title: Patterns of herpes simplex virus shedding over 1 month and the impact of acyclovir and HIV in HSV-2-seropositive women in Tanzania.
abstract: OBJECTIVE
  Few studies have examined the frequency and duration of genital herpes simplex virus (HSV) shedding in sub-Saharan Africa. This study describes HSV shedding patterns among a sample of HSV-2-seropositive women enrolled in a placebo-controlled trial of HSV suppressive therapy (acyclovir 400 mg twice a day) in Tanzania.
  
  
  METHODS
  Trial participants were invited to participate in a substudy involving 12 clinic visits over 4 weeks. At each visit, cervical, vaginal and external skin swabs were taken and analysed for HSV DNA using inhouse real-time PCR.
  
  
  RESULTS
  HSV shedding was mainly subclinical (90%; 57/63 shedding days in the placebo arm). The most frequent shedding site was the external skin, but HSV DNA was detected from all three sites on 42% (27/63) of shedding days. In HIV-negative women, HSV DNA was detected on 3% (9/275) of days in the acyclovir versus 11% (33/309) in the placebo arm, while in HIV-positive women, detection was on 14% (23/160) versus 19% (30/155) of days, respectively.
  
  
  CONCLUSIONS
  HSV shedding was common, varying greatly by individual. Shedding rates were similar to studies in African and non-African settings. Among HIV-negative women, shedding rates were lower in the acyclovir arm; however, acyclovir did not substantially impact on HSV shedding in HIV-positive women.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK. c.tanton@ucl.ac.uk
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Jerome
authors.initials: J
authors.lastname: LeGoff
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Tim C
authors.initials: TC
authors.lastname: Clayton
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
authors.forename: Laurent
authors.initials: L
authors.lastname: Belec
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications*; D015497:HIV-1; D006558:Herpes Genitalis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D018258:Herpesvirus 2, Human; D006801:Humans; D013636:Tanzania; D013997:Time Factors; D017201:Virus Shedding / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir