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02.05.2015

Recurrent hsv 1 genital herpes, herpes cure - Reviews

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Compare and contrast characteristics and clinical features related to HSV1 and HSV2 infections.
Compare and contrast advantages and disadvantages of various tests for the detection of HSV. A major contributor to the continuation of an ongoing epidemic of genital herpes is that most people with the infection are unaware that they have it. As mentioned above, genital herpes often remains undiagnosed due to lack of symptoms or inaccurate clinical diagnosis. Although genital herpes has previously been more often associated with HSV2, it can also be caused by HSV1, the virus more traditionally associated with orolabial herpes (cold sores). With the availability of new in vitro diagnostic tests for HSV, laboratories have an opportunity to contribute to the management and containment of genital herpes infections by offering HSV testing and typing. Viral culture is the traditional test for evaluation of patients with genital ulcers or other mucocutaneous lesions and, until recently, was the gold standard for HSV testing.
Molecular testing is the emerging gold standard for virologic diagnosis of genital herpes, gaining popularity for lesion testing because it is more sensitive and faster compared to culture and can provide dependable results even when a healing lesion is sampled.2,5 Currently, there are two commercially available HSV tests using molecular methodologies. Serologic testing detects HSV antibodies, markers of prior or current infection in serum samples, and has been valuable in epidemiological surveys. Direct detection of HSV antigen employing enzyme-specific immunoassays (EIA) or direct fluorescent antibody staining (DFA) is sometimes used.
Cytology (Tzanck smear) is sometimes performed on lesion scrapings from patients with active genital lesions. For the reasons discussed above, serologic testing, direct antigen testing, and cytology are less commonly used in HSV testing for the purpose of supporting clinical diagnosis. Diagnosis and treatment of HSV1 and HSV2 infections are a first step toward managing genital herpes.
However, recent advances in herpes virus diagnosis and management provide tools for both more accurate diagnosis and for management to help patients with this all-too-common and often misdiagnosed sexually transmitted disease, which also has particular implications for women.
While the severity of symptoms may vary, genital herpes generally causes psychological distress in people when they become aware of the infection.
It is estimated that up to 90% of people with herpes are unaware that they have the disease.


Over the past decade the proportion of genital herpes caused by HSV1 has increased, and today in some settings HSV1 accounts for at least half of first episodes of genital herpes.1 Clinical features of initial genital HSV1 and HSV2 outbreaks are similar, but once infection has occurred the prognoses are quite different (Table 1).
For viral culture, vesicular fluid or cellular material from the base of a genital lesion is collected, placed in culture media, and transported expeditiously to the laboratory for cell culture.
One uses Strand Displacement Amplification (SDA) technology for the direct, qualitative detection and differentiation of HSV1 and HSV2 DNA in clinician-collected external anogenital lesion specimens from symptomatic female and male patients.
Accurate type-specific HSV serologic assays, based on the IgG response to the HSV-specific glycoproteins G1 (HSV1) and G2 (HSV2), are available. Direct antigen detection is less sensitive than culture for early lesions, but it may be superior to culture for detecting HSV in healing lesions.
Thus, the following discussion will focus on culture and molecular methods, the primary choices for genital herpes testing. Most experts agree that when possible, amplified molecular testing is preferable to culture for diagnosis and to guide management decisions for people with possible genital herpes.
In some molecular testing both HSV1 and HSV2 are tested simultaneously, so the typing results are included in the initial reporting, saving time.10 In contrast, viral culture requires a second step, typically using DFA, to identify the HSV type once the specimen tests positive. Hook presents a thorough and fair analysis of the two primary choices for HSV testing-culture and molecular-he clearly suggests that the latter is the preferable choice for most clinical labs. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. Consequently, genital herpes is most often transmitted by infected people who are unaware that they have the infection or are asymptomatic at the time of transmission. Genital HSV1 infection recurs less frequently (on average less than once a year) compared to HSV2, which typically recurs three to four times annually.
HSV2) is helpful in assessing prognosis and counseling patients.1,2 The CDC now recommends molecular methods for HSV testing. Following culture, HSV is most often detected using antibody staining and fluorescence microscopy. Another method is polymerase chain reaction (PCR)-based qualitative test for HSV1 and HSV2 detection and typing of vaginal lesion swab specimens from symptomatic female patients. Most laboratories cite low cost as a primary reason for its use; however, sometimes such estimates fail to consider all costs of cell culture diagnosis of HSV.


Some advocate the use of HSV serologic screening of select populations, such as people who have a partner with genital herpes.
For distinguishing between HSV1 and HSV2, positive cultures may be stained and viewed under a fluorescence microscope using type-specific antibody reagents. Molecular testing of genital herpes is also available as laboratory-developed tests (LDTs) at some reference laboratories. In the case of HSV testing, the timely availability of virus type in infected people is also important, since knowledge of whether a patient has HSV1 or HSV2 influences patient management and counseling. Prevention of neonatal herpes, often a result of infant exposure to HSV in the birth canal at delivery, is built on identifying and counseling women at risk of HSV acquisition and, in the case of infected mothers, protecting the infant from exposure to HSV during labor and delivery. The CDC cautions providers to specify serologic type-specific assays when ordering such tests for their patients, since not all serologic tests can accurately distinguish between HSV1 and HSV2 antibodies. Furthermore, viral culture is substantially less sensitive for diagnosis of recurrent as opposed to initial infections. This is less problematic when HSV2-specific antibody is detected, since HSV2 positivity implies anogenital infection. Another economic consideration is the opportunity to leverage an existing molecular platform and add HSV testing without acquiring new instrumentation. Studies have demonstrated that HSV2 infection is an independent risk factor for HIV infection. The presence of HSV1 antibodies is more difficult to interpret since a positive test may represent the presence of either orolabial or genital infection.
The synergy between HSV and HIV, as demonstrated by co-infection of the same cell and up-regulation of HIV-1 replication by HSV proteins, is of interest not only in therapeutics development but also in prevention strategies in couples in which one partner is infected.1 In all of these scenarios, the intervention strategy begins with accurate and timely diagnosis of genital herpes, a critical role for the clinical laboratory. Also, false-negative results are more frequent during early stages of infection, as development of a positive IgG antibody response following initial HSV infection may take up to six months. False-positive results can also occur and are common when serologic testing for HSV antibodies is performed in lower-risk populations.



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Comments to “Recurrent hsv 1 genital herpes”

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