PubMed · 12403309
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Jeffrey M Weinberg. 2002. HELP for herpes.. https://pubmed.ncbi.nlm.nih.gov/12403309/
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BACKGROUND: The seroprevalence of herpes simplex virus (HSV) type 2 in the United States has increased dramatically since the 1970s. Vaccines are being developed to control the epidemic. We determined the potential public health impact that imperfect, preexposure HSV-2 vaccines could have on reducing the incidence of infection. METHODS: We modeled the future impact of preexposure vaccines with both prophylactic and therapeutic properties. We predicted the individual-level (cumulative number of new infections prevented per 1000 vaccinated individuals) and population-level (cumulative percentage reduction in new infections) impact. RESULTS: We show that the percentage reduction in incidence of infection would be relatively modest. However, HSV-2 incidence rates are extremely high; thus, we calculate that even imperfect vaccines would prevent >1 million infections in the United States within a decade after introduction. We found that vaccines would prevent 3 times as many infections per vaccinated person in a high-prevalence epidemic than in a moderate-prevalence epidemic. We also identified the vaccine characteristics that have the greatest impact on reducing the incidence of infection. We determined that vaccine take and degree of protection against infection are equally important, whereas therapeutic characteristics are unimportant. CONCLUSIONS: Designing preexposure HSV-2 vaccines with therapeutic characteristics will have little impact on reducing the incidence of infection. HSV-2 vaccines will have a substantially greater public health impact in developing than in developed countries.
This study audited the utilization of herpes simplex virus polymerase chain reaction (HSV PCR) in the investigation of recurrent anogenital ulceration at the Mortimer Market Centre. Clinic guidelines for use of HSV PCR were modified in April 2003 to expand PCR use. Ninety-six case-notes belonging to patients presenting with recurrent anogenital ulceration between 1 April and 16 October 2003 were reviewed and 59 were suitable for inclusion. Details of the investigations carried out at each visit were recorded. HSV PCR was used according to guidelines in eight of the 59 cases studied. This audit showed under-utilization of HSV PCR testing with poor adherence to clinic guidelines when cases of suspected recurrent genital herpes were investigated. This led to under-diagnosis and delay in diagnosis. This audit stresses the importance of informing all clinical staff of the improved sensitivity and relative affordability of HSV PCR compared with HSV tissue culture.