Background The frequency, pattern, and anatomical sites of subclinicalshedding of herpes simplex virus (HSV) in the genital tract,along with factors that predict such shedding, have not beenwell characterized.
Methods We studied prospectively the clinical and virologiccourse of genital herpes in 110 women. The women kept symptomdiaries and provided daily samples from the vulva, cervix, andrectum for viral culture.
Results During a median follow-up of 105 days, subclinical sheddingof virus was identified in 36 of 65 women (55 percent) withHSV type 2 (HSV-2), in 16 of 31 women (52 percent) with HSVtype 1 (HSV-1) and HSV-2, and in 4 of 14 women (29 percent)with only HSV-1. Among women with genital HSV-2 infection, subclinicalshedding occurred on a mean of 2 percent of the days. The meanduration of viral shedding during subclinical episodes was 1.5days, as compared with 1.8 days during symptomatic episodes.HSV was isolated from several sites in the genital tract andrectum in 17 percent of subclinical episodes and 22 percentof symptomatic episodes. Half the episodes of subclinical sheddingof HSV occurred within seven days of a symptomatic recurrence.The risk of subclinical shedding increased with the frequencyof symptomatic recurrences. Subclinical shedding was more frequentamong women with more than 12 recurrences per year than amongthose with no symptomatic recurrences (odds ratio, 3.3; 95 percentconfidence interval, 1.4 to 7.9); it was also more frequentamong women who had recently acquired genital herpes (odds ratiofor women with HSV acquired in the past year as compared withthose who had had the infection for a year or more, 1.85; 95percent confidence interval, 1.1 to 3.1).
Conclusions Among women with a history of genital herpes infection,subclinical shedding of HSV is common and accounts for nearlyone third of the total days of reactivation of HSV infectionin the genital tract. Women with frequent symptomatic recurrencesalso have frequent subclinical shedding and may be at high riskfor transmitting HSV.
Source Information
From the Departments of Medicine (A.W., L.C.), Statistics (J.Z.), Laboratory Medicine (S.S., R.L.A., L.C.), and Microbiology (L.C.), University of Washington, Seattle.
Address reprint requests to Dr. Corey at the Virology Division, University of Washington, Rm. 9301, 1200 12th Ave. South, Seattle, WA 98144.
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