Frequent genital herpes simplex virus 2 shedding in immunocompetent women. Effect of acyclovir treatment.

TLDR

HSV‑2 reactivates intermittently, detectable clinically and by viral culture. The study aimed to assess HSV‑2 reactivation frequency and pattern using viral isolation and PCR. The authors collected daily genital swabs from 27 HSV‑2‑positive women, some of whom received 400 mg oral acyclovir twice daily. HSV DNA was found on 28 % of 1,410 days (vs.

Abstract

Reactivation of herpes simplex virus type 2 (HSV-2) occurs intermittently as perceived clinically and by viral culture. We performed a series of studies to evaluate the frequency and pattern of HSV-2 reactivation using both viral isolation and HSV PCR assay. Daily samples of genital secretions were obtained from 27 HSV-2 seropositive women; a subset of subjects obtained samples while receiving oral acyclovir 400 mg PO twice a day. HSV DNA was detected in genital swab specimens on 28% of 1,410 d compared with 8.1% of days by viral isolation. 11 of 20 women had HSV DNA detected on > 20% of days, 4 on > 50%, and 2 on > 75% of days; in contrast, none of the women shed on > 21% of days by viral isolation. The daily administration of oral acyclovir promptly reduced the frequency of HSV DNA detection by a median of 80%. Within 3-4 d of discontinuing daily acyclovir, HSV DNA again appeared in the genital area. HSV-2 shedding in the genital mucosa occurs much more frequently than previously appreciated. This frequent reactivation likely plays a role in the epidemic spread of genital herpes worldwide.