Frequent genital herpes simplex virus 2 shedding in immunocompetent women. Effect of acyclovir treatment.
Reactivation of herpes simplex virus type 2 (HSV-2) occurs intermittently as perceived clinically and by viral culture. We performed a series of studies to evaluate the frequency and pattern of HSV-2 reactivation using both viral isolation and HSV PCR assay. Daily samples of genital secretions were obtained from 27 HSV-2 seropositive women; a subset of subjects obtained samples while receiving oral acyclovir 400 mg PO twice a day. HSV DNA was detected in genital swab specimens on 28% of 1,410 d compared with 8.1% of days by viral isolation. 11 of 20 women had HSV DNA detected on > 20% of days, 4 on > 50%, and 2 on > 75% of days; in contrast, none of the women shed on > 21% of days by viral isolation. The daily administration of oral acyclovir promptly reduced the frequency of HSV DNA detection by a median of 80%. Within 3-4 d of discontinuing daily acyclovir, HSV DNA again appeared in the genital area. HSV-2 shedding in the genital mucosa occurs much more frequently than previously appreciated. This frequent reactivation likely plays a role in the epidemic spread of genital herpes worldwide.
Wald
A
A
Department of Medicine, University of Washington, Seattle 98195, USA. annawald@u.washington.edu
Corey
L
L
Cone
R
R
Hobson
A
A
Davis
G
G
Zeh
J
J
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015153:Blotting, Western; D018592:Cross-Over Studies; D004279:DNA, Viral / Q000187:drug effects / Q000302:isolation & purification; D004311:Double-Blind Method; D005260:Female; D005836:Genitalia, Female / Q000821:virology; D006558:Herpes Genitalis / Q000188:drug therapy* / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D006801:Humans; D007121:Immunocompetence; D010865:Pilot Projects; D016133:Polymerase Chain Reaction / Q000379:methods; D012008:Recurrence; D012698:Serologic Tests; D012749:Sexually Transmitted Diseases / Q000188:drug therapy* / Q000821:virology*; D013997:Time Factors; D017735:Virus Latency; D017201:Virus Shedding
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir