First-episode, recurrent, and asymptomatic herpes simplex infections.
Genital herpes simplex virus infections should be classified into first-episode and recurrent infections. First-episode infections include true primary infections in patients with seronegative results who have never been infected with any type of herpes and nonprimary first-episode infections in patients who have been infected before and have serum antibody and humoral immunity, an example being genital infection with type 2 in adolescence after orolabial infection with type 1 in childhood. First-episode infections show more extensive disease, more systemic symptoms, and greater viral shedding than do recurrent infections. Ten percent to 15% of patients with first-episode primary genital herpes have oropharyngeal infections with the same virus strain. Herpesvirus can be isolated from the urethra in about 30% of male patients with first-episode infections. In recurrent vulvar herpes, virus can be isolated from the cervix in 10% to 15% of patients. Many genital lesions that clinically suggest something else turn out to be herpes; herpes may be diagnosed 5% of the time clinically but cultures are positive 14% of the time. Primary genital herpes type 2 infections recur about 95% of the time whereas type 1 infections recur about 50% of the time. Recurrences are highly unpredictable from patient to patient and time to time. The role of asymptomatic shedding in the spread of herpes is a major area for future study. Antiviral treatment is probably going to change the epidemiology of herpetic infections very little.
Corey
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Department of Laboratory Medicine, University of Washington, Seattle.
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006558:Herpes Genitalis / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012008:Recurrence; D013283:Stomatitis, Herpetic / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors