIV was detected significantly more frequently in participants infected with Neisseria gonorrhoeae (125 of 309 participants, 41%) than in those without N gonorrhoeae infection (311 of 988 participants, 32%; P = 0.004). HIV was not significantly more frequently detected in persons infected with Chlamydia trachomatis (28 of 67 participants, 42%) than in those without C trachomatis infection (375 of 1149 participants, 33%; P = 0.13). Median HIV load reported in only one study was greater in men with urethritis (12.4 x 104 versus 1.51 x 104 copies/ml; P = 0.04). In the only cohort study in which this could be fully assessed, treatment of women with any STD reduced the proportion of those with detectable HIV from 39% to 29% (P = 0.05), whereas this proportion remained stable among controls (15-17%). A second cohort study reported fully on HIV load; among men with urethritis, viral load fell from 12.4 to 4.12 x 104 copies/ml 2 weeks posttreatment, whereas viral load remained stable in those without urethritis. CONCLUSION: Few high-quality studies were found. HIV is detected moderately more frequently in genital secretions of men and women with a STD, and HIV load is substantially increased among men with urethritis. Successful STD treatment reduces both of these parameters, but not to control levels. More high-quality studies are needed to explore this important relationship further.

Cohort Studies↗
PubMed2000

Premarket evaluation of the POCkit HSV-2 type-specific serologic test in culture-documented cases of genital herpes simplex virus type 2 [see comment].

BACKGROUND AND OBJECTIVES: The genital herpes epidemic continues, in part, because patients with subclinical or atypical presentations cannot be identified by most herpes simplex virus (HSV) antibody tests. A new product, POCkit HSV-2, has been developed to rapidly and accurately detect antibodies to HSV type 2 (HSV-2) in capillary blood or serum. GOAL: Sera from patients with culture-documented genital or oral herpes were tested to determine the sensitivity and specificity of the POCkit HSV-2 rapid point-of-care antibody test (Diagnology, Belfast, Northern Ireland). STUDY DESIGN: Sera from 50 patients with culture-documented HSV type 1 (9 oral, 41 genital) and from 253 patients with genital HSV-2 were tested by POCkit HSV-2 for HSV-2 antibodies. Each subject had a positive culture for HSV within 6 months of serum collection. Sera were preselected to include only those that were seropositive to the respective virus subtype by University of Washington Western blot. RESULTS: Compared with viral culture and Western blot analysis, sensitivity of the POCkit HSV-2 test for HSV-2 antibody was 96%; specificity was 98%. CONCLUSION: This test provides rapid, accurate identification of HSV-2 antibody in subjects with established HSV infections.

Antibodies, Viral↗
PubMed2001

Genital ulceration in rural Uganda: sexual activity, treatment-seeking behavior, and the implications for HIV control.

BACKGROUND: Genital ulcer disease (GUD) is documented as a significant risk factor for HIV acquisition. Its prompt recognition and effective treatment are important components of HIV control in sub-Saharan Africa. GOALS: To determine the rate and risk factors for GUD, and to describe sexual and treatment-seeking behavior. STUDY DESIGN: A longitudinal follow-up study of 525 individuals, both those infected with HIV and those uninfected, was conducted in a population-based, clinical cohort over 9 years. RESULTS: The rate of GUD in this population was 16/100 person years, and 30% of the participants reported an episode during the follow-up period. The rates were almost four times higher in participants infected with HIV than in those who were HIV-negative. Half of the participants with a regular sexual partner reported engaging in sex while symptomatic, and only 16% informed their partner. Treatment was sought for only 12% of the genital ulcer disease episodes, despite open access to doctors at a free clinic. A self-diagnosis of genital herpes did not affect treatment-seeking or sexual behavior. CONCLUSIONS: Genital ulcer disease is very common in this rural population, especially among those infected with HIV. Few seek treatment, and many continue sexual activity despite symptoms without informing their partners. The implications of these findings for HIV control are a cause for concern.

Adult↗
PubMed2002

Relapses after treatment of external genital warts are more frequent in HIV-positive patients than in HIV-negative controls.

BACKGROUND: Recurrences of cervical lesions associated with human papillomavirus are more frequent in HIV-infected (HIV+) than in HIV- women. Recurrences of external genital warts were investigated in HIV+ patients and HIV- control subjects. GOAL: To compare relapses after treatment of external genital warts between HIV+ and HIV- patients. STUDY DESIGN: At the sexually transmitted disease (STD) center in Brescia, Italy, 1336 patients (241 HIV+ and 1095 HIV-) with external genital warts were examined in the decade 1990 to 1999. Various local treatments were used. RESULTS: Treatments generally triggered recovery from the lesions. The relapses observed up to 1 year after the response, examined by survival analysis, were significantly (P < 0.001) more frequent in the HIV+ (160 cases; 66.4%) than in the HIV- (294 cases; 26.8%) subjects. Multiple relapses observed up to 1 year after treatment occurred in 69 of 241 HIV+ patients, as compared with 14 of 1095 HIV- control subjects (P < 0.001). CONCLUSION: According to the study findings, HIV infection can be considered a risk factor for the development and recurrence of external genital warts. Multiple relapses should drive patients to HIV testing.

AIDS-Related Opportunistic Infections↗
PubMed2003

Differences in HIV-1 pol sequences from female genital tract and blood during antiretroviral therapy.

OBJECTIVE: To determine whether HIV-1 replicates locally in the female genital tract during therapy, and to study whether endocervix is the dominant source of virus in cervicovaginal lavage fluid. DESIGN: Sequence analyses of HIV-1 pol were performed from cervicovaginal secretions and blood plasma of HIV-infected women failing antiretroviral therapy with detectable viral load in both compartments, as well as from drug-naive subjects. METHODS: Viral RNA was extracted from cervicovaginal lavage fluid, endocervical secretions collected by Sno-strips, and blood plasma. Population sequencing of HIV-1 pol was performed using cycle sequencing. Drug resistance mutations were analyzed. Phylogenies were constructed based on synonymous positions in the sequences. RESULTS: Resistant virus was detected concordantly in blood and genital tract specimens, consistent with drug selection pressure in both compartments. However, drug-selected mutations often differed in each compartment, and phylogenetic analysis showed differences in virus lineage in these compartments, consistent with local replication in female genital tract. Viruses in cervicovaginal lavage and endocervical secretions were genetically distinguishable, suggesting that endocervix is not the only source of virus found in cervicovaginal lavage. CONCLUSION: These data support the hypothesis that HIV replication is compartmentalized within the female genital tract during antiretroviral therapy, which has implications for pathogenesis and for epidemiologic surveillance of drug-resistant virus.

Adult↗
PubMed2005

Involvement of the female genital tract in pemphigus vulgaris.

BACKGROUND: Involvement of the genital tract in women with pemphigus vulgaris has rarely been reported. We report 34 patients with pemphigus vulgaris who have involvement of the vulva, vagina, or both. METHODS: We reviewed the clinical data on 34 women treated at a tertiary dermatology referral center from July 1988 to June 2005. RESULTS: Of 34 patients, 21 had labial involvement, 3 had vaginal involvement, and 10 had both labial and vaginal involvement. The mean age of onset of pemphigus vulgaris was 49 years. All patients had pemphigus vulgaris involvement at multiple other sites, and all had other mucous membrane involvement, most commonly oral (97%). Recurrent episodes of genital pemphigus vulgaris were noted in 35%, with a mean of 6 recurrences (range 1-11). In all the patients the pemphigus vulgaris was controlled with systemic and local therapy. Long-term follow-up for a mean of 76 months (range 9-204) indicated that no long-term sequela occurred due to genital involvement. CONCLUSION: Involvement of the female genital tract in pemphigus vulgaris is rare. Vulvar lesions occur more commonly than vaginal lesions. With appropriate topical and systemic therapy, patients can have full recovery with no sequelae. LEVEL OF EVIDENCE: II-3.

Adolescent↗
PubMed2003

Testing for genital gonorrhea infections in prepubertal girls with suspected sexual abuse.

BACKGROUND: The medical diagnosis of child sexual abuse is based on a combination of factors, including disclosures by the child, specific physical examination findings and sexually transmitted infections. Genital infections with Neisseria gonorrhoeae (GC) are regarded as definitive evidence of sexual contact in children, but current microbiologic culture methods have low sensitivity for detecting vulvovaginal GC infections in prepubertal girls. METHODS: To compare the three strategies of culture alone, nonculture alone (Gen-Probe PACE 2) and sequential testing for genital GC (nonculture followed by culture of nonculture positives), we conducted a decision analysis to identify optimal testing strategies using published test sensitivities, specificities and pretest probabilities of genital GC. We surveyed community child welfare professionals to determine values for each potential health outcome. RESULTS: Sequential testing yielded a higher overall health outcome value (0.855) than culture (0.834) or nonculture methods (0.838). These results were insensitive to changes in GC prevalence, test characteristics and individual health outcome values over clinically important ranges. With a baseline prevalence of 10%, more children (4 per 100) with GC infection were missed by culture than were inaccurately labeled as having GC infection (0.5 per 100) by nonculture methods. Sequential testing yielded fewer false negative results (0.8 per 100) than culture and had no false positives. CONCLUSIONS: With the use of clinical decision analysis, sequential testing using nonculture methods followed by culture was preferred to culture or nonculture methods alone in the evaluation of GC in prepubertal girls with genital discharge. Current recommendations for GC testing should be reassessed with clinical decision analysis as new test methods or strategies become available.

Child↗
PubMed2005

Clean intermittent catheterization in genitally sensate children: patient experience and health related quality of life.

PURPOSE: Clean intermittent catheterization (CIC) has proven successful for bladder emptying in children without genital sensation with success rates of 94% to 100% in select groups. A subset of the pediatric population requires CIC for bladder dysfunction, yet has normal genital sensation. This study was designed to assess our experience with CIC in genitally sensate children and the health related (HR) quality of life (QOL) for them and their families. MATERIALS AND METHODS: A multimodality questionnaire on the usage, learning curve and degree of difficulty of CIC was developed. The PedsQLtrade mark 4.0 Generic Core Scales, a reliable, validated HRQOL survey developed for pediatric patients with chronic disease, was used to assess patient and parental QOL. Children in our practice with normal genital sensation and bladder dysfunction requiring CIC were contacted to complete these questionnaires. When possible, QOL data were collected from the patient (self-report) and one or both of the parents (parent-proxy report). RESULTS: Data for 12 males and 8 females were collected, including 30 QOL questionnaires (12 self, 18 proxy). Of the patients 80% were able to learn CIC technique in 1 clinic visit with the help of a nurse. On a 10-point scale (1-not difficult, 10-very difficult) the mean degree of difficulty for learning the CIC technique was 3.25 for males and 4.00 for females (3.55 overall). On a 10-point scale (1-uncomfortable, 10-very comfortable) mean comfort level with the CIC technique was 9.12 for females and 9.46 for males (9.33 overall). On the PedsQL 100-point scale mean QOL was 83.24 for the self-report compared to 81.78 for the parent proxy report. The QOL for normal children has previously been shown as 83 (self) to 87.61 (proxy). CONCLUSIONS: CIC was an easy technique for most sensate children to learn in 1 visit and master in a short time. Overall comfort with the technique was excellent and few problems were encountered. Their HRQOL was comparable to that of normal children.

Adolescent↗
PubMed2005

Epidemiology of genital herpes simplex virus infections in a community-based sample in France: results of the HERPIMAX study.

OBJECTIVE: The objective of this study was to provide information on the prevalence of herpes simplex infections in the general population in Europe. GOALS: The goals of this study were to determine the prevalence of clinically probable genital herpes and the relationship between serotype and clinical expression in a French community-based sample. STUDY: A total of 4410 subjects chosen at random were serotyped for herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Data on symptoms were obtained by questionnaire allowing retrospective diagnosis of clinically probable genital herpes. RESULTS: Questionnaire data and serotype were available for 3192 subjects. Seroprevalences of HSV-1 and HSV-2 were 65.6% and 15.5%, respectively. Prevalence of clinically probable genital herpes was 11.8%, identified in 11.1% of HSV-1-positive subjects and 26.8% of HSV-2-positive subjects, with a lower prevalence in those coinfected with both virus types. CONCLUSIONS: Clinically probable genital herpes was observed in one fourth of subjects with HSV-2 infections and in some subjects with HSV-1 infection. Coinfection with HSV-1 appeared to protect against symptom expression in subjects infected with HSV-2.

Adult↗
PubMed2006

When an adult female seeks ritual genital alteration: ethics, law, and the parameters of participation.

Ritual genital cutting for women, a common practice in Africa and elsewhere around the world, remains dangerous and controversial. In recent years, a 14-year-old girl living in Sierra Leone exsanguinated and died following a ritualistic genital cutting. Hoping to avoid that fate, women with backgrounds that accept ritual genital cutting may, when they reach majority age, ask plastic surgeons to perform genital alterations for cultural reasons. Although plastic surgeons routinely perform cosmetic procedures, unique ethical and legal concerns arise when an adult female patient asks a surgeon to spare her the tribal elder's knife and alter her genitalia according to tradition and custom. Misinformation and confusion about this issue exist. This article explores the ethical and legal issues relevant to this situation and explains how the thoughtful surgeon should proceed.

Adult↗
PubMed2006

A comparison of genital HIV-1 shedding and sexual risk behavior among Kenyan women based on eligibility for initiation of HAART according to WHO guidelines.

BACKGROUND: Guidelines for initiating antiretrovirals are based on markers of advanced disease and are not directly linked to markers of HIV-1 transmission such as viral shedding. METHODS: We evaluated genital HIV-1 shedding and risk behavior among 650 antiretroviral-naïve women stratified by WHO criteria for initiating antiretrovirals based on CD4 count and symptoms. RESULTS: Genital HIV-1 concentrations increased in stepwise fashion with declining CD4 counts and the presence of symptoms. Compared with the reference group (asymptomatic with CD4 >350 cells/microL), those with advanced immunosuppression (CD4 <200 cells/microL) had significantly higher cervical HIV-1 RNA concentrations (2.4 log10 copies/swab vs. 3.8 log10 copies/swab, P < 0.001). However, women with CD4 counts <200 cells/microL were also less likely than the reference group to report intercourse during the past week (58% vs. 26%, P < 0.001). CONCLUSIONS: Antiretroviral guidelines focusing on individuals with the most advanced immunosuppression will target those with the highest genital HIV-1 concentrations. However, individuals with less advanced immunosuppression also have high levels of genital HIV-1 and may be more sexually active. The effect of increased antiretroviral availability on the spread of HIV-1 might be enhanced by extending treatment, in addition to other risk reduction services, to those with less advanced disease.

Acquired Immunodeficiency Syndrome↗
PubMed1983

A comparative analysis of restriction enzyme digests of the DNA of herpes simplex virus isolated from genital and facial lesions.

The restriction endonuclease (RE) cleavage patterns of the DNA of herpes simplex virus (HSV) genital isolates from two geographically distinct groups and from one group of facial isolates were examined. Eleven of 21 genital isolates from females, 1 of 27 genital isolates from males and all 17 of the facial isolates were HSV type 1 (HSV-1). The groups of isolates of the same serotype could not be distinguished by significant differences in the frequency of variable restriction endonuclease sites or molecular weight of variable length fragments. Simultaneous consideration of two or more variable sites has disclosed some which are apparently correlated in the HSV-1 isolates, and which could provide a useful marker for phylogenetic relationships. However, most pairs showed no correlation, while certain sites appeared more closely correlated in the genital than in the facial isolates. All 39 HSV-2 isolates could be distinguished from each other on the basis of a combination of variable RE sites and variable length fragments. Bg/II RE sites appeared less variable than other RE sites.

DNA Restriction Enzymes↗