title: The kinetics of mucosal herpes simplex virus-2 infection in humans: evidence for rapid viral-host interactions.
abstract: BACKGROUND
  Herpes simplex virus type 2 (HSV-2) reactivations in the genital tract are responsible for mucocutaneous lesions and transmission and manifest as discrete shedding episodes.
  
  
  METHODS
  We analyzed duration, peak copy number, and expansion and decay rates of 1020 shedding episodes in 531 immunocompetent HSV-2-seropositive persons from whom daily swabs of genital secretions were collected.
  
  
  RESULTS
  Viral quantity varied by as much as a multiple of 10 million in a single person over time. Peak episode copy number was distributed approximately evenly from 10(3) through 10(8) HSV DNA copies/mL. Median rate of increase was 10(7.6) HSV DNA copies/day during the first 12 hours of an episode and 10(5) copies/d from episode initiation to peak. These values depended only moderately on episode duration. Median decay rate was -10(6.2) HSV DNA copies/d during the final 12 hours of an episode and -10(3.6) copies/d from peak to termination. Episodes lasted a median of 3 days (interquartile range, 1-8 days). Prolonged (>5 days) episodes were associated with nonmonotonic decay.
  
  
  CONCLUSIONS
  HSV-2 shedding episodes are notable for rapid expansion and decay and extreme heterogeneity of duration and viral production. The net effect of these dynamic episodes is frequent shedding at high copy numbers.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA. jschiffe@fhcrc.org
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Schiffer
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Stacy
authors.initials: S
authors.lastname: Selke
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
mesh_terms: D000328:Adult; D000368:Aged; D006558:Herpes Genitalis / Q000378:metabolism / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000502:physiology*; D054884:Host-Pathogen Interactions; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D014775:Virus Activation; D017201:Virus Shedding; D055815:Young Adult