title: Rapidly cleared episodes of oral and anogenital herpes simplex virus shedding in HIV-infected adults.
abstract: OBJECTIVE
  To determine whether rapidly cleared episodes of herpes simplex virus (HSV) reactivation occur in HIV-infected adults.
  
  
  METHODS
  Twenty HSV-2-seropositive, HIV-seropositive adults, including 9 (45%) who were also HSV-1 seropositive, collected oral and anogenital swabs for HSV DNA polymerase chain reaction 4 times a day for 60 days. Samples were positive for HSV if we detected > or =150 copies of HSV DNA/mL of specimen.
  
  
  RESULTS
  Median HSV shedding episode duration was 7.5 (range 4-253) hours for oral and 11 (range 4-328) hours for anogenital reactivation. Thirty-five percent of oral and 29% of anogenital reactivations lasted < or =6 hours, and 59% of oral and 53% of anogenital reactivations lasted < or =12 hours. Seven of 9 participants who shed orally and 10 of 15 who shed anogenitally had > or =1 reactivation lasting < or =6 hours. The median maximum level of HSV DNA detected in an episode increased with episode duration for both oral and anogenital episodes. Concurrent oral and anogenital shedding occurred more frequently than expected: oral HSV shedding was detected on 17% of time points with anogenital but 1% of time points without anogenital, shedding (P < 0.001).
  
  
  CONCLUSIONS
  Rapidly cleared episodes of oral and anogenital HSV shedding occur in HIV-infected persons, supporting the hypothesis that frequent anogenital mucosal immune activation caused by HSV-2 is present in HIV coinfected persons, potentially contributing to HIV infectiousness.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA. karen.mark@cdph.ca.gov
authors.forename: Karen E
authors.initials: KE
authors.lastname: Mark
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Amalia S
authors.initials: AS
authors.lastname: Magaret
authors.forename: Stacy
authors.initials: S
authors.lastname: Selke
authors.forename: Steven
authors.initials: S
authors.lastname: Kuntz
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006561:Herpes Simplex / Q000453:epidemiology* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification*; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000821:virology*; D016133:Polymerase Chain Reaction; D014775:Virus Activation; D017201:Virus Shedding
chemical_list: D004279:DNA, Viral