title: Overlapping reactivations of herpes simplex virus type 2 in the genital and perianal mucosa.
abstract: BACKGROUND
  Genital shedding of herpes simplex virus (HSV) type 2 occurs frequently. Anatomic patterns of genital HSV-2 reactivation have not been intensively studied.
  
  
  METHODS
  Four HSV-2-seropositive women with symptomatic genital herpes attended a clinic daily during a 30-day period. Daily samples were collected from 7 separate genital sites. Swab samples were assayed for HSV DNA by quantitative polymerase chain reaction. Anatomic sites of clinical HSV-2 recurrences were recorded.
  
  
  RESULTS
  HSV was detected on 44 (37%) of 120 days and from 136 (16%) of 840 swab samples. Lesions were documented on 35 (29%) of 120 days. HSV was detected at >1 anatomic site on 25 (57%) of 44 days with HSV shedding (median, 2 sites; range, 1-7), with HSV detected bilaterally on 20 (80%) of the 25 days. The presence of a lesion was significantly associated with detectable HSV from any genital site (incident rate ratio [IRR], 5.41; 95% confidence interval [CI], 1.24-23.50; P= .02) and with the number of positive sites (IRR, 1.19; 95% CI, 1. 01-1.40; P=.03). The maximum HSV copy number detected was associated with the number of positive sites (IRR, 1.62; 95% CI, 1.44-1.82; P<.001).
  
  
  CONCLUSIONS
  HSV-2 reactivation occurs frequently at widely spaced regions throughout the genital tract. To prevent HSV-2 reactivation, suppressive HSV-2 therapy must control simultaneous viral reactivations from multiple sacral ganglia.
authors.affiliation: Vaccine and Infectious Disease Institute, University of Washington, Seattle, USA.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Tata
authors.forename: Christine
authors.initials: C
authors.lastname: Johnston
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.forename: Stacy
authors.initials: S
authors.lastname: Selke
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000821:virology*; D001004:Anus Diseases / Q000473:pathology / Q000821:virology*; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D052776:Female Urogenital Diseases / Q000473:pathology / Q000821:virology*; D005836:Genitalia, Female / Q000821:virology*; D006558:Herpes Genitalis / Q000473:pathology / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D009092:Mucous Membrane / Q000821:virology*; D014775:Virus Activation; D017201:Virus Shedding
chemical_list: D004279:DNA, Viral