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Asymptomatic Reactivation of Herpes Simplex Virus in Women after the First Episode of Genital Herpes

David M. Koelle, MD; Jacqueline Benedetti, PhD; Andria Langenberg, MD; and Lawrence Corey, MD
[+] Article, Author, and Disclosure Information

Grant Support: By National Institutes of Health grants AI-20381 and AI-30731. Dr. Koelle is supported by a training award from the American Social Health Association.

Requests for Reprints: Lawrence Corey, MD, University of Washington, 1200 12th Avenue South, Room 9301, Seattle, WA 98144.

Current Author Addresses: Dr. Koelle: Virology Office, D536, Children's Hospital CH-82, 4800 Sand Point Way North East, P.O. Box C-5371, Seattle, WA 98105.

Dr. Benedetti: Department of Biostatistics, ZH-15, University of Washington, Seattle, WA 98195.

Dr. Langenberg: Kaiser Permanente, 280 West MacArthur Boulevard, Oakland, CA 94611.

Dr. Corey: University of Washington, Virology Division, 1200 12th Avenue South, Room 9301, Seattle, WA 98144.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(6):433-437. doi:10.7326/0003-4819-116-6-433
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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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