Follow up after a family based genetic screening programme for familial hypercholesterolaemia: is screening alone enough?

in the proportion of isolates attributable to HSV-1 occurred in each of the four age and sex subgroups (P < 0.0001) (figure). Comment Both the number and percentage of genital HSV-1 infections have risen. Genital infection with HSV-1 is strongly associated with being young (aged < 25 years) and being female. Explanations include changing host susceptibility and changing sexual behaviour of the population. The population seroprevalence of HSV-1 is falling: increasing numbers of young adults are susceptible to HSV-1 infection. 3 As genital tract reactivation of latent HSV-1 infection is infrequent, most new cases of genital HSV-1 infection are likely to be due to orogenital transmission, but there is no evidence suggesting that oral sex practices have changed substantially. 4 The occurrence of HSV-1 infection in women, seen consistently in other studies, 1 is unexplained. These results have three important implications for management. Firstly, patients should be counselled about the more favourable clinical course of genital HSV-1 than of HSV-2 infection; recurrences are generally milder and infrequent. Secondly, subclinical shedding of HSV-1 is less common; this has a direct bearing on the likelihood of transmission. 5 Thirdly, preventive strategies for genital herpes should focus on the risk of unprotected orogenital intercourse, which is frequently perceived as " safe " in the context of sexually transmitted infections. We thank Geoffrey Clements, previously director of the West of Scotland Specialist Virology Centre. Contributors: AS initiated and designed the study, analysed and interpreted the results, and wrote the paper. JN and NM analysed and interpreted the results and wrote the paper. GG contributed to the study design and analysis of results. WC contributed to the study design, analysis, and interpretation of the results. AS is guarantor. Funding: No additional funding. Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic. The burden of infection with HSV-1 and HSV-2 in England and Wales: implications for the changing epidemiology of genital herpes. after oral and genital herpes simplex virus infection: influence of site of infection and viral type. Familial hypercholesterolaemia is an autosomal dominant disorder of lipoprotein metabolism, with an estimated frequency of 1 in 500 in Western countries; it results in excess mortality from coronary artery disease. 1 Now that the genetic defects can be detected and statins are available to lower lipids effectively, genetic screening has been considered. 2–3 In 1994 a family based genetic screening programme for familial hypercholesterolaemia …