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Try out PMC Labs and tell us what you think. Learn More. Patients with newly acquired genital herpes simplex virus 2 HSV-2 infection have virus frequently detected at the genital mucosa. Rates of genital shedding initially decrease over time after infection, but data on long-term viral shedding are lacking. For this study, healthy adults with history of symptomatic genital HSV-2 infection collected anogenital swabs for HSV-2 DNA polymerase chain reaction for at least 30 consecutive days.
Time since first genital herpes episode was ificantly associated with reduced genital shedding. Total HSV shedding occurred on Subclinical HSV shedding occurred on On days with HSV detection, mean quantity was 4. Rates of total and subclinical HSV-2 shedding decrease after the first year following the initial clinical episode.
However, viral shedding persists at high rates and copy s years after infection, and therefore may pose continued risk of HSV-2 transmission to sexual partners. Herpes simplex virus 2 HSV-2 is the major cause of genital herpes and one of the most frequent sexually transmitted diseases STDs worldwide. Nearly half of these days represent subclinical shedding, occurring on the days without genital lesions [ 6 ].
Clinical recurrences are also common, with a median rate of 4 recurrences in the first year of infection [ 7 ]. The patterns of HSV-2 mucosal shedding after the initial years of infection are less clear. Clinical recurrences among patients followed for several years decreased over time in one study.
HSV-2 shedding may also decrease over time, as 2 studies demonstrated that subclinical shedding rates declined by approximately half after the first year of infection [ 68 ]. Despite these observations, detailed data on genital HSV-2 shedding many years after herpes acquisition are limited. Because the long-term natural history of genital herpes affects the risk of transmission, and consequently has psychosocial, clinical management, and public health implications, we sought to describe patterns of genital HSV-2 shedding and recurrences in years remote from the first genital herpes episode. We evaluated a cohort of healthy adults with a history of symptomatic genital HSV-2 infection enrolled in prospective studies of the natural history of genital herpes at the University of Washington Virology Research Clinic Seattle, Washington or the Westover Heights Clinic Portland, Oregon from to Participants were included in our analysis if they had a known date of their first genital herpes episode, were HSV-2 seropositive, and had at least 30 consecutive days of anogenital swab samples analyzed for HSV by polymerase chain reaction PCR.
No participants were known to be HIV-infected; participants were offered HIV testing if they reported high-risk sexual behavior or requested testing. All participants provided written informed consent, and institutional review boards approved all study protocols. Demographic and clinical data were collected on standardized forms. An experienced research clinician reviewed the clinical s and symptoms of genital herpes with participants and taught them to keep a diary of genital lesions and symptoms.
Antiviral therapy was not used during the sampling session and at least 7 days prior to study entry. Participants were also taught to obtain genital swab specimens for HSV detection as described elsewhere [ 69 ]. Depending on the time when they participated in the studies, women were instructed to collect separate genital swabs from the cervix, vulva, and perianal region or a mixed swab of the entire anogenital area [ 10 ].
Men collected separate genital swabs from penile skin and perianal area or a mixed swab of the entire anogenital region [ 10 ]. If a lesion was present, participants collected a separate lesion swab. The reliability of patient sampling methods for detecting HSV DNA from mucosal and skin surfaces has been ly established and has been determined to be comparable or superior to clinician sampling [ 56 ]. Time from the first genital herpes episode was defined as the interval between a participant's first reported genital herpes episode and the study sampling session. For participants only recalling the month and year of their first herpes episode, the day was estimated to be the 15 th of the month; for those only recalling the year of their first episode, the day and month was estimated to be July 1 to represent the mid-point of the year.
A sampling session was defined as the period during which the participant collected genital swabs for at least 30 consecutive days.Clear Signs She Wants to Sleep with You!
