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The frequency of central nervous system infections due to herpesvirus have been studied in various populations; however, studies in Mexican mestizo patients are scant. This paper documents the frequency of herpesvirus encephalitis in Mexican mestizo patients from the National Institute of Neurology and Neurosurgery (NINN) of Mexico. To study the frequency of herpetic viral encephalitis at the NINN in the period from 2004 to 2009. We reviewed clinical records from patients with clinically suspected encephalitis; polymerase chain reaction assays were done for detection of herpesviruses in cerebrospinal fluid (CSF) samples. The total number of patients studied was 502; in 59 (12%), the diagnosis of herpetic encephalitis was confirmed by PCR-based testing of CSF. Of them, 21 (36%) were positive for herpes simplex virus type 1, 15 (25%) for Epstein–Barr virus, 10 (17%) for varicella zoster virus, 8 (14%) for cytomegalovirus, 3 (5%) for human herpesvirus 6, and 2 (3%) for herpes simplex virus 2. Our results show a varied frequency of viral encephalitis in mestizo patients due to herpesviruses in a tertiary neurological center and point out the importance of modern molecular technology to reach the etiological diagnosis in cases of encephalitis.

OBJECTIVESGenital herpes simplex virus type 2 (HSV-2) is one of the most prevalent sexually transmitted infections in the United States. We sought to assess differences in HSV-2 seroprevalence among non-Hispanic blacks and non-Hispanic whites and describe trends over time from 1988 to 2010. METHODSData from National Health and Nutrition Examination Surveys (NHANES) were used to determine national HSV-2 seroprevalence estimates from National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2002, 2003 to 2006, and 2007 to 2010. Persons aged 14 to 49 years were included in the analyses. Race/Ethnicity was defined by self-report as non-Hispanic white or non-Hispanic black. Purified glycoprotein specific for HSV-2 was used to detect type-specific antibodies using an immunodot assay. The same assay was used in all surveys. History of diagnosed genital herpes was self-reported. RESULTSOverall, HSV-2 seroprevalence decreased in the United States between 1988 to 1994 and 2007 to 2010, from 21.2% to 15.5%. Among non-Hispanic white females, HSV-2 seroprevalence decreased from 19.5% (1988–1994) to 15.3% (2007–2010; P < 0.001); HSV-2 seroprevalence remained stable among non-Hispanic black females, 52.5% (1988–1994) to 49.9% (2007–2010; P = 0.1). The female black/white prevalence ratio was 2.7 (95% confidence interval [CI], 2.4–3.0) in 1988 to 1994 increasing to 3.3 (95% CI, 2.9–3.7) in 2007 to 2010 (P = 0.01). Among males, the black/white prevalence ratio was 2.4 (95% CI, 1.9–2.9) in 1988 to 1994 increasing to 4.4 (95% CI, 3.3–5.8) in 2007 to 2010 (P = 0.001). The overall percentage of HSV-2–seropositive survey participants who reported never being told by a doctor or health care professional that they had genital herpes did not change significantly between 1988 to 1994 and 2007 to 2010 and remained high (90.7% and 87.4%, respectively). CONCLUSIONSAlthough HSV-2 seroprevalence decreased overall, the decrease was most marked among non-Hispanic whites, and racial disparities significantly increased over time. These persistent disparities demonstrate the need for innovative prevention strategies among this at-risk population.

Herpes simplex virus type 2 (HSV-2) causes vesicular and ulcerative lesions in adults 1 – 3 and may cause severe systemic disease in neonates and immunosuppressed hosts. 4 – 6 In addition, genital ulceration caused by HSV-2 may facilitate the transmission of the human immunodeficiency virus (HIV). 7 – 12 Infections with HSV-2 typically affect the genital area, and transmission is usually sexual. 6 , 13 , 14 In contrast, herpes simplex virus type 1 (HSV-1) commonly causes oropharyngeal infection, and transmission is primarily by nongenital personal contact. 2 , 15 However, both viruses are capable of causing either genital or oropharyngeal infection and can produce mucosal lesions that are clinically . . .

