mlp0515

出處：WebMD醫學新聞

　　January 27, 2010 — 根據線上發表於1月20日且將在2月15日感染病期刊(Journal of Infectious Diseases)印行的研究，單純疱疹病毒第2型(HSV-2)可以在整個生殖道內定期地再活化，這個發現將對治療與預防有所影響。
　　
　　Fred Hutchinson癌症研究中心、華盛頓大學的Christine Johnston醫師等人寫道，HSV-2血清型陽性者的縱向研究顯示，超過90%的人的生殖道有HSV再活化。
　　
　　研究者檢視了有出現症狀之生殖器疱疹、HSV-2血清型陽性的4名婦女，初次感染發生在研究前1年(中位數)，這些研究對象被連續觀察30天，每次從生殖道的7個不同位置取樣，為了偵測HSV-1和HSV-2的抗體，使用HSV西方墨點法分析血清，將拭子樣本上的DNA進行定量HSV聚合酶鏈鎖反應。這些研究對象在試驗期間沒有服用抗病毒藥物。
　　
　　研究發現如下：
　　* 120病患天數(4名病患x30天)內，在44病患天數(37%)的840個拭子樣本中，有136個(16%)發現有HSV。
　　* 120病患天數中有35病患天數(29%)有病灶紀錄。
　　* 有發現HSV的44病患天數中，其中25病患天數(57%)發現有1個以上的解剖位置有HSV (中位數，2個位置；範圍1 – 7處)，而這25病患天數中有20病患天數(80%)發現在身體兩側都有。
　　* 肉眼可見的病灶與任何生殖器位置有HSV(發生率比率[IRR]為5.41；95%信心區間[CI]為1.24 - 23.50；P = .02)和陽性位置數量(IRR，1.19；95% CI，1.01 - 1.40；P = .03)有顯著關係。
　　* HSV最大拷貝數發現與陽性位置數量有關(IRR，1.62；95% CI，1.44 - 1.82；P < .001)。
　　
　　作者們寫道，這些結果顯示，多處薦骨神經結可能會同時發生生殖道HSV再活化；至於機轉仍需要後續研究。
　　
　　研究限制包括，研究對象少以及一些其他特徵，例如這4人中有3人的初次感染發生在研究開始前1年內，她們這些相對較新的感染增加了病毒再活化與病灶數量高的可能性，再者，其中最近才染有疱疹的2名婦女佔了絕大多數的病灶天數，作者們承認，需要更多不同的世代進行研究。
　　
　　作者們寫道，需要後續研究探討，是否有更為廣泛的次臨床再活化發生在HSV-2血清型陽性而無HSV-2臨床史的人，或者是那些長年有HSV-2的感染者。
　　
　　Jefferson縣衛生局、阿拉巴馬大學的Edward Hook 三世醫師在編輯評論中指出，五分之一的美國人有生殖器疱疹，但是只有大約10%有被診斷，Hook醫師呼籲對這些高風險者進行全國性的血清檢測活動，以提供更好的預防基礎，他也提議，對於有HSV-2感染、有性生活的男性和女性、但是性伴侶不知道被傳染者，進行抑制性治療。
　　
　　Hook醫師表示，這是不簡單的任務，醫師須對他們的診斷與處置方法重新再概念化，此外，也需要不再把生殖器疱疹視為「淫蕩的字眼」，而只是人類性行為之後的不良結果，透過更廣泛的檢查與更積極的治療來減少對個人和公共衛生的影響。
　　
　　國家健康研究中心/國家過敏與感染症研究中心支持本研究，多位研究作者接受國家健康研究中心、GlaxoSmithKline、Antigenics、Astellas、Aicuris和/或Immune Design公司等的資金或擔任顧問。一名共同作者主持華盛頓大學病毒學實驗室，在診斷HSV感染上有相當幫助。詳細的宣告內容登載在期刊文章後。
　　
　　J Infect Dis. 線上發表於2010年1月20日、且將在2010年2月15日印行(201:486-487, 499-504)。


Genital Herpes Virus Can Repeatedly Reactivate in Genital Tract

By Nancy Fowler Larson
Medscape Medical News

January 27, 2010 — Herpes simplex virus type 2 (HSV-2) can regularly reactivate throughout the genital tract, a finding that may affect treatment and prevention, according to a study published online January 20 and in the February 15 print edition of the Journal of Infectious Diseases.

