The Epidemiology and Natural History of Genital Herpes Simplex Virus (hsv) Infection

Genital infection with herpes simplex virus type 2 (HSV -2) is increasingly common worldwide. The aims of this thesis were to investigate the epidemiology and natural history of genital herpes among GUM attendees with symptomatic genital herpes, and among HIV-l infected individuals. In our study of GUM attendees in the UK, we demonstrated HSV -1 to account for 9% of first episodes of genital herpes. These findings are in contrast with observations made elsewhere in the UK, where HSV -1 has accounted for >50% of first-episode cases. As most individuals with genital HSV -2 infection remain clinically misdiagnosed, the need for improved diagnostic methods to detect genital HSV infection is warranted. We compared the performance of virus culture and PCR in patients clinically diagnosed with genital herpes. PCR increased HSV detection in patients with both early and late presentations and in first and recurrent diseases. PEG precipitation was the most sensitive specimen preparation method of choice. A HSV positive PCR was also associated with heterosexuals, early presentation, and visible genital ulceration. HSV -1 and HSV -2 genital infections were also associated with white and black ethnicity respectively. This suggests that host susceptibility and behavioural factors may influence the epidemiological patterns of genital herpes. Current data support the use of HSV type-specific serology and PCR to diagnose HSV infections. In addition to PCR, we evaluated the performance of type-specific serology (HerpeSelect EIA, Focus Technologies, Cypress, California, USA) for the diagnosis of HSV infection. Our findings indicated that increasing the assay cut-off from 1.1 to 3.1 increased specificity and maintained sensitivity. By performing an inhibition EIA using an inhibition value of