title: Psychological stress and other potential triggers for recurrences of herpes simplex virus eye infections. Herpetic Eye Disease Study Group.
abstract: OBJECTIVE
  To assess psychological stress and other factors as possible triggers of ocular herpes simplex virus (HSV) recurrences.
  
  
  METHODS
  A prospective cohort study nested in a randomized, placebo-controlled, clinical trial.
  
  
  METHODS
  Fifty-eight community-based or university sites.
  
  
  METHODS
  Immunocompetent adults (N = 308), aged 18 years or older, with a documented history of ocular HSV disease in the prior year and observed for up to 15 months. EXPOSURE VARIABLES: Psychological stress, systemic infection, sunlight exposure, menstrual period, contact lens wear, and eye injury recorded on a weekly log. The exposure period was considered to be the week before symptomatic onset of a recurrence.
  
  
  METHODS
  The first documented recurrence of ocular HSV disease, with exclusion of cases in which the exposure week log was completed late after the onset of symptoms.
  
  
  RESULTS
  Thirty-three participants experienced a study outcome meeting these criteria. Higher levels of psychological stress were not associated with an increased risk of recurrence (rate ratio, 0.58; 95% confidence interval, 0.32-1.05; P =.07). No association was found between any of the other exposure variables and recurrence. When an analysis was performed including only the recurrences (n = 26) for which the exposure week log was completed late and after symptom onset, there was a clear indication of retrospective overreporting of high stress (P =.03) and systemic infection (P =.01). Not excluding these cases could have produced incorrect conclusions due to recall bias.
  
  
  CONCLUSIONS
  Psychological stress does not appear to be a trigger of recurrences of ocular HSV disease. If not accounted for, recall bias can substantially overestimate the importance of factors that do not have a causal association with HSV infection.
mesh_terms: D015331:Cohort Studies; D003261:Contact Lenses; D015828:Eye Infections, Viral / Q000209:etiology*; D005131:Eye Injuries / Q000150:complications; D005260:Female; D006561:Herpes Simplex / Q000209:etiology*; D018259:Herpesvirus 1, Human / Q000254:growth & development*; D006801:Humans; D008297:Male; D008598:Menstruation; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D013472:Sunlight; D014775:Virus Activation / Q000502:physiology*