Comment20194.1

author: Prof. Antonio Chuh, E-mail: antonio.chuh@yahoo.com.hk

Honorary Clinical Associate Professor; Department of Family Medicine and Primary Care; The University of Hong Kong
Honorary Clinical Associate Professor; JC School of Public Health and Primary Care; The Chinese University of Hong Kong

Submission: 12.09.2019; Acceptance: 12.09.2019

Dear Editor,
We read with admiration the report by Funda T et al on the association of patients with anogenital warts and serological evidence of herpes simplex virus 1 and 2 (HSV-1 and -2) infections [1]. We take the liberty to offer four comments.
Firstly, for patients with any sexually transmitted infection (STI), we have always been recommending investigations for other STI [2]. The report by Funda T et al [1] thus provides evidence for this practice covering part of the broad spectrum of STI.
Secondly, we have investigated the tests for other STI to other levels, namely dermoscopy and help-seeking behaviour [3]. We reported that patients with genital herpes, genital viral warts, or genital molluscum contagiosum diagnosed by clinical examination and substantiated by dermatoscopic examinations were significantly more willing to pay US$ 300 to investigate for other STI (RR 2.52, 95% CI: 1.32 – 3.18), and bring at least one sexual partners for investigations (RR 1.32, 95% CI 1.12 – 1.55), compared to patients diagnosed by clinical examination alone [3]. Our results thus shine light on the findings by Funda T et al on how to convince patients to investigate for other STI in the first place.
Thirdly, the associations of sites of herpes and HSV-1 or -2 infections are not specific. Around 10% of patients with extragenital herpes are actually related to HSV-2 infection. In reciprocity, around 30-50% of patients with genital herpes are related to HSV-1 [4,5]. In another study on college students, most (85%) subjects with genital herpes are related to HSV-1 [6].
In other words, the title of this article should be “Should patients with anogenital warts be tested for herpes simplex virus 2 infection – initial results of a pilot study”.
Lastly, most patients with suspected STI present to family physicians initially. Family physicians offer continuous care for physical, psychological, and social aspects of the patients and their families. They are well placed to recommend investigations for other STI.  Some family physician practices conduct contact tracing, and offer investigations and managements for all parties concerned. We thus recommend Funda T et al and other investigators conducting research along the same veins to share findings as review articles in journals in family medicine. Their messages would then be disseminated among family physicians internationally to optimise the quality of care for patients with STI and their sexual partners.
We congratulate Funda T et al for publishing this well-written pilot study.