Jacqueline K. Benedetti, PhD; Judith Zeh, PhD; Lawrence Corey, MD
Acknowledgments: The authors thank the patients and staff at the University of Washington Virology Research Clinic for their cooperation and help during the conduct of these studies; Michael Remington and Carol Winter; Stacy Selke for data management; and Dr. Anna Wald for thoughtful discussion.
Grant Support: In part by the National Institutes of Health (grants AI-30731 and AI-30619).
Requests for Reprints: Lawrence Corey, MD, 1100 Fairview Avenue North (D3-100), Box 19024, Seattle, WA 98109-1024.
Current Author Addresses: Dr. Benedetti: University of Washington, Department of Biostatistics, Box 357232, Seattle, WA 98195.
Dr. Zeh: University of Washington, Department of Statistics, Box 354322, Seattle, WA 98195.
Dr. Corey: 1100 Fairview Avenue North (D3-100), Box 19024, Seattle, WA 98109-1024.
Visits to physicians for genital herpes simplex virus (HSV) infection continue to increase. Most patients with symptomatic infections have recurrences, but no studies of the long-term clinical course of genital herpes are available.
To determine whether the frequency of HSV recurrences decreases over time.
Observational cohort study.
University-based research clinic.
664 persons with genital herpes followed for at least 14 months.
Patients were classified as having initial or recurrent HSV-1 or HSV-2 infection. Patient-reported recurrences and observed recurrences were recorded in a database; more than 12 000 recurrences were analyzed.
Median recurrence rates in the first year of follow-up were one and five per year in patients with newly acquired HSV-1 and HSV-2 infection, respectively; second-year rates were significantly lower in both groups. Patients presenting with recurrent HSV-2 infection had higher rates of recurrence in the first and second years and no significant decrease; significant decreases were detected with longer follow-up. One third of all patients experienced a decrease of two or more recurrences per year between years 1 and 2. Patients infected with HSV-2 who were followed for more than 4 years had a median decrease of two recurrences between years 1 and 5. However, 25% of these patients had an increase of at least one recurrence in year 5, illustrating the variability among HSV-infected persons. Decreases over time among patients who never received suppressive therapy were similar to decreases during untreated periods in patients who received suppressive therapy.
Herpes simplex virus type 2 infection continues to be a chronic remitting illness. Over time, however, clinically significant reductions occur in a majority of patients. Physicians may wish to periodically assess the need for continued treatment with daily suppressive antiviral chemotherapy.
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Benedetti JK, Zeh J, Corey L. Clinical Reactivation of Genital Herpes Simplex Virus Infection Decreases in Frequency over Time. Ann Intern Med. 1999;131:14–20. doi: 10.7326/0003-4819-131-1-199907060-00004
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Published: Ann Intern Med. 1999;131(1):14-20.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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