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Signs herpes outbreak is coming

Objective: To describe the prevalence of Herpes Simplex Virus-2 (HSV-2) infection among males in six major cities of Pakistan.
Methods: A cross sectional behavioural and biological survey of urban male population aged 16-45 years was conducted in Rawalpindi, Lahore, Karachi, Faisalabad, Peshawar and Quetta to measure the prevalence of five sexually transmitted infections and assess sexual behaviours.
Conclusion: Empirical evidence from this study suggests that there is city wise variation in the prevalence of HSV-2 infection across the major cities in Pakistan. Globally Herpes Simplex Virus Type-2 (HSV-2) is amongst the most common sexually transmitted infections.1 HSV-2 seroprevalence studies show variation in infection by geographic location. Till recently, we did not have either national or city wise prevalence estimates for HSV infection in Pakistan. The main component of the study was a cross-sectional behavioural and biological survey of 2400 men carried out in six major cities of Pakistan from June to August 2007. City selection was based on inclusion of the four provincial capitals of the country, Lahore, Peshawar, Quetta and Karachi as well as two other larger cities, Rawalpindi and Faisalabad.
The structured survey questionnaire was developed taking into consideration existing questionnaires developed on this topic by previous studies such as Behavioural Surveillance Survey.8 Separate informed consent was obtained from the participants for conducting both the behavioural questionnaire and obtaining biological specimens. The entire study was approved by the Ethical Review Boards of the Population Council in New York, the London School of Hygiene and Tropical Medicine and HOPE (Health Oriented Preventive Education), a Pakistani research NGO which has its own ethical clearance board.
Of a total of 83 respondents, 12 were positive for HSV-2 infection and were also diagnosed with syphilis.
In Table, the multivariate analysis shows that HSV-2 infection was significantly associated with age greater than 27 years (27 years was selected as the cut off since it was the median age of the respondents in the overall sample). According to Corey et al,14 more than 30 epidemiologic studies have demonstrated that prevalent HSV-2 is associated with a two to four fold increased risk of HIV-1 acquisition.
The clear linkage between HSV-2 infection and HIV acquisition points to the need for the prompt diagnosis and early management of HSV-2 infections as an important strategy for combating the spread of the HIV infection. An important aspect of HSV infection that raises a major public health challenge is the high proportion of infections that are unrecognized by both patients and clinicians. Many cases of genital herpes are transmitted by persons who are unaware that they are infected. Based on the growing international evidence policy makers and programme managers should consider the prevalence of HSV-2 infection as a "canary in the mine" in predicting the emergence of a future HIV epidemic and the need to invest in HSV-2 surveillance programmes.
Future prevention intervention must therefore keep in mind targeting this specific group of older men, through focused IEC (Information, Education and Communication) and behaviour change strategies that reduce individual vulnerability by modifying sexual behaviours. To further enhance the effectiveness of prevention programmes, primary care providers should be trained to recognize, counsel and adequately manage STIs.
Currently, due to paucity of specific STI clinics in the public sector facilities, most men resort to traditional or private practitioners to manage their sexual health problems. The study of Sexually Transmitted Infections among urban male population in Pakistan: Identifying the Bridging Population was commissioned by the National AIDS Control Program, Government of Pakistan, with funding from the Department for International Development (DFID), United Kingdom. 9.Enzyme-linked immunosorbent assay (ELISA) for the qualitative detection of human IgG class antibodies to HSV-2.
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This is a viral infection of the lips and mouth which is caused by the herpes simplex virus a€“ termed HSV.
Herpes doesna€™t always develop symptoms a€“ it does not always cause any outward, visible signs. Kissing or touching and any sexual contact with the area that is infected spreads oral herpes.
Many individuals have symptoms of itching, burning, and tingling proceeding the outbreak of blisters or sores. The most concentrated pain from these sores occurs at the onset and can make drinking or eating hard.
If a child with cold sores is less than 6 weeks old, the babya€™s physician needs to be notified if oral blisters or sores appear.
Individuals with weakened immunity systems should also notify their primary care physician if sores or blisters appear.
A physician will make a tentative diagnosis on data provided by the patient and on the physician exam. Topical anesthetic such as lidocaine (xylocaine, Nervocaine, Dilocaine, Zilactin-L) can be approved for pain relieve of oral blisters and lesions.
Oral or IV drugs exist for HSV but only for individuals with weakened immune systems, infants younger than 6 weeks or those with severe disease.
Topical Denavir (penciclovir) creams can shorten attacks of recurrent HSV-if it is applied early, normally before lesions develop.
