title: Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons.
abstract: BACKGROUND
  Most persons who have serologic evidence of infection with herpes simplex virus (HSV) type 2 (HSV-2) are asymptomatic. Historically, it has been assumed that these persons have less frequent viral reactivation than those with symptomatic infection.
  
  
  METHODS
  We conducted a prospective study to investigate genital shedding of HSV among 53 subjects who had antibodies to HSV-2 but who reported having no history of genital herpes, and we compared their patterns of viral shedding with those in a similar cohort of 90 subjects with symptomatic HSV-2 infection. Genital secretions of the subjects in both groups were sampled daily and cultured for HSV for a median of 94 days.
  
  
  RESULTS
  HSV was isolated from the genital mucosa in 38 of the 53 HSV-2-seropositive subjects (72 percent) who reported no history of genital herpes, and HSV DNA was detected by the polymerase-chain-reaction assay in cultures prepared from genital mucosal swabs in 6 additional subjects. The rate of subclinical shedding of HSV in the subjects with no reported history of genital herpes was similar to that in the subjects with such a history (3.0 percent vs. 2.7 percent). Of the 53 subjects who had no reported history of genital herpes, 33 (62 percent) subsequently reported having typical herpetic lesions; the duration of their recurrences in these subjects was shorter (median, three days vs. five days; P<0.001) and the frequency lower (median, 3.0 per year vs. 8.2 per year; P<0.001) than in the 90 subjects with previously diagnosed symptomatic infection. Only 1 of these 53 subjects had no clinical or virologic evidence of HSV infection.
  
  
  CONCLUSIONS
  Seropositivity for HSV-2 is associated with viral shedding in the genital tract, even in subjects with no reported history of genital herpes.
authors.affiliation: Department of Medicine, University of Washington, Seattle 98122, USA. annawald@u.washington.edu
authors.forename: A
authors.initials: A
authors.lastname: Wald
authors.forename: J
authors.initials: J
authors.lastname: Zeh
authors.forename: S
authors.initials: S
authors.lastname: Selke
authors.forename: T
authors.initials: T
authors.lastname: Warren
authors.forename: A J
authors.initials: AJ
authors.lastname: Ryncarz
authors.forename: R
authors.initials: R
authors.lastname: Ashley
authors.forename: J N
authors.initials: JN
authors.lastname: Krieger
authors.forename: L
authors.initials: L
authors.lastname: Corey
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005835:Genitalia / Q000821:virology*; D006558:Herpes Genitalis / Q000503:physiopathology / Q000821:virology*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D008297:Male; D012008:Recurrence; D014775:Virus Activation; D017201:Virus Shedding
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral