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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 5  |  Page : 387-388

Genital herpes - A maker of HIV infection




Correspondence Address:
Bhushan Kumar


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Source of Support: None, Conflict of Interest: None


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  Abstract 

An HIV positive patient with severe genital herpes and oral hairy leukoplakia is reported. Lower rate of heterosexual transmission and implications of transimission of HIV in a hospital set up are stressed.


Keywords: HIV positivity, Oral hairy leucoplakia, Genital herpes, Heterosexual transmission


How to cite this article:
Kumar B, Sehgal S. Genital herpes - A maker of HIV infection. Indian J Dermatol Venereol Leprol 1990;56:387-8

How to cite this URL:
Kumar B, Sehgal S. Genital herpes - A maker of HIV infection. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 May 27];56:387-8. Available from: http://www.ijdvl.com/text.asp?1990/56/5/387/3581


Acquired immuno deficiency syndrome erupted in the 1980's and there has been since then an exponential rise of cases all over the world. The major routes of transmission are sexual, especially among homosexuals; by blood products or contaminated needles. Heterosexual transmission of AIDS had been accorded less importance than homosexual transmission, but there are evidences to indicate that it may be for more important in African and Asian countries.[1]

We report an HIV positive patients who presented with atypical and widespread herpes and oral hairy leukoplakia. This patient also highlights some factors regarding heterosexual transmission of AIDS and risk of acquiring infections in the hospital.


  Case report Top


A 36-year old man was referred with history of recurrent vesiculobullous lesions on the glans penis, popliteal fossae and buttocks of 5 years duration. Lesions were in the form of grouped vesicles on an erythematous base [Figure - 1]. Eruption started on the penis, subsequent lesions appeared elsewhere. Patient had been attending the medical outpatient department with the complaints of low grade fever with evening chills of 3 months duration. Lymphadenopathy of cervical, axillary and inguinal groups was noted; a biopsied lymph node showed reactive lymphoid hyperplasia. During the course of investigations, the patient also developed myalgia, bone pains, recurrent sore throat and dull chest pain. Chest x-ray was normal and sputum grew Pseudomonas. No other localising cause of fever was found. He responded to appropriate antibacterial therapy.

On follow up, it was found that herpes simplex lesions occurred on penis, popliteal fossae and buttocks. Oral mucosa revealed lesions suggestive of oral hairy leukoplakia.[Figure - 2] It was then found that the patient was HIV positive by ELISA; western blot showed antibodies to Gp 160, 120, P66, 55, 44, 24, and 15. The T4/T8 ratio was undisturbed. The patient probably acquired the infection from a contaminated needle while he was in Zambia 5 years previously, where he had been admitted repeatedly with asthmatic attacks for aminophylline administration. There was no history of extramarital contact or homosexual behaviour. The patient was married for 7 years and had regular unprotected genito-genital sexual contact with his wife. However, neither wife nor children were symptomatic and all were negative for HIV antibody by ELISA.


  Comments Top


Herpes simplex is known to occur as a manifestation of AIDS, where it is more severe and atypical and perianal lesions are characteristic [2] We had seen three cases of AIDS who presented with extensive lesions of herpes simplex in our centre. Oral hairy leukoplakia as seen in the present case is also an important marker of AIDS, it seemingly carries a bad prognosis in ARC.[3]

This patient had unprotected sex with his wife for 5 years (after the acquisition of H!V) without sero-conversion of the spouse. His wife has borne two healthy seronegative children subsequently. This confirms the low risk of heterosexual transmission of HIV as compared to homosexual transmission. This fact has been highlighted earlier.[4] Some authors suggest that heterosexual transmission depends upon the number of exposures,[5] while others feel that blacks and hispanics are more at risk than whites [6] In various studies, the risk has varied from 5-18%.[4],[6],[7]

A high index of suspicion is necessary to pick up a case of HIV positivity from an outpatient department. Awareness of the disease and its various manifestations is necessary.

 
  References Top

1.Piot P, Carael M. Epidemiology of HIV infection. J Roy Col. Phy 1988; 22(3) : 133-135.  Back to cited text no. 1    
2.Siegal FP, Lopez C, Hammer AS et al. Severe acquired immunodeficiency in homosexuals, manifested by chronic perianat ulcerative herpes simplex lesions. N Eng J Med 1981; 305: 1439-44.  Back to cited text no. 2    
3.Pinching AJ. Clinical aspects of AIDS and HIV infection in the developed world. B Med Bull 1988; 44(1) : 89-100.  Back to cited text no. 3    
4.Ragni MV, Gupta P, Renaldo CR et al. HIV transmission to female sexual partners of HIV antibody positive hemophiliacs. Pub Health Rep 1988; 103: 54-58.  Back to cited text no. 4    
5.Handsfield HH. Editorial : Heterosexual transmission of HIV. J A M A 1988; 260(13): 1943-44.  Back to cited text no. 5    
6.Haverkos HW, Edelman R. Epidemiology of AIDS among heterosexuals. J A M A 1988; 260(13): 1922-29.  Back to cited text no. 6    
7.Peterman TA, Stoneberger RL, Allen JR et al. Risk of HIV transmission for heterosexual adults with transfusion associate infections. J A M A 198 259 (1) : 55-58.  Back to cited text no. 7    


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[Figure - 1], [Figure - 2]



 

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