Vaccine and Infectious Disease Division

Identifying ulcers

A VIDD study has found that patients co-infected with HIV and genital herpes are not always aware of herpes-induced ulcers, suggesting that new methods to prevent herpes and HIV transmission in this population are needed. Herpes simplex virus 2 (HSV-2) is a common sexually transmitted infection, especially in men who have sex with men (MSM); one-quarter of HIV-negative MSM have HSV-2, and 80 percent of those with HIV are also HSV-2-positive. The interplay between these two viruses is complex and not completely understood, but it is known that they each increase the chances of acquisition of the other. HSV-2 outbreaks, which often manifest as genital ulcers, especially increase the risk of both HSV-2 and HIV transmission, and as such HSV-2 and HSV-2/HIV-positive people are often advised to abstain from sex during flare-ups. 


VIDD affiliate investigator Dr. Christine Johnston, VIDD member Dr. Anna Wald, Center President and Director Dr. Larry Corey and colleagues conducted a study to determine whether men dually infected with HSV-2 and HIV are able to correctly identify clinical herpes ulcers. The study enrolled 10 co-infected MSM, who were educated by the study clinicians on identifying genital ulcers. The volunteers were asked to keep detailed symptom diaries, and clinicians assessed the volunteers daily for eight weeks for the presence of ulcers and concurrently collected genital swabs for HSV-2 testing. The researchers found that the volunteers only noted 51 percent of clinically-identified ulcers. As these men had been specifically coached, this percentage is likely to be even lower in the general population, indicating that abstinence during symptomatic periods is unlikely to obtain much success in preventing HIV or HSV-2 transmission.

Sandlin MI, Johnston C, Bowe D, Saracino M, Schacker T, Shaughnessy M, Corey L, Wald A.  Clinician and patient recognition of anogenital herpes disease in HIV positive men who have sex with men.  Sex Transm Dis. 2011 Sep;38(9):833-6.