Herpes simplex virus type 2 shedding in human immunodeficiency virus-negative men who have sex with men: Frequency, patterns, and risk factors

We investigated the frequency, site, and risk factors for herpes simplex vi rus (HSV) shedding in 30 human immunodeficiency virus (HIV)-negative HSV ty pe 2 (HSV-2)-seropositive men who