| Herpes simplex virus(HSV) is a double-stranded DNA virus, its size is about 152kb. HSV encompasses two viruses(HSV-l,HSV-2) that are related and both belong to the herpes virus group.The gene homology of the two virus is about 50%. To infect people, HSV-1 and HSV-2 must get into the body through broken skin or a mucous membrane, such as inside the mouth or in the genital area. With viral replication at the site of primary infection, either an intact virion or, more simply, the capsid is transported retrograde by neurons to the dorsal root ganglia where, after another round of viral replication, latency is established. The more severe the primary infection, as reflected by the size, number, and extent of lesions, the more likely it is that recurrences will ensue. Although replication sometimes leads to disease and, infrequently, results in life-threatening infection (e.g., encephalitis), the host-virus interaction leading to latency predominates. After latency is established, a proper stimulus (such as exposure to the sun, fever, menstruation, emotional stress, a weakened immune system, or an illness) causes reactivation; virus becomes evident at mucocutaneous sites, appearing as skin vesicles or mucosal ulcers.HSV-1 is the main cause of herpes infections that occur on the mouth and lips, including cold sores and fever blisters. It is transmitted through kissing or sharing drinking utensils. HSV-1 can also cause genital herpes, however, HSV-2 is the main cause of genital herpes. HSV-2 is contracted through sexual contact. Genital Herpes is one of the sexually transmitted disease and has great impact on quality of life.It makes patients feel anxiety,depression and sleep-disorder.Also,it can affect immune function and relationship between husband and wife.Especially in patients of women,many patient were neglected,it can infect neonate,or lead to pretem, stillbirth, excessively tire and so on.Genital herpes can be encompassesed to primary infection, recurrent infection, subclinical reactivation of HSV and so on. Subclinical reactivation of HSV means there's no discernible signs or symptoms at all, but can be detected virus shedding. Reactivation of HSV can be found in many region of anatomy, such as viginal, cervical and rectum. Transmission of HSV occurs when a person who is shedding virus in the genital tract or on other skin or mucosal surface, inoculates virus onto a mucosal surface or small crack in the skin of a sexual partner. A key determinant of transmission is the nature of HSV-2 shedding in the source partner. Over the last decade, the concept of subclinical shedding in the genital tract has taken on increasing importance. Initial protocols indicated that approximately one third of HSV-2 shedding episodes occur in the absence of genital lesions or symptoms. More recent studies employing swabs every six hours suggest that over 75% of mucosal HSV-2 reactivations are subclinical, with half of episodes lasting less than 12 hours. Sites of subclinical shedding include the cervix, vulva, anus, urethra, penile skin and peri-anal region, and concomitant shedding can occur at several anatomic sites.For these reasons, patients with genital herpes should be educated about potential for infectivity regardless of symptomatology.Laboratory confirmation of the clinical diagnosis is necessary for estimating the potential infectivity during episodes of lesions, identifying persons at risk of transmitting infection subclinically, selecting women at future risk of transmitting the infection to the neonate and confirming the clinical diagnosis in those for whom antiviral therapy for HIV infection should be prescribed. The recommendations for sample transportation for testing using microscopy, culture and NAATs.ObjectivesGenital herpes which infected by herpes simplex virus is spread very fast. This is related to subclinical reactivation of HSV. In order to control genital herpes effectively and to prevent the dissemination of genital herpes, to compare the sensitivity and specificity of three different methods in detection virus infection. To compare the clinical and virologic effects of aciclovir and valacyclovir administered as suppressive therapy for persons with genital herpes.Methods1. Eighty-four samples were collected from patients and blood samples.We used ELISA, PCR, Virus isolation culture to detect different samples. And collected 30 blood samples from health people as control of ELISA; 30 samples collected from patients who were not infect of herpes simplex virus as control of PCR. To compare the sensitivity and specificity of three different methods, in order to find the more suitable method to detect subclinical reactivation of HSV.2. Two randomized, standard-controlled studies comparing aciclovir 400mg twice everyday for 3 months with valacyclovir 500mg twice everyday the first 3 months were performed. To collect the secretion of cervical or urethral weekly, then detected by PCR. And observed the relationship between treatment and subclinical reactivation of HSV. 3. Statistics and analysis:The SPSS(version 13.0) software packages were used for the statistical analyses. Pearson correlation analysis was used for the relationship betweenin IgM/IgG and course or recurrence frequency. McNemar test was used to compare PCR and Viral isolation culture.Crosstable was used to compare detectablerate of different samples by PCR.Measurement data were expressed with x±s, differences were significant if P<0.05.Results1. HSV-2 IgM has ralated to course(Spearman corelation r=-0.570, P<0.001); HSV-2 IgG has related to course(Spearman corelation r=0.334, P<0.001); HSV-2 IgM has related to recurrence frequency(Spearman corelation r=-0.542, P<0.001); HSV-2 IgG has significant related to recurrence frequency (Spearman corelation r=0.284, P=0.009).2.60 out of 84 samples (71.4%) were positive by virus isolation culture detection in which 36 out of 44 blisters samples (81.8%) were positive and 24 out of 40 erosion or ulcer samples (60%) were positive. Significant difference was found between the two different samples(χ2=4.89, P=0.027).3.79 out of 84 samples (94.0%) were positive by PCR detection, in which 43 out of 44 blisters samples (97.7%) were positive and 36 out of 40 erosion or ulcer samples (90%) were positive. There was no significant difference between the two different samples(χ2=1.068, P=0.301).4. The positive rate was no significantly difference (χ2= 0.359, P P=0.549)between PCR and ELISA(HSV IgG). The positive rate was significantly difference (χ2= 11.432, P P=0.001)between virus isolation culture and ELISA(HSV IgG). There were high positive ratio both PCR and virus isolation culture detection in blister samples (97.7%,81.8%).But in erosion or ulcer samples, the positive ratio in PCR detection(90%) was higher than virus isolation culture detection(60%)。 Significant difference was found between the two groups (x2=9.600, P=0.002)5. PCR can detect the asymptomaticasymptomatic shedding in cervical secretions and urethral secretions. Two treatments were reduced the relapse frequency. Significant difference was found between the two groups in reducing asymptomatic shedding (t=5.21, P＜0.001)Conclusion1. The etiological diagnosis by three different methods, ELISA or PCR detection is better, both are suitable for clinical detection. PCR is more sensitive, especially in not blister samples,and more time-saving than virus isolation culture which is more expensive and requires high technology. So PCR is more suitable for clinical detection.2. Valaciclovir can not only reduce the recurrence of genetial herpes, but also reduce genital track shedding. In order to reduce recurrence frequence and the asymptomatic shedding, we advise the patients who recurrent more frequency to oral valaciclovir at least 3 months... |
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