title: Asymptomatic perianal shedding of herpes simplex virus in patients with acquired immunodeficiency syndrome.
abstract: OBJECTIVE
  To determine the frequency of asymptomatic perianal shedding of herpes simplex virus (HSV) in adult patients with acquired immunodeficiency syndrome (AIDS).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A 1000-bed, state-supported hospital in Brazil that provides comprehensive health care.
  
  
  METHODS
  Eighty-two consecutively hospitalized patients with AIDS (Centers for Disease Control and Prevention class C).
  
  
  METHODS
  Specimens for HSV culture were obtained with premoistened swabs of the perianal region at approximately 7-day intervals during the hospitalization of each patient. After the specimens were inoculated into cultures of human foreskin and Vero cells, supernatants of cultures showing the cytopathic effect characteristic of HSV infection were tested for virus in a confirmatory immunoenzymatic assay. Typing of HSV was performed by polymerase chain reaction amplification of HSV-1- and HSV-2-specific DNA polymerase sequences.
  
  
  RESULTS
  On early into the study, 12 (15%) of 82 patients had perianal ulceration and 70 did not. None of the patients in the latter group developed perianal ulcers during the study period, but HSV was isolated at least once from 17 (24%) of them. Nine of the 17 asymptomatic perianal shedders had a mean of 3 perianal swabs collected before the first HSV isolation, and 11 (65%) of 17 had a total of 18 perianal swabs collected 8 to 62 days after the HSV isolation. All postpositive samples were negative for HSV except 1 obtained from a patient 13 days after the first positive sample. Twelve of the 17 asymptomatic perianal shedders of HSV were followed up clinically for 8 to 62 days after the first episode of shedding and none developed perianal ulceration.
  
  
  CONCLUSIONS
  We conclude that asymptomatic perianal shedding of HSV is common in patients with AIDS, even among those without a history of perianal HSV lesions. This shedding appears to be short-lived, intermittent, and not associated with early subsequent development of perianal ulcers. These findings present a new perspective on the natural course of perianal HSV infection in patients with AIDS.
authors.affiliation: Infectious Diseases Service, State Employees Hospital of São Paulo, Brazil.
authors.forename: C S
authors.initials: CS
authors.lastname: Pannuti
authors.forename: M
authors.initials: M
authors.lastname: Cristina
authors.forename: D S
authors.initials: DS
authors.lastname: Finck
authors.forename: R S
authors.initials: RS
authors.lastname: Grimbaun
authors.forename: L M
authors.initials: LM
authors.lastname: Sumita
authors.forename: A L
authors.initials: AL
authors.lastname: Almeida
authors.forename: N F
authors.initials: NF
authors.lastname: Rezende
authors.forename: M P
authors.initials: MP
authors.lastname: Gomes
authors.forename: J R
authors.initials: JR
authors.lastname: Pinho
authors.forename: L V
authors.initials: LV
authors.lastname: Kirchhoff
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000821:virology*; D000328:Adult; D001004:Anus Diseases / Q000821:virology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018139:Simplexvirus; D014456:Ulcer / Q000821:virology*; D017201:Virus Shedding