Department of Medicine, University of Washington, Seattle, USA.
JAMA. 2011 Apr 13;305(14):1441-9. doi: 10.1001/jama.2011.420.
Since herpes simplex virus type 2 (HSV-2) antibody tests have become commercially available, an increasing number of persons have learned that they have genital herpes through serologic testing. The course of natural history of HSV-2 in asymptomatic, seropositive persons is uncertain.
To evaluate the virologic and clinical course of HSV genital shedding among individuals with symptomatic and asymptomatic HSV-2 infection.
DESIGN, SETTING, AND PARTICIPANTS: Cohort of 498 immunocompetent HSV-2-seropositive persons enrolled in prospective studies of genital HSV shedding at the University of Washington Virology Research Clinic, Seattle, and Westover Heights Clinic, Portland, Oregon, between March 1992 and April 2008. Each participant obtained daily self-collected swabs of genital secretions for at least 30 days.
The rate of viral shedding measured by quantitative real-time fluorescence polymerase chain reaction for HSV DNA from genital swabs.
Herpes simplex virus type 2 was detected on 4753 of 23,683 days (20.1%; 95% confidence interval [CI], 18.3%-22.0%) in 410 persons with symptomatic genital HSV-2 infection compared with 519 of 5070 days (10.2%; 95% CI, 7.7%-13.6%) in 88 persons with asymptomatic infection (P < .001). Subclinical shedding rates were higher in persons with symptomatic infection compared with asymptomatic infection (2708 of 20,735 days [13.1%; 95% CI, 11.5%-14.6%) vs 434 of 4929 days [8.8%; 95% CI, 6.3%-11.5%]) (P < .001). However, the amount of HSV detected during subclinical shedding episodes was similar (median, 4.3 [interquartile range, 3.1-5.6] log(10) copies in the symptomatic infection group vs 4.2 [interquartile range, 2.9-5.5] in the asymptomatic infection group, P = .27). Days with lesions accounted for 2045 of 4753 days (43.0%; 95% CI, 39.8%-46.5%) with genital viral shedding among persons with symptomatic genital HSV-2 infection compared with 85 of 519 days (16.4%; 95% CI, 11.2%-23.9%) among persons with asymptomatic infection (P < .001).
Persons with asymptomatic HSV-2 infection shed virus in the genital tract less frequently than persons with symptomatic infection, but much of the difference is attributable to less frequent genital lesions because lesions are accompanied by frequent viral shedding.
自从单纯疱疹病毒 2 型（HSV-2）抗体检测商业化以来，越来越多的人通过血清学检测得知自己患有生殖器疱疹。无症状、血清阳性的 HSV-2 自然史尚不清楚。
评估有症状和无症状 HSV-2 感染个体中生殖器疱疹病毒脱落的病毒学和临床过程。
设计、地点和参与者：1992 年 3 月至 2008 年 4 月，西雅图华盛顿大学病毒学研究诊所和俄勒冈州波特兰市威斯特弗高地诊所，对 498 名免疫功能正常的 HSV-2 血清阳性者进行了生殖器疱疹脱落的前瞻性研究。每位参与者每天至少采集 30 天的生殖器分泌物进行自我采集拭子。
用定量实时荧光聚合酶链反应法检测生殖器拭子中 HSV DNA 的病毒脱落率。
与 88 名无症状感染个体中 519 天（10.2%；95%置信区间[CI]，7.7%-13.6%）相比，410 名有症状生殖器 HSV-2 感染个体中 4753 天（20.1%；95%CI，18.3%-22.0%）中检测到单纯疱疹病毒 2 型（P<.001）。与无症状感染相比，有症状感染个体的亚临床脱落率更高（2708 天[13.1%；95%CI，11.5%-14.6%]比 434 天[8.8%；95%CI，6.3%-11.5%]）（P<.001）。然而，亚临床脱落期间检测到的 HSV 量相似（中位数，症状感染组为 4.3 [四分位间距，3.1-5.6] log(10)拷贝，无症状感染组为 4.2 [四分位间距，2.9-5.5]）（P=.27）。在有症状生殖器 HSV-2 感染个体中，有生殖器病毒脱落的 4753 天中，有症状感染个体的生殖器病变占 2045 天（43.0%；95%CI，39.8%-46.5%），而无症状感染个体的生殖器病变占 519 天（16.4%；95%CI，11.2%-23.9%）（P<.001）。
无症状 HSV-2 感染个体生殖器病毒脱落频率低于有症状感染个体，但大部分差异归因于生殖器病变较少，因为病变伴有频繁的病毒脱落。
