EPIDEMIOLOGY AND OUTCOME OF GESTATIONAL HSV INFECTIONS

生殖器单纯疱疹病毒（HSV）感染是最常见的 在美国常见的性传播疾病（STD）。 这些感染是引人注目的痛苦的过程中，频繁 复发性、高传染性和持续潜伏性。 最 生殖器疱疹的危害有哪些？ 分娩时排出病毒的母亲。 暴露婴儿 单纯疱疹病毒可能会感染与未经治疗的死亡率 的70%。 尽管存在新生儿HSV感染的问题， 生殖器疱疹的流行病学数据缺乏， 怀孕 大多数现有数据涉及以下情况： 有生殖道感染史的女性中SHV无症状脱落 HSV。 这些数据的一个主要局限性体现在 据观察，50%感染HSV的新生儿出生时 既无当前症状也无生殖器疾病既往史的女性 疱疹 显然需要更多的资料， 这种性病在孕妇中的流行病学。 虽然10-15%的 生殖器疱疹是由单纯疱疹病毒1型引起的，其余的是 由HSV-2引起。 生殖器疱疹的危害有哪些？ 通过测定HSV-2抗体近似。 广泛 HSV-1和HSV-2蛋白之间的抗原同源性干扰了 与既往HSV-1和HSV-2感染的血清学区别。 最近，HSV-2的gG蛋白（gG-2）已被证实 具有类型特异性表位。 的核苷酸序列 gG-2的基因已被阐明。 单克隆抗体 对gG-2的反应为ELISA血清学测定提供了基础， 用于确定HSV-2感染的真实患病率。 一 目前的IgG-2 ELISA方法的局限性在于它是间接的， 需要进行多个孵育步骤。 虽然这 检测灵敏度高、特异性强，但费时费钱。 如果使用一种新的方法， 可获得gG-2抗原来源，其不需要 制备的免疫亲和步骤。 重组DNA克隆 提供了一种方法，通过该方法可以将特定的基因产物 大量表达，不含其他病毒蛋白， 抗原 我们建议开发一种简单快速的检测方法， 基于重组的HSV-2感染的血清学诊断 DNA方法。 我们将gG-2序列克隆到质粒中， 适合于在哺乳动物细胞系统中表达，并使用该方法 在检测HSV-2特异性抗体的测定中使用gG-2来源。 产前培养未能预测无症状 复发性生殖器疱疹妇女分娩时的脱落 沿着这样一个事实，即许多新生儿的母亲 生殖器疱疹有哪些危害？ 解决新生儿单纯疱疹病毒的问题 我们建议调查 早期进行HSV-2特异性血清学检测的价值 妊娠晚期 过去或最近的HSV-2感染将 通过检测第一次产前检查的配对血清确定， 怀孕28周。 HSV-2感染的频率 有或无生殖器疾病史的连续妊娠妇女 HSV和原发性感染的比例将是 评估。 将从所有母亲和婴儿中获得培养物 在交付。 HSV无症状脱落的频率 有或无既往血清学证据的妇女分娩 或最近的HSV-2感染将被确定。 的频率 早产、低出生体重和/或宫内HSV证据 血清学阳性母亲所生新生儿的感染 将评估HSV-2感染的证据。 大部分 新生儿HSV的持续发病率和死亡率是由于 延误诊断 虽然交付文化不会阻止 婴儿暴露于无症状的母体单纯疱疹病毒，鉴定 暴露的婴儿应允许早期诊断和立即 疗法

Genita herpes simplex virus (HSV) infection is one of the most common sexually transmitted diseases (STD) in the United States. These infections are conspicuous by their painful course, frequent recurrence, high contagiousness, and persistent latency. The most grave consequence of genital herpes is infection of infants born to mothers who are excreting virus at delivery. Infants exposed to HSV may contract an infection with an untreated mortality rate of 70%. Despite the problem of neonatal HSV infection, there is a paucity of data on the epidemiology of genital herpes during pregnancy. Most of the available data concerns the incidence of asymptomatic shedding of SHV in women with histories of genital HSV. A major limitation of these data is exemplified by the observation that 50% of neonates who contract HSV are born to women with neither current symptoms nor a past history of genital herpes. There is a clear need for more information regarding the epidemiology of this STD in pregnant women. Although 10-15% of genital herpes infections are caused by HSV-1, the remainder are caused by HSV-2. Therefore, the prevalence of genital herpes can be approximated by determining antibody to HSV-2. Extensive antigenic homology between HSV-1 and 2 proteins has interfered with the serologic distinction of past HSV-1 and 2 infections. Recently, the gG protein of HSV-2 (gG-2) has been demonstrated to have type specific epitopes. The nucleotide sequence of the gene specifying gG-2 has been elucidated. A monoclonal antibody to gG-2 provides the basis for an ELISA serologic assay which can be used to define the true prevalence of HSV-2 infections. A limitation of the current gG-2 ELISA method is that it is indirect, requiring multiple incubation steps to perform. Although this assay is sensitive and specific, it is time-consuming and costly. The assay would be simpler, more rapid, and less expensive if a source of gG-2 antigen were available which did not require immunoaffinity steps for preparation. Recombinant DNA cloning provides a means whereby specified gene products can be expressed in large quantities, free of other viral proteins and antigens. We propose to develop a simple and rapid assay for the serologic diagnosis of HSV-2 infection based upon recombinant DNA methods. We will clone the gG-2 sequences into a plasmid suitable for expression in a mammalian cell system and use this source of gG-2 in an assay to detect HSV-2 specific antibodies. The failure of antepartum cultures to predict asymptomatic shedding at delivery in women with past recurrent genital herpes along with the fact that many mothers of infants with neonatal HSV have no history of genital herpes requires another approach to the problem of neonatal HSV. We propose to investigate the value of performing HSV-2 specific serologic testing early and late in gestation. Past or recent HSV-2 infection will be determined by testing paired sera from the first prenatal visit and 28 weeks gestation. The frequency of HSV-2 infections in consecutive pregnant women with or without a history of genital HSV and the proportion which are primary infections will be assessed. Cultures will be obtained from all mothers and infants at delivery. The frequency of asymptomatic shedding of HSV at delivery among women with or without serologic evidence of past or recent HSV-2 infections will be determined. The frequency of prematuity, low birth weight, and/or evidence of intrauterine HSV infections among neonates born to mothers with serologic evidence of HSV-2 infections will be assessed. Much of the continued morbidity and mortality of neonatal HSV is due to delayed diagnosis. While delivery cultures will not prevent the exposure of infants to asymptomatic maternal HSV, identification of exposed infants should allow early diagnosis and immediate therapy.