title: Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes.
abstract: 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.
authors.affiliation: University of Washington, Seattle.
authors.forename: D M
authors.initials: DM
authors.lastname: Koelle
authors.forename: J
authors.initials: J
authors.lastname: Benedetti
authors.forename: A
authors.initials: A
authors.lastname: Langenberg
authors.forename: L
authors.initials: L
authors.lastname: Corey
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral