Herpes Simplex Viruses

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Herpes simplex viruses (HSV) are enveloped double-stranded DNA viruses in the herpesvirus family. HSV I and II have the capacity to invade and replicate in the central nervous system, establish latent infection, and recur in the presence of humoral and cell-mediated immunity. Latent stages of HSV I and II occur as a result of viral entry into sensory nerve endings following primary infection. The virus is then transported to the nuclei of sensory ganglia where, in the majority of patients, it remains for the life of the individual. Reactivation often follows local or systemic stimuli, that is, physical or emotional stress, fever, exposure to ultraviolet light, tissue damage, or immunosuppres-sion. The spectrum of HSV disease includes primary and recurrent infections of mucous membranes (i.e., gingivostomatitis, herpes labialis, and genital HSV), kerato-conjunctivitis, neonatal herpes, visceral HSV infections in immunocompromised hosts, and HSV encephalitis (17,18).

Epidemiology

More than one third of the world's population has recurrent HSV infection. The frequency of HSV I infections is influenced by geographic location, socioeconomic status, race, sex, and age. Individuals in developing countries and lower socioeconomic populations have evidence of seroconversion earlier in life, with approximately one third of children under the age of 5 yr having serologic evidence of HSV I infection. The prevalence of HSV I infection increases to 70-80% by early adolescence. Middle socioeconomic populations demonstrate a 20% seroconversion rate in children over 5 yr of age that increases to 40-60% by the second and third decades of life. University students have a 5-10% annual incidence of HSV I infections, compared to an approx 2% annual incidence of HSV II infections.

Herpes simplex virus type II is usually acquired through sexual contact. The annual incidence of HSV II infection is approx 500,000, with 40-60 million latently infected individuals in the United States. Gender, race, number of sexual partners, marital status, and place of residence affect the incidence of HSV II infections. Individuals who are divorced (compared to single or married) or live in cities (compared to suburbs) have a higher prevalence of HSV II. The seroprevalence is approx 10% from ages 15 to 29 yr and 35% by age 60 with a three- to fourfold higher rate in African-Americans as compared to Caucasians. The highest seroprevalence rates are among injection drug users (40-60%), female prostitutes (75%), and male homosexuals (83-95%). The number of lifetime sexual partners is directly correlated with acquisition of infection (Table 4).

Women have a higher rate of infection than men (Table 4). The estimated risk of transmission from a male with active lesions to a susceptible female after a single contact is 80%. Transmission between monogamous sexual partners with discordant infection status is 10-15% yearly. During pregnancy the rate of infection is approx 2% per gestation with transmission to the fetus related to shedding of the virus at the time of

Table 4

Serologic Evidence of HSV II Infection by Number of Partners

Table 4

Serologic Evidence of HSV II Infection by Number of Partners

Number of Partners

Heterosexual Women

Heterosexual Men

Homosexual Men

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