These medications may stop viral reproduction in the skin but do not eradicate HSV from the body or stop later outbreaks. This website is for informational purposes only and Is not a substitute for medical advice, diagnosis or treatment.
Depiction of the molecular interactions in the ganglia showing the inverse relationship between LATs and lytic proteins. Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. Herpes is a condition feared by many since it is associated with sexually transmitted disease which is an unacceptable condition in the society. Among the most prevalent cause of herpes eye is the varicella-zoster virus which is also the reason behind chicken pox and shingles.


Moreover, there is also another virus behind the condition and it is the herpes simplex type 1, basically the same thing that triggers the condition of cold sores found on the mouth and lips. The doctor will have to examine the eye through the use of a magnifier; sometimes a stain is also dropped in order to see the irregularities. When the problem had not yet reaches its peak, the physician would probably prescribe oral anti-viral medicine or topical creams which will be applied on the spot. These antiviral medicines should be employed as frequent as possible; sometimes one drop hourly is required. More from my siteHerpes Simplex Virus Causes, Symptoms and TreatmentWhat Does Herpes Look Like? Enter your email address to subscribe to this blog and receive notifications of new posts by email.
In 2007 the Ministry of Health and the National Aids Control Program (NACP) commissioned a behavioural and biological study of urban male population that was implemented by the Population Council. Only male population were selected as they constitute the bridging population that is a conduit for the spread of sexually transmitted infections from high to low risk general population.
A multistage sampling design was employed to select a total of 400 men aged 16-45 years in each city.
Two data collection teams, each comprising a doctor, phlebotomist, lab technician and two social interviewers remained in the field for 45 days in each city. Proportion of unmarried respondents was 47 percent of which 80 percent were employed and 14 percent were illiterate. Nine respondents who tested positive for HSV-2 reported as never having had sexual intercourse in their life times. The presence of a concentrated epidemic in the high risk groups suggests the need for more targeted interventions at mitigating high risk behaviours including the acquisition of sexually transmitted infections. Up to 70 percent of genital HSV infections are unrecognized.3 Asymptomatic infection plays a major role in maintaining viral circulation in society.
Results from this study also show the relationship between educational level and infection prevalence to be city specific.
Counseling will play an important role in preventing transmission to the partner and subsequent neonatal mortality. These practitioners mostly prescribe antibiotics which may cover bacterial infections, but they do not treat viral infections.
Appropriate strategies for preventing acquisition and management of Sexually Transmitted Infections should be amongst the priorities for curtailing the future spread of an HIV epidemic in Pakistan.
Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection.
Trends in HIV-1 and HIV-2 prevalence and risk factors in pregnant women in Harare, Zimbabwe.
HIV testing in national population-based surveys: experience from the Demographic and Health Surveys. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. Sero-epidemiological and sociological patterns of herpes simplex virus infection in the world. The epidemiology of herpes simplex virus type-2 infection among married women in Mysore, India. The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics.
Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka.
Antibody to herpes simplex virus type 2 as a marker of sexual risk behavior in rural Tanzania.
High seroprevalence of HSV-1 and HSV-2 in STD clinic attendees and non-high risk controls: A case control study at a referral hospital in South India. Activation comprises active transcription of viral RNA and high lytic protein expression accompanied by low LAT production. This is because of the lack of proper knowledge among individuals, they are not aware that there are two kinds of herpes virus which include the one which works as the culprit behind cold sores and the other one triggers chickenpox to occur which may lead to serious eye condition.
Since it targets the whole body, time will come that it will attack the eye and when this take place, it’s now known as herpes zoster ophthalmicus. When this second strain reaches the eye, it typically creates a disturbing infection of the cornea known as herpes simplex keratitis. Among the most prevalent sign of the illness includes; irritation, tearing, recurring eye infections, watery discharge, foreign body sensation, eye redness, swelling around the eyes, eye sores, and sensitivity to light. Mostly, a small ulcer within the cornea is seen which may indicate the presence of herpes eye condition. If only the eyelid as well as the conjunctiva is affected, it is not necessary to do any treatment procedure since the problem will most likely clear up on their own after a span of 1 to 3 weeks.
Sometimes, the cornea will be scraped to get rid off the diseased cells which are the main reason behind the problem. But if the problem is beyond treatment of ordinary medicines then a physician would have no other option but to opt for corneal transplant. In each city 10 blocks demarcated by the Population Census Organization were selected based on probability proportional to socio-economic status.