Clinical recurrences were defined as the presence of any genital lesion consistent with HSV infection noted by the study participant or study clinician. Subclinical shedding rates were calculated as for the total HSV genital shedding rate, excluding all days on which genital lesions were observed. Episodes of shedding were defined by consecutive days with positive PCR and at least 1 day with negative HSV PCR before and after the episode; clinical episodes were defined by consecutive days with genital lesions. Outcomes included total HSV shedding rate, subclinical shedding rate, genital lesion rate, HSV copyand episode frequency and duration from time since first genital herpes episode.
We examined race, age, gender, sexual preference, age at sexual debut, age at first genital herpes episode, and HSV antibody status as potential covariates. Men were classified as men who have sex with men MSM if they reported any sex with men, whereas women were categorized as women who have sex with women WSW if they reported exclusively sex with women. Risk factors for total shedding, subclinical shedding, lesion rates, and episode frequency were evaluated using generalized estimating equations GEE with Poisson distribution and log link to for within-person correlation and for those participants contributing more than one session to the dataset.
GEE models with Gaussian distribution were used to compare log copy s and episode duration. All statistical calculations were performed using Stata 9.
A total of participants were enrolled in study sessions. The median age at sexual debut was 17 years range, 5—24 yearsand the median age at first genital herpes episode was 27 years range, 8—66 years. The median time since first genital herpes episode and the initiation of the study to evaluate HSV shedding was 7. Data are no. The study participants collected genital swabs for a median of 64 days per session range, 30— days. A total of 25, days with genital swabs were included in the analysis.
To determine whether daily genital swabbing increased the risk of viral shedding, we compared the rate of shedding on the first day of the sampling session to subsequent days. As shown in Figure S1 which is available in the supplementary material onlineno difference was detected between the rate of shedding on the first day versus subsequent days of the study.
The overall percentage of days with genital HSV shedding was The time since first clinical episode of genital HSV-2 was ificantly associated with reduced genital shedding. HSV shedding occurred on These differences in shedding rate remained ificant in multivariate analysis among those 1—9 years IRR. Nonwhite race was also ificantly associated with less shedding compared with white race IRR. HSV-1 serostatus was not a predictor of total shedding in univariate or multivariate analysis, nor did we find an interaction between HSV-1 infection and race.
No other variables, including gender, age at acquisition, or sexual preference, were found to be ificant predictors of shedding in multivariate analysis. The overall percentage of days with subclinical HSV shedding was The time since the first genital herpes episode was ificantly associated with reduced subclinical shedding. These differences remained ificant among those 1—9 years IRR. ASubclinical positive days; BGenital lesion days; Overall percentage of days indicated above box plot for each group.
Nonwhite race was also associated with less subclinical shedding compared with white race near statistical ificance IRR. No other variables, including HSV-1 serostatus, were found to be ificant predictors of shedding in multivariate analysis. The overall percentage of days with genital lesions was Lesions occurred on The percentage of days with genital lesions was reduced in persons who were 10 or more years since initial genital HSV-2 episode compared with those within 1 year of first episode IRR.
Nonwhite race was associated with fewer genital lesions compared with white race IRR. No other variables, including HSV-1 serostatus, were found to be ificant predictors of genital lesions in multivariate analysis. Of the days on which HSV-2 was detected on any genital swab, the mean quantity was 4.
Of the days on which HSV was detected on days without lesions, the mean quantity was 4. Next, we investigated whether the decline in shedding rates over time was attributable to reduced frequency or shorter duration of episodes. The mean frequency of episodes over a 1-year period for the entire cohort was Episode frequency did not change ificantly over time since first herpes episode.
The duration of clinical recurrences decreased after the first year following the first genital HSV-2 episode. The mean recurrence length was In contrast to clinical recurrences, the duration of total and subclinical episodes did not change ificantly by year since initial HSV-2 episode. The mean duration of any viral shedding episode was 4. Race was found to be ificantly associated with both frequency and duration of recurrences. Nonwhite race was also associated with a mean 1. No ificant differences in length of subclinical episodes were found between white and nonwhite groups, but the s were small.
