David M. Koelle, MD; Jacqueline Benedetti, PhD; Andria Langenberg, MD; Lawrence Corey, MD
Koelle DM, Benedetti J, Langenberg A, Corey L. Asymptomatic Reactivation of Herpes Simplex Virus in Women after the First Episode of Genital Herpes. Ann Intern Med. 1992;116:433-437. doi: 10.7326/0003-4819-116-6-433
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Published: Ann Intern Med. 1992;116(6):433-437.
▪ Objective: To determine frequency, anatomic site, and host factors associated with asymptomatic shedding of herpes simplex virus after initial episodes of genital herpes.
▪ Design: Cohort study with follow-up for a median of 63 weeks.
▪ Setting: Referral clinic.
▪ Patients: Women (306) with first episode of herpes; 43 had primary herpes simplex virus type 1, and 227 and 36 had primary and nonprimary herpes simplex virus type 2, respectively.
▪ Measurements: Cultures were obtained for herpes simplex virus every 4 to 6 weeks at times in which genital lesions and symptoms were not present.
▪ Main Results: Asymptomatic shedding was detected among 11.9%, 18.3%, and 22.9% of women with primary herpes simplex virus type 1, primary HSV type 2, and nonprimary HSV type 2, respectively. Among patients with type 2 infection, previous type 1 antibody was associated with a lower rate of asymptomatic vulvar shedding. Asymptomatic cervical shedding was 3 times more frequent during the first three months after resolution of primary type 2 disease than during later time periods. In contrast, the rate of symptomatic recurrent herpes did not change over time.
▪ Conclusions: Asymptomatic genital herpes simplex type 2 is more common than type 1. Asymptomatic genital shedding occurs more often during the first 3 months after acquisition of primary type 2 disease than during later periods. Patients with HSV type 2 should be advised of this high early rate of asymptomatic shedding and of potential transmission to sexual partners.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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