Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 23, Num. 2, 2005, pp. 143-144

Indian Journal of Medical Microbiology, Vol. 23, No. 2, April-June, 2005, pp. 143-144

Letter To Editor

Coinfection of HSV with other Sexually Transmitted Diseases

Peters B.P., Rastogi V.L., Monica, Nirwan P.S.

Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Ajmer

Correspondence Address:of Microbiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan - 305 001, drvjlata@datainfosys.net

Code Number: mb05041

Dear Editor,

The emerging prosodemic of AIDS/HIV disease in India has made STD Control as one of the strategies imperative and probably the most important to decrease HIV transmission in community.[1] Among various STDs, prevalence pattern of syphilis and herpes genitalis is pivotal and NACO has already issued guidelines to test for these two diseases in AIDS as well as non-AIDS patients by serology. We conducted this study to analyse the seroepidemiology of HSV in STD patients and to provide data for implementation of the joint STD/HIV control programme.

Sera of 66 patients (22 females and 44 male) with various STD symptoms (21 ulcerative and 45 non-ulcerative) attending the STD clinic, JLN Hospital, Ajmer, was tested for the presence of IgM antibodies to HSV-1 and 2 (to detect primary/first episode genital HSV infection)[2] by ELISA, for syphilis by RPR and TPHA and for HIV by ELISA. Out of 66 STD patients 27 were IgM-HSV positive (40.9%), 15 were syphilis positive (22.7%) and 7 HIV positive (10.6%) [Table - 1]. Coinfection rate of HSV in syphilis and HIV positives was 40.6% and 42.9% respectively. However only two out of the 27 IgM-HSV positive patients had clinical herpes genitalis yielding a subclinical HSV coinfection rate of 37.8%. Hence, according to current WHO treatment regimen, 25 cases of primary/first episode genital HSV infections would have been missed clinically leading to inappropriate treatment. This lapse in diagnosis can nevertheless catapult onto grevious consequences like meningoencephalitis, disseminated herpes or even death, especially if the patient becomes immunocompromised or if transmitted from mother to newborn.

In our study a large proportion (40.7%) of HSV positives were females of child bearing age and can act as potential transmitters to their offspring. Transmission of infection from HSV positive males to their sexual partners may further cascade the situation.[3] Detection of subclinical HSV coinfection by serology facilitates counselling regarding advisability of acyclovir therapy (in addition to treating the other coexisting STD), the risk of recurrences and appropriate measures to reduce HSV transmission to contacts.[4]

HIV infection in our STD clinic attendees was 10.6% which is quite alarming. Our study strongly suggests that every case of STD, be it ulcerative or non-ulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications.[5]

References

Copyright 2005 - Indian Journal of Medical Microbiology

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