Herpes : the journal of the IHMF
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The prevalence of herpes genitalis (genital herpes) has increased markedly over the past three decades. The most common cause is infection with the herpes simplex virus type 2 (HSV-2), but it can also occur as a result of HSV-1 infection. Herpes genitalis can cause substantial psychosexual as well as physical morbidity and, in immunocompromised individuals, such as those who are HIV-positive, HSV infection can result in severe disease with progressive and extensive lesions. ⋯ In HIV-positive patients, antiherpes therapy has proved effective in speeding healing of lesions and reducing subclinical shedding, and can be used to treat genital HSV-2 infections in this group. Suppressive antiviral therapy has been shown to decrease the risk of HSV transmission in heterosexual couples. New approaches to the prevention of HSV infection, including vaccines and topical microbicides, are under investigation.
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Sensorineural hearing loss is the most frequent sequela of congenital cytomegalovirus (CMV) infection, and epidemiological evidence also suggests that congenital CMV infection is responsible for a substantial proportion of sensorineural hearing loss in children. Hearing loss due to congenital CMV infection can be present at birth or can appear later, usually during the first year of life; it usually worsens as the infant or child ages. ⋯ Based on the benefits of early detection of hearing loss, one could propose screening all infants for congenital CMV infection so that those with hearing impairment can be identified as early as possible by appropriate audiological follow-up. Antiviral treatment that could improve hearing outcome, with a safety profile suitable for use in minimally ill infants, would clearly increase the benefit of universal screening for congenital CMV infection.
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At the 11th Annual Meeting of the International Herpes Management Forum (IHMF), held 27-29 February 2004, I delivered the Martin Wood Memorial Lecture on the management of herpes zoster-associated pain. Prevention of post-herpetic neuralgia is an important goal in the management of herpes zoster. Recognition of individuals at high risk of progression, followed by prompt intervention with antiviral agents, helps to reduce the disability, distress and healthcare resource utilization caused by this disease and its consequences. In established cases of post-herpetic neuralgia, first line therapy with tricyclic antidepressants and second line therapy with some anticonvulsants and opioids have both shown efficacy in many patients, but development of more effective treatments is needed for optimal outcomes.
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Neonatal herpes simplex virus (HSV) infection can have severe consequences. Skin, eye and mouth infection is rarely fatal, but disseminated or central nervous system (CNS) disease has a mortality rate of 80% in the absence of therapy, and most surviving infants have neurological sequelae. Aciclovir therapy can improve the outcome of neonatal herpes, but is often delayed due to the early non-specific symptoms of the disease. ⋯ If maternal antiviral therapy is considered, the potential benefits of treatment should be balanced against potential adverse outcomes for mother and fetus, although it may be warranted when the mother has severe or life-threatening disease. Studies on the use of antiviral prophylaxis in women with known recurrences at labour are ongoing. Invasive fetal monitoring can increase the risk of neonatal herpes, and should only be used in HSV-2 seropositive women for defined obstetrical indications.
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Herpes simplex encephalitis (HSE) is a life-threatening consequence of herpes simplex virus (HSV) infection of the central nervous system (CNS). Although HSE is rare, mortality rates reach 70% in the absence of therapy and only a minority of individuals return to normal function. Antiviral therapy is most effective when started early, necessitating prompt diagnosis. ⋯ Limited evidence suggests that aciclovir may be effective in its treatment. Recurrent aseptic meningitis is predominantly caused by HSV-2 infection, and is characterized by self-limited episodes of fever, meningismus and severe headache. Many cases are indistinguishable from cases previously classified as "Mollaret's meningitis", a term that should now be reserved for idiopathic cases of recurrent aseptic meningitis.