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Development of Clinically Recognizable Genital Lesions among Women Previously Identified as Having "Asymptomatic" Herpes Simplex Virus Type 2 Infection

Andria Langenberg, MD; Jacqueline Benedetti, PhD; Jennifer Jenkins, BS; Rhoda Ashley, PhD; Carol Winter, RN, BSN; and Lawrence Corey, MD
[+] Article, Author, and Disclosure Information

Grant Support: Supported in part by National Institutes of Health grant AI-20381.

The results of this study were presented in part in October 1988 at the Twenty-eighth Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, California.

Requests for Reprints: Lawrence Corey, MD, Virology Division, D-536, University of Washington, Children's Hospital Medical Center, 4800 Sand Point Way North East, Seattle, WA 98105.

Current Author Addresses: Andria Langenberg, MD, Department of Dermatology, University of California, San Francisco, Ambulatory Care A316, 400 Parnasus, San Francisco, CA 94143.

Drs. Benedetti, Ashley, and Corey, and Ms. Winter: Virology Division, D-536, Children's Hospital, ZC-10, 4800 Sand Point Way North East, P.O. Box C-5371, Seattle, WA 98105.

Ms. Jenkins: Pacific Medical Center, ZB-30, 1200 12th Avenue S., Room 9307, Seattle, WA 98144.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(11):882-887. doi:10.7326/0003-4819-110-11-882
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Study Objective: To determine if patients initially identified by history, clinical examination, and serologic status as having asymptomatic herpes simplex virus type 2 infection report clinically recognizable genital lesions after having a detailed instructional session on the clinical signs and symptoms of genital herpes.

Design: Prospective follow-up of two groups of women.

Setting: Outpatient clinic of an urban city-county hospital.

Patients: Two populations of women were recruited. One group was referred because they had documented asymptomatic genital herpes or were suspected of asymptomatically transmitting genital herpes to a sex partner. The other group was recruited from the hospital's general gynecologic clinic and consisted of women with herpes simplex virus type 2 antibodies who denied a history of genital herpes.

Intervention: Patients had a one-on-one interview describing the clinical symptoms of genital herpes.

Measurements and Main Results: Twelve of nineteen women with herpes simplex virus type 2 antibodies who had documented asymptomatic genital herpes or were suspected of asymptomatically transmitting infection to a sex partner, and 18 of 43 women with herpes simplex virus type 2 anti-bodies who were recruited from the gynecologic clinic developed clinically recognizable genital lesions during a 5-month follow-up. Symptomatic genital herpes was the most frequent gynecologic complaint identified during follow-up.

Conclusions: Approximately 50% of women with herpes simplex virus type 2 antibodies who do not initially report a history of genital lesions do indeed have clinically symptomatic genital herpes. These women can be accurately counseled and taught to distinguish genital herpes from other genitourinary infections. Identification of symptomatic recurrences and counseling to avoid sexual activity during these episodes may help reduce transmission of genital herpes.





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