"Longitudinal studies in HSV-2–seropositive persons have shown that HSV reactivates in the genital tract in >90% of persons," write Christine Johnston, MD, MPH, and colleagues at the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle. "Anatomic patterns of genital HSV-2 reactivation have not been intensively studied."

Researchers examined 4 HSV-2–seropositive women with a history of symptomatic genital herpes. The primary infection occurred a median of 1 year before the study. Participants were observed every day for 30 days, and samples were collected from 7 different genital locations each time. To detect antibodies to HSV-1 and HSV-2, serum was assayed by HSV Western blot. DNA from swab samples underwent quantitative HSV polymerase chain reaction. The participants took no antiviral medication during the trial.

The findings were documented as follows:

HSV was found on 136 (16%) of 840 swab samples from 44 (37%) of the 120 patient days.
Lesions were recorded on 35 (29%) of the 120 days.
HSV was discovered at more than 1 anatomic site on 25 (57%) of 44 days in which there was HSV shedding (median, 2 sites; range, 1 - 7) and was noted on both sides of the body on 20 (80%) of the 25 days.
Visible lesions had a significant relationship with documented HSV from any genital location (incident rate ratio [IRR], 5.41; 95% confidence interval [CI], 1.24 - 23.50; P = .02) and with the number of positive sites (IRR, 1.19; 95% CI, 1.01 - 1.40; P = .03).
The maximum HSV copy number found was related to the number of positive sites (IRR, 1.62; 95% CI, 1.44 - 1.82; P < .001).
"These results demonstrate that genital HSV reactivation may occur simultaneously from multiple sacral ganglia; the mechanism behind these observations requires further investigation," the authors write.

Limits to the study included the small number of participants and some of their specific characteristics. In 3 of the 4 subjects, the initial infection occurred within a year of the study's initiation. Their relatively new infections raised the probability that both viral reactivation and lesions numbers would be high. Furthermore, the 2 women who had most recently contracted herpes accounted for most of the lesion days. The authors acknowledged the value of a more diverse cohort.

"Whether widespread subclinical reactivation occurs in HSV-2–seropositive persons without a clinical history of HSV-2, or in persons with long-standing HSV-2 infection, requires further study," the authors write.

In an editorial published with the findings, Edward Hook III, MD, from the University of Alabama at Birmingham and Jefferson County Department of Health, notes that 1 in 5 Americans has genital herpes but only about 10% are diagnosed. Dr. Hook called for a national campaign for serological testing of those at high risk to provide the basis for better prevention. He also advocated suppressive therapy for sexually active men and women who have HSV-2 infection but whose partners are not known to be infected.

"This would not be a simple task. Clinicians would need to reconceptualize their approach to diagnosis and management," Dr. Hook said. "In addition, there would be a need to portray genital herpes not as a 'scarlet letter' but rather as a widespread untoward consequence of human sexuality, the impact of which on personal and public health could be reduced through broader testing and more aggressive treatment."

The National Institutes of Health/National Institute of Allergy and Infectious Diseases supported the study. Several study authors have received funding from or have consulted for the National Institutes of Health, GlaxoSmithKline, Antigenics, Astellas, Aicuris, and/or Immune Design Corporation. One coauthor directs the University of Washington Virology Laboratory, which has been instrumental in diagnosing HSV infections. A full list of disclosures is available at the end of the journal article.

J Infect Dis. Published online January 20, 2010. Print publication February 15, 2010;201:486-487, 499-504.