Background. Trichomoniasis vaginalis, the most prevalent nonviral sexually transmitted infection, is associated with negative reproductive outcomes and increased HIV transmission and may be overrepresented among African Americans. Methods. Atotal of 135 African American women who used drugs were screened for Trichomonas vaginalis on ⩾2 occasions between March 2003 and August 2005. Women were administered a structured questionnaire in a community-based research center, underwent serological testing for human immunodeficiency virus and herpes simplex virus type 2, and were screened for Neisseria gonorrhoeae and Chlamydia trachomatis. Results. Fifty-one women (38%) screened positive for T. vaginalis at baseline. Twenty-nine (31%) of 95 women with negative results of baseline tests became infected, for an incidence of 35.1 cases per 100 person-years at risk (95% confidence interval [CI], 23.5–49.0). Prevalent infection was associated with drug use in the past 30 days, and incident infection was associated with sexual behavior in the past 30 days, namely having >1 male sex partner. Women who reported having >1 partner were 4 times as likely as women with fewer partners to acquire T. vaginalis (hazard ratio, 4.3; 95% CI, 2.0–9.4). Conclusion. T. vaginalis may be endemic in this community of African American women. A control strategy that includes T. vaginalis screening in nonclinical settings and rapid point-of-care testing could contribute to the disruption of transmission of this pathogen.

Background: Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted infection (STI) that is the main cause of genital herpes. Studies have found racial/ethnic disparities in HSV-2 prevalence, but there have been few studies of racial/ethnic differences in the proportion of infections that go without a genital herpes diagnosis. Methods: Data from 1396 HSV-2-seropositive participants of the National Health and Nutrition Examination Survey 1999-2004 were used to examine racial/ethnic differences in the odds of reporting being diagnosed previously with genital herpes. Results: The proportion of participants who reported not being diagnosed previously with genital herpes was 85.5%. In adjusted analysis, non-Hispanic blacks had twice the odds of reporting being undiagnosed as non-Hispanic whites (adjusted odds ratio = 2.0, 95% CI = 1.37, 2.87). Being undiagnosed was also significantly associated with less than high school education, no prior STI history or HIV test, no current health insurance, and residence in the Midwest and South. Conclusions: The low proportion of genital herpes diagnosis among non-Hispanic blacks with HSV-2 is not accounted for by other sociodemographic factors or health insurance. Combined with the high prevalence of HSV-2, the low proportion of diagnosis in this population is more likely to contribute to ongoing HSV-2 transmission than among non-Hispanic whites or Mexican Americans. More research is needed to assess the role that lack of diagnosis plays in ongoing HSV-2 transmission, and whether targeted HSV-2 screening, counseling and treatment could be part of a more effective prevention strategy for non-Hispanic blacks.

Herpes simplex virus type 2 (HSV-2) is one of the most common sexually transmitted infections worldwide and the primary cause of genital and neonatal herpes and genital ulcer disease. Multiple studies have shown that HSV-2 infection increases the risk for human immunodeficiency virus (HIV) infection by at least twofold. HSV-2 infection is lifelong, and serologic testing provides the best method to estimate HSV-2 prevalence. Since 1976, CDC has monitored HSV-2 seroprevalence in the United States through the National Health and Nutrition Examination Survey (NHANES). After increasing from 1976-1980 (NHANES II) to 1988--1994 (NHANES III), HSV-2 seroprevalence decreased, from 21.0% in 1988-1994 to 17.0% in NHANES 1999-2004. To determine whether HSV-2 seroprevalence in the United States has changed since 1999-2004 and to estimate HSV-2 seroprevalence by age, race/ethnicity, and reported lifetime number of sex partners, CDC analyzed serologic test results from persons aged 14-49 years who participated in NHANES 2005-2008. The results indicated that HSV-2 seroprevalence was 16.2% overall, not statistically different from the seroprevalence in 1999-2004. Seroprevalence was highest among women (20.9%) and non-Hispanic blacks (39.2%). Of those infected with HSV-2, 81.1% had not received a diagnosis. Clinicians, health departments, health-care organizations, and community groups should promote measures that prevent HSV-2 transmission, including minimizing the number of sex partners, avoiding concurrent sexual partnerships, and using condoms consistently and correctly. Patients with known HSV-2 infection should be tested for HIV.

There has been a recent increase in notifications of genital herpes but it is not known whether this has been reflected in the pregnant population. We have therefore carried out a study to determine the prevalence of herpes simplex antibodies in pregnant women and to estimate the incidence of primary infection. Sera were collected from 3533 women at antenatal clinics and tested for total antibodies to herpes simples virus (HSV), and if positive, for specific antibodies to HSV-2. Estimates of HSV-1 seroprevalence were derived from the HSV-2 seronegative population. HSV-1 seroprevalence was nearly 100% in black women born in Africa or the Caribbean and 60-80% in white, Asian and UK born black women. It was lower in women in non-manual employment. HSV-2 seroprevalence was related to age, rising from 0 at age 16 to 40% at age 35 in black women, and to about 10% in Asian and white women. The estimated incidence of primary HSV-2 infection during pregnancy, per 1000 pregnancies, was about 2.4 in Asian women, 5 in white women, and 20 in black women. Estimates of the incidence of neonatal infection were derived from these figures and compared to the nationally reported rates.

Our objective was to evaluate the seroprevalence of herpes simplex virus (HSV)-2 and HSV-1 in a population of men and women attending the STD clinic of Hôpital St-Louis (Paris, France). Four hundred and eighty-seven patients (264 men and 223 women) were tested for HSV-2 and HSV-1 antibodies by specific enzyme immunoassay (EIA) (Smithkline-Beecham Biologicals). Univariate and multivariate analyses were carried out for correlations with clinical, socio-epidemiological and behavioural data. HSV-2 seroprevalence was 55% (44.7% in men, 67.3% in women). HSV-1 seroprevalence was 93% (94.7% in men, 91% in women). The predictive factors of HSV-2 seropositivity being female (OR: 3.37), age (OR: 1.04), country of origin (Central Africa OR: 3.52, North Africa OR: 1.36), history of genital herpes (OR: 10.97), hepatitis B virus (HBV) markers (OR: 1.92) and hepatitis C virus (HCV) markers (OR: 3.96). The only protective factor was HSV-1 seropositivity (OR: 0.25). The predictive factors of HSV-1 seropositivity were only the country of origin (Central Africa OR: 2.95, North Africa OR: 1.83) and the absence of genital herpes (OR: 11.01). Only 23 (8.6%) HSV-2 seropositive patients had a history of genital herpes. This study underlines the very high HSV-2 seroprevalence of patients with STDs, only a few of whom have a history of genital herpes. Detection and counselling is urgently needed for these patients.

OBJECTIVE: To ascertain factors associated with HSV-1 and HSV-2 isolates in patients attending a genitourinary medicine clinic with symptomatic first episode genital herpes (FEGH). DESIGN: Retrospective study. SUBJECTS: A total of 606 females and 333 males presenting with culture positive FEGH between 1990-94. SETTING: Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK. METHODS: Group comparison of referral patterns, demographic data, prior and concurrent episodes of STD, recent partner change. RESULTS: HSV-1 infected patients of either sex were more likely to be general practitioner (GP) referred, to be white, and less likely to have had preceding STD episodes. Recent sexual partner change had occurred significantly more often in HSV-2 infected females but there was no similar difference between HSV-1 and HSV-2 infected males. CONCLUSION: The relative HSV-1:HSV-2 isolate ratio in FEGH is influenced by the referral patterns. HSV-1 isolates predominate in patients presenting to GPs who refer the patients to GUM clinics for accurate diagnosis, counselling, follow up and screening for other STDs.

Objectives: To study the prevalence of circumcision in the United States and to examine the association between circumcision and herpes simplex virus Type 2 (HSV-2) infection. Methods: As part of National Health and Nutrition Examination Surveys from 1999 to 2004, 6174 men were interviewed about circumcision status and sexual behaviors, and were tested for HSV-2 antibodies. Medical artwork was used to aid the reporting of circumcision status. Results: The overall prevalence of circumcision was 79% and varied by race/ethnicity (88% in non-Hispanic whites, 73% in nonHispanic blacks, 42% in Mexican Americans, and 50% in others). For men born in the United States from 1940 through 1979, the prevalence of circumcision increased, with larger increases in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites; the prevalence of circumcision decreased significantly in those born in the 1980s (84%) compared to those born in 1970s (91%) (P <0.001). Circumcision status was not associated with sexual behaviors we assessed. In multivariate analyses, circumcision was not associated with HSV-2 infection (P = 0.47). Conclusions: The prevalence of circumcision apparently peaked in those born in the 1970s and declined in those born in the 1980s. Circumcision was not associated with HSV-2 infection.