Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes.
OBJECTIVE
To determine frequency, anatomic site, and host factors associated with asymptomatic shedding of herpes simplex virus after initial episodes of genital herpes.


METHODS
Cohort study with follow-up for a median of 63 weeks.


METHODS
Referral clinic.


METHODS
Women (306) with first episode of herpes; 43 had primary herpes simplex virus type 1, and 227 and 36 had primary and nonprimary herpes simplex virus type 2, respectively.


METHODS
Cultures were obtained for herpes simplex virus every 4 to 6 weeks at times in which genital lesions and symptoms were not present.


RESULTS
Asymptomatic shedding was detected among 11.9%, 18.3%, and 22.9% of women with primary herpes simplex virus type 1, primary HSV type 2, and nonprimary HSV type 2, respectively. Among patients with type 2 infection, previous type 1 antibody was associated with a lower rate of asymptomatic vulvar shedding. Asymptomatic cervical shedding was 3 times more frequent during the first three months after resolution of primary type 2 disease than during later time periods. In contrast, the rate of symptomatic recurrent herpes did not change over time.


CONCLUSIONS
Asymptomatic genital herpes simplex type 2 is more common than type 1. Asymptomatic genital shedding occurs more often during the first 3 months after acquisition of primary type 2 disease than during later periods. Patients with HSV type 2 should be advised of this high early rate of asymptomatic shedding and of potential transmission to sexual partners.
Koelle
D M
DM
University of Washington, Seattle.
Benedetti
J
J
Langenberg
A
A
Corey
L
L
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002584:Cervix Uteri / Q000382:microbiology; D005260:Female; D006558:Herpes Genitalis / Q000382:microbiology*; D006801:Humans; D011446:Prospective Studies; D012008:Recurrence; D018139:Simplexvirus / Q000254:growth & development / Q000276:immunology / Q000502:physiology*; D013997:Time Factors; D014775:Virus Activation
D000914:Antibodies, Viral