The two main objectives of this DFID-funded study were to estimate the prevalence of five commonly occurring STIs, including HIV, in six major cities of the country and to document sexual behaviours amongst urban male population. In the first stage 10 blocks demarcated by the Population Census Organization (that comprise 200-250 households) were selected in each city based on probability proportionate to socio-economic status using male and female literacy as a proxy indicator for economic status. Data analysis included descriptive statistics measuring frequencies, bi and multivariate analysis based on logistic regression models. In total 106 individual respondents were diagnosed with one of the five STIs, out of which 83 cases were diagnosed with HSV-2 infection. Association was also observed between presence of HSV-2 infection and respondents having four or more non-marital sexual partners (either male or female) in the last 12 months [adjusted O.R.
Having multiple partners is statistically significantly associated with disease occurrence.
For instance, Rawalpindi with a high male literacy rate (82 percent) had the lowest prevalence of HSV-2. To ensure adequate treatment, antibody specific tests for HSV-2 detection should be made available on an incremental basis at all tertiary level care facilities, at least at the district headquarter hospitals where functional laboratories are already present.
Mass awareness must be created in the general population to access services from trained providers who have the facilities to provide information, counseling, testing, and appropriate treatment. Rana Muzaffar, Head of Molecular Biology at Sindh Institute of Urology and Transplantation (SIUT), and her team, Dr. Be reminded that these two viruses is not the major cause for genital herpes so it is right to presume that herpetic eye disease has nothing to do with sexually transmitted disease.
If a couple or more of these condition occurs, it warrants an immediate visit to your doctor.
You need to talk with your doctor about the possible outcome of one medication for herpes eye because some medications may further make the problem worse therefore it is your main obligation to know its side effects. This paper discusses results related to the prevalence of HSV-2 infection amongst males in the six major cities of Pakistan. Within each block 40 individuals were selected from each household through systematic sampling with a random start.
All specimens were transported to the laboratory of the Sindh Institute of Urology and Transplantation at Karachi. In this paper the multivariate analysis has looked at the association of the independent factors age, education, marital status, sex in the last three months and number of partners with the presence of HSV-2 infection. The results related to the prevalence of Genital Herpes (HSV-2) in the six major urban centres of the country are presented in Figure. With a concentrated HIV epidemic already manifest in the high risk groups, genital herpes may serve as a conduit for the spread of subsequent HIV infections into the general low risk population of women.
On the other hand Karachi which is a metropolitan city with a large migrant population of unskilled workers and a lower male literacy level (72 percent) had the highest prevalence of all six cities.
Furthermore health educational campaigns launched through health facilities should educate men about risk factors and the need for periodic testing in order to avoid complications that can occur in case they remain asymptomatic for long. In total 2400 men were administered a behavioural questionnaire and 2396 provided biological specimens for laboratory testing. Informed consent was obtained for both the interview and the sampling of biological specimens. Specimens were airlifted to Karachi taking special precautions during transportation that included maintaining the cold chain and avoidance of spillage and contamination of the specimens. On the other hand, occupation, income and marital status were not found to be significantly associated. Future prevention programmes must, therefore, be cognizant of and adapt as needed, to city differentials. Encouraging a healthy lifestyle by providing youth with life skills education within schools can be an effective approach in reaching out to young men. Special containers were provided by Sind Institute of Urology and Transplantation for this purpose. Without treatment 70 percent of neonates with disseminated infections are unable to survive19 and half of the survivors develop neurological conditions. The empirical evidence from the literature has shown a higher seroprevalence of HSV-2 among females as compared to males.21-23 This argues for the inclusion of women in the overall STI prevention strategy.
The information must include messages that conform to our religious and societal norms and emphasize behaviours such as abstinence and marital fidelity along with explanations of the modes of transmission and associated morbidities of sexually transmitted infections.
The overall refusal rate was 37 percent well within the range of other surveys comprising male population.7,8 The sample size calculations were based on a conservative expected 7 percent prevalence of any tested STI (chlamydia, gonorrhea, or syphilis). Expected compliance for the biological data collection was 70 percent, based on the pretest results. The design effect (which takes into account the increase in standard errors due to clustering) was set at 2.0.
This test qualitatively detects the presence or absence of human lgG class antibodies to HSV-2 in human sera. The focus diagnostics ELISA uses purified recombinant type specific IgG-2 antigen immobilized on polystyrene microwells.
The proposed sample size was also justified in terms of its power to detect behavioural change with statistical confidence.



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Comments
  1. Aida 11.04.2014 at 22:16:56
    Let the body itself clear.
  2. LOREAL_GOZELI 11.04.2014 at 15:17:36
    Reactivate and recur over are.
  3. L_E_O_N 11.04.2014 at 21:13:22
    Enough relaxation and sleep, and can get relief.
  4. V_U_S_A_L17 11.04.2014 at 18:56:46
    Cause severe neurological disease and even demise in infants born.