title: The epidemiology of genital infection with herpes simplex virus types 1 and 2 in genitourinary medicine attendees in inner London.
abstract: OBJECTIVE
  To characterise the epidemiological and clinical features of genital herpes and the diagnostic role of HSV-2 specific serology in an ethnically diverse cohort of genitourinary medicine (GUM) attendees in inner London.
  
  
  METHODS
  Genital swabs (n = 186) were tested by real time polymerase chain reaction (PCR) and serum samples (n = 70) by HSV-2 specific enzyme linked immunoassay (ELISA).
  
  
  RESULTS
  Among 186 patients (median age 29 years), 104/186 (56%) were male and 176/186 (95%) heterosexual; ethnicity was predominantly black Caribbean (76/186, 41%), white (65/186, 35%), or black-African (41/186, 22%). The most common lesion sites were penis (85/104 men, 82%) and vulva (63/82 women, 77%); 114/186 (61%) patients were diagnosed clinically with first episode disease. Women were more likely to present <5 days of onset (p = 0.008). Black Caribbean patients were more likely to present > or = 5 days (p = 0.04) and decline HIV testing (p = 0.03). By PCR, 108/186 (58%) swabs tested positive for HSV-1 (7/108, 6.5%) or HSV-2 (101/108, 93.5%). Independent predictors of a positive PCR were heterosexual group, <5 days of onset, and visible genital ulceration on examination. HSV-2 was associated with black Caribbean and black African ethnicity; HSV-1 with white ethnicity (p = 0.006). By HSV-2 specific serology, 16/42 (38%) first episodes caused by HSV-2 were recurrent infections, and 7/19 (37%) patients with recurrent genital disease but negative PCR had genital herpes.
  
  
  CONCLUSIONS
  Epidemiological trends in genital HSV-1 and HSV-2 infection appear to vary between ethnic groups in the United Kingdom. HSV-2 specific serology improves diagnostic accuracy in GUM populations where most genital infections are caused by HSV-2.
authors.affiliation: Department of Virology, Royal Free Hospital and Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ramaswamy
authors.forename: C
authors.initials: C
authors.lastname: McDonald
authors.forename: C
authors.initials: C
authors.lastname: Sabin
authors.forename: M
authors.initials: M
authors.lastname: Tenant-Flowers
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: A M
authors.initials: AM
authors.lastname: Geretti
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006558:Herpes Genitalis / Q000175:diagnosis / Q000453:epidemiology*; D018259:Herpesvirus 1, Human; D018258:Herpesvirus 2, Human; D020010:Heterosexuality / Q000706:statistics & numerical data; D006716:Homosexuality / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014900:West Indies / Q000208:ethnology