RECURRENCE RATES IN GENITAL HERPES AFTER SYMPTOMATIC FIRST-EPISODE INFECTION

Objective: To evaluate the frequency of reactivation of genital herpes infection and to identify predictors for recurrence. Design: Prospect ive, observational cohort study. Setting: Research clinic. Patients: 4 57 consecutive patients who did not have acute-phase serum antibodies to herpes simplex virus type 2 (HSV-2) but who did have herpes simplex vines (HSV) isolated from genital lesions. Results: Eighty-nine perce nt of patients with HSV-2 had at least one recurrence during follow-up (median, 391 days); the median monthly recurrence rate was 0.34. Thir ty-eight percent had at least 6 recurrences during the first year and 20% had more than 10 recurrences. The median monthly recurrence rate w as 0.43 for men and 0.33 for women (difference, 0.10 [95% CI, 0.03 to 0.19]; P < 0.01). Twenty-six percent of women and 8% of men had no or 1 recurrence in year 1 of follow-up, whereas 14% of women and 26% of m en had more than 10 recurrences. Patients who had severe primary HSV-2 infection (duration, greater than or equal to 35 days) had recurrence s nearly twice as often (0.66 compared with 0.36 recurrences per month [95% CI, 0.18 to 0.57]) and had a shorter time to first recurrence wh en compared with those who had shorter first episodes. Conclusions: Al most all persons with initially symptomatic HSV-2 infection have sympt omatic recurrences. More than 35% of such patients have frequent recur rences. Recurrence rates are especially high in persons with an extend ed first episode of infection, regardless of whether they receive anti viral chemotherapy with acyclovir. Men with genital HSV-2 infection ha ve about 20% more recurrences than do women, a factor that may contrib ute to the higher rate of HSV-2 transmission from men to women than fr om women to men and to the continuing epidemic of genital herpes in th e United States.