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Headlines:
> California
STD Controllers Association Releases Summary Guidelines for HSV
Type-2 Serologies
> Study
Verifies Increased Risk of HIV Acquisition with HSV Type-2
> Medscape Newsclip: Importance of Testing and Diagnosis in Genital Herpes
> CDC STD
HSV Treatment Guidelines Emphasize HSV Type-Specific Tests
California
STD Controllers Association Releases Summary Guidelines for HSV
Type-2 Serologies
The California Sexually Transmitted Diseases (STD) Controller Association
and the California Department of Health Services (CADHS) have jointly published
recommendations for the use of HSV-2 type-specific serology tests. The guidelines,
initially distributed at the 2004 National Prevention conference in Philadelphia,
summarize the recommendations for healthcare providers into seven clinical
scenarios:
- Diagnosis of genital lesions/symptoms: type-specific serology
tests should be available for diagnostic purposes in conjunction
with virologic tests at any setting where patients are evaluated
for STDs.
- Screening in patients at-risk for STD/HIV (Current STD, recent
STD, high-risk behaviors): should be offered to select patients.
- Screening in patients in partnerships or considering partnerships
with HSV-2-infected people: should generally be offered
- Screening in HIV-positive patients: should be generally offered.
- Universal screening in pregnancy: should generally not be offered.
- Screening in general population: should generally not be offered.
- Herpes education and prevention/transmission counseling is
necessary for all people being tested or screened for HSV-2.
The complete text of the guidelines document is available at:
http://www.stdhivtraining.org
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Study
Verifies Increased Risk of HIV Acquisition with HSV Type-2
A recent article by Lawrence Corey, MD posted on Medscape Infectious Diseases
describes the alarming increase worldwide of HSV-2 infections over the past 20
years, and points to mounting evidence for the epidemiologic synergism between
HSV-2 infection and increased HIV-1 transmission. One retrospective study in
particular showed that the seropositivity of the susceptible partner increased
the risk of HIV acquisition by 5 to 8-fold per sexual contact. The conclusions,
based on several studies, illustrate the dramatic effect that HSV-2 seropositivity
has on the spread of HIV.
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Medscape Newsclip: Importance of Testing and Diagnosis in Genital Herpes
A recently published review article by Dr. Rhoda Ashley Morrow
at the University of Washington Department of Medicine provides
an update on genital herpes and the need for diagnostic testing.
The article, entitled “Importance of Testing and Diagnosis
in Genital Herpes”, states that only 1 in 10 HSV-2 infected
individuals has a history of genital herpes, and describes the
transmission of disease in the absence of symptoms. Currently,
over 20% of US adults are infected with herpes simplex virus (HSV)
type 2, and the prevalence approaches 80% in some STD clinics.
Individuals at risk for more serious disease include babies born
to infected mothers and persons at risk for HIV. The article goes
on to describe laboratory diagnostic tests for HSV, including viral
detection and serology tests. Based on recommendations by the CDC
and CADOH, type-specific HSV-2 serology tests should be available
to help the physician accurately diagnose genital herpes in the
following clinical scenarios:
- Anogenital lesions are observed on examination
- Patient reports symptoms consistent with Herpes
- Patient is HIV positive or at risk of HIV infection
- STD screening is requested
- Prenatal screening is performed
in selected patients
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CDC STD HSV Treatment Guidelines Emphasize HSV Type-Specific Tests
The Centers for Disease Control and Prevention (CDC) has issued national guidelines
designed to help healthcare providers protect their patients from the health
consequences that result from sexually transmitted diseases (STDs). The 2006
Guidelines for Treatment of Sexually Transmitted Diseases integrate recommendations
on the most effective treatment regimens, screening procedures and prevention
strategies for STDs. For genital herpes simplex virus (HSV) infections the new
guidelines recommend that both culture and type-specific serologic tests be available
in clinical settings that provide care for patients with STDs or those at risk
for STDs. CDC recommends that serologic type-specific gG-based assays, such as
HerpeSelect® type-specific test kits from Focus Diagnostics be specifically
requested when serology is performed. The guidelines state that accurate type-specific
assays for HSV antibodies must be based on the HSV-specific glycoprotein G2 for
the diagnosis of infection with HSV type-2 and glycoprotein G1 for diagnosis
of infection with HSV type-1. The complete CDC guidelines are available at:
http://www.cdc.gov/STD/treatment/2006/rr5511.pdf
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