No other variables, including age, gender, sexual preference, age at sexual debut, age at first genital herpes episode, or HSV antibody status, were found to be ificant predictors of episode frequency or duration in the analyses. Our study is the first to our knowledge to describe the natural history of viral shedding in HSV-2 seropositive persons more than 10 years since first clinical episode of genital herpes, and it reveals several important observations about long-term HSV-2 reactivation.
Rates of total and subclinical HSV-2 shedding and genital HSV-2 lesions decrease after the first year following the first genital herpes episode. However, most persons still shed HSV-2 either clinically or subclinically at high rates for years after infection.[BTS] Falling Into Your Smile 你微笑时很美 - Xu Kai and Cheng Xiao's one of many kiss scenes 💋
These high rates and quantity of HSV shedding observed in years remote from infection suggest that patients with long-standing genital HSV-2 infection pose a continued risk of HSV-2 transmission to sexual partners. Studies of other herpesviruses, particularly Epstein-Barr Virus EBVhave shown that virus levels reach an equilibrium and maintain a constant level in host cells after acute infection [ 16 ]. Reductions in HSV shedding might be explained by the development of a more efficient host immune response that le to improved clearance of virus [ 17 ], since repeated detection of virus is likely the result of frequent reactivations rather than persistence of infectious material in the mucous membranes [ 1819 ].
The amount of virus released from neurons may also decrease over time, as the concentration of latent HSV DNA present in ganglia has been shown to decline with time in animal models [ 2021 ]. Either of these explanations could also for the shorter duration of clinical episodes observed in years following the initial clinical episode.
Additional studies of HSV immunology and neuronal viral load in humans are needed to verify these hypotheses. Our finding that nonwhite race was associated with lower shedding rates, lower clinical recurrence rates, and shorter clinical durations compared with white race is intriguing. A recent study also reported that white race was associated with greater likelihood of HSV-2 viremia during primary genital infection [ 23 ].
However, in our study, HSV-1 seropositivity had no impact on the HSV-2 set point of long-term shedding or recurrence rates. It is possible that genetic or immunologic differences among racial or ethnic groups may affect the ability to control HSV-2 infection.
Racial differences may also have important implications for the epidemiology of HSV-2 in Africa and may in part explain the high rates of herpes infections in African countries. Our study is limited to adults with a history of symptomatic genital herpes, so its findings may not be generalizable to those with serologic evidence of HSV-2 infection but no clinical history.
Our study is also based on the time from the first clinical diagnosis and may not accurately reflect the time from HSV-2 infection. In some persons, the first recognized episode of genital herpes occurs months or years following HSV-2 acquisition [ 2627 ]. This possible misclassification of time since genital herpes acquisition would result in a conservative misclassification, however, and would diminish the apparent decrease in HSV-2 shedding observed after the first year of infection. From a clinical perspective these limitations may not be important, since most counseling and treatment efforts are focused on patients with symptomatic genital herpes and are guided by clinical symptoms.
Our sample may also be biased toward those with more severe disease, although these participants took part in studies of the natural history of genital herpes and were not enrolled based on the severity of their clinical symptoms. The length of sampling sessions did vary among participants, but session length was determined by study protocol rather than symptoms, so participants with more severe disease are not over-represented. In summary, our study demonstrates that while HSV-2 reactivation and HSV-2 shedding quantity decrease after the first year following the first genital herpes episode, HSV-2 shedding frequency, clinical recurrences, and HSV-2 shedding quantity remain at high levels for many years following infection.
These findings have important implications for the long-term management of genital HSV and may warrant strategies such as long-term use of antiviral medications for clinical suppression and continued condom use to reduce transmission to partners.
The funding sources played no role in the de and conduct of the study; collection, management, analysis, and interpretation of the data, and preparation, review, or approval of the manuscript. National Center for Biotechnology InformationU.
J Infect Dis. Author information Copyright and information Disclaimer. Corresponding author. Potential Conflicts of Interest: L. All other authors report no conflicts. All rights reserved. For Permissions, please e-mail: journals. This article has been cited by other articles in PMC.Seeking a woman hsv2 24 35
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Herpes Genitalis: Diagnosis, Treatment and Prevention