title: Famciclovir reduces viral mucosal shedding in HSV-seropositive persons.
abstract: OBJECTIVE
  Many cases of herpes simplex virus (HSV) infection occur through asymptomatic shedding from persons without evidence of clinical disease. This study explores whether famciclovir reduces HSV shedding in HSV-2 seropositive persons with or without a history of symptomatic genital herpes.
  
  
  METHODS
  One hundred twenty-seven HSV-2 seropositive participants were randomly assigned to 42 days of famciclovir, followed by 14 days of washout and 42 days of placebo, or vice versa. All subjects swabbed the genital/perianal area; those with HSV-1 infection also swabbed the oral area daily for HSV DNA PCR.
  
  
  RESULTS
  Famciclovir reduced genital and oral HSV shedding from 11.4% of days during the placebo period to 4.7% of days during famciclovir therapy. The reduction was greater in participants with a history of genital herpes (74%) than in those without such a history (30%). In multivariate analyses, famciclovir protected against total (clinical and subclinical) genital shedding among persons with a clinical history of genital herpes (RR, 0.23; 95% CI, 0.15-0.35; P < 0.001). Among HSV-2 seropositive participants without a history of genital herpes, 60% had HSV detected in the genital area at least once during the study. Famciclovir therapy did not result in a statistically significant reduction in total HSV shedding in participants without a history of genital herpes.
  
  
  CONCLUSIONS
  Famciclovir therapy decreases genital HSV shedding in HSV-seropositive persons, especially those with a history of genital herpes. Overall, antiviral drugs may have varying effects on symptomatic and asymptomatic viral shedding, depending on the clinical history of the disease.
authors.affiliation: University of North Carolina, Chapel Hill, NC 27599-7030, USA. peter_leone@med.unc.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Leone
authors.forename: Terri
authors.initials: T
authors.lastname: Warren
authors.forename: Kamal
authors.initials: K
authors.lastname: Hamed
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fife
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
mesh_terms: D015075:2-Aminopurine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004279:DNA, Viral / Q000032:analysis; D004311:Double-Blind Method; D000077595:Famciclovir; D005260:Female; D006558:Herpes Genitalis / Q000097:blood / Q000188:drug therapy* / Q000821:virology*; D018258:Herpesvirus 2, Human; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000821:virology; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D017201:Virus Shedding / Q000187:drug effects; D014861:Washington
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D015075:2-Aminopurine; D000077595:Famciclovir