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Rapid Responses: Rapid Responses published:
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The Herpes Viruses Association
- Nigel Scott (21 May 2007)
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Herpes Virus association
- Dr Simon Barton (25 May 2007)
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Can genital herpes cause oral manifestations and viceversa?
- Eduardo M. Curbeira Hernández. MDD, Eduardo E. Castillo Betancourt. MDD, Moisés Santos Peña. MD, Juana Isabel Hernández Fernández. MsC (29 May 2007)
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Diagnosis of HSV infection in this article does not reflect reality
- Malur Sudhanva (30 May 2007)
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Recurrent herpes at onset of labour
- Julian Law (1 June 2007)
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Nigel Scott, Deputy Director Herpes Viruses Association, 41 North Road, London N7 9DP
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Sen and Barton’s excellent genital herpes management guidelines feature included a useful box containing additional educational resources. Patient support organisations from around the world were listed, but inexplicably, the UK charity the Herpes Viruses Association was omitted. This can only have been an oversight as Dr Barton has been a firm friend to the Association for many years. The HVA publishes 'Herpes Simplex - The Guide', fifteen thousand copies of which are bought by UK sexual health clinics annually, for distribution to newly diagnosed patients. The charity's website is at www.hva.org.uk ; the helpline number is 0845 123 2305 and the office is at 41 North Road, London N7 9DP, phone 020 7607 9661. Competing interests: The writer is an employee of the Herpes Viruses Association |
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Dr Simon Barton, Consultant Chelsea & westminster hospital SW19 3JE
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Nigel is quite correct to add the HVA to the list of excellent resources for patients. Many apologies for missing their contact details in the list in our article. The association offers invaluable support and clear information to individuals with HSV infection and their partners. The HVA have also been involved with the production of National guidelines for management of HSV in the UK that is available through www.bashh.org . Competing interests: None declared |
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Eduardo M. Curbeira Hernández. MDD, Dentistry and Epidemiology Departments Gustavo Aldereguía Lima University Hospital. Cienfuegos, Cuba, Eduardo E. Castillo Betancourt. MDD, Moisés Santos Peña. MD, Juana Isabel Hernández Fernández. MsC
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An analysis of the article related to the management of Genital Herpes published at the BMJ has led us to comment about our experience in a Cuban clinic in regard to the oral manifestations of this disease.1
Herpes is a general term used to identify two viral infections that can affect the area around the mouth. ( Oral Herpes), or the area around the genitalia (Genital Herpes ). A few time ago, it was thought that oral herpes was caused by Herpes Simplex Virus Type 1 (VHS-1), while Genital Herpes was caused by Herpes Simplex Virus Type 2 (HSV-2). At present, it is known that both viruses can cause lesions in both areas. As HSV-1 can cause genital lesions, VHS-2 can also cause oral lesions. Although HSV-1 and HSV-2 are different viruses they are very similar and are treated in a similar way. As Herpes Zoster does, Herpes Simplex virus causes painful lesions in the skin. Generally the first symptoms are pruritus and paresthesia, followed by the appearance of painful vesicles . 2-3 The infection remains for a period of time. Both Herpes Simplex 1 and 2 remain in the nerve cells, generally infradermically. Any of them is all the time active. Sometimes they remain latent or inactive in these cells for long periods of time or through life . This is called “latency”. For some reasons that researchers still don’t know , the virus can be activated causing symptoms, which include aphtus ulcers or vesicles around the mouth or near the genitalia. This is called “reactivation”. These symptoms can appear and disappear that is why they are called herpetic bouts or reactivation episodes. . 2, 3 Without any analysis of HIV, any person infected with one of these viruses can experience genital or oral herpetic bouts. On average, bouts due to HSV-1 occur once a year and those due to HSV-2 can occur four times a year. 3 References: 1. P Sen, S E Barton. Genital herpes and its management. BMJ 2007;334:1048-1052 2. Wald A. Genital Herpes. Clinical Evidence BMJ Publishing Group 2001; 5: 1090-8. 3. Worrall G. Herpes labialis. Clinical Evidence BMJ Publishing Group 2001; 5: 1169-74. Competing interests: None declared |
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Malur Sudhanva, Consultant Virolgist London South Specialist Virology Centre, HPA London, Kings College Hospital NHS Foundation T.SE5 9NU
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As a Consultant Virologist, I appreciate this article for touching all bases. But I find that the table 1 is out of date and does not reflect laboratory practise among the virologists of UK clinical virology network www.clinical- virology.org. Virus isolation is not ideal as it is less sensitive and prone to bacterial contamination of cells. Virus nucleic acid detection (DNA detection) by PCR is the method of choice. PCR is not expensive, in fact in our lab it is less expensive than virus isolation. It is not just used in research studies but used in routine diagnosis of HSV-1 and HSV-2 DNA. This table with appreciating details of virus culture and antigen detection along with "expensive" label put out on PCR sends the wrong message to the clinicians. Competing interests: Webmaster for UK Clinical Virology Network http://www.clinical- virology.org |
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Julian Law, GP - Kyle of Lochalsh IV40 8DD
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I am not sure if all experts recommend delivery by caesarean section for recurrent genital herpes if lesions are present at onset of labour as quoted in this article (1). The RCOG guideline from 2002 Management of Herpes in Pregnancy mentions rates of transmission of between 0-3% for recurrent genital HSV lesions at onset of labour (2). It goes on further to suggest that if all women with an episode of recurrent genital herpes at onset of labour were to undergo a caesarean section then 1583 (range 632-6340) caesarean sections would need to be performed to prevent one case of herpes related morbidity or mortality. Balancing the small risks of transmission from recurrent genital herpes at onset of labour should be set against the risks to the mother of a caesarean section. I would be interested to hear the experts' opinion on this topic. 1. Catalano PM, Merritt AO, Mead PB. Incidence of genital herpes simplex virus at the time of delivery in women with known risk factors. Am J Obstet Gynecol 1991;164:1303-6. 2.http://www.rcog.org.uk/resources/Public/pdf/Genital_Herpes_No30.pdf Competing interests: None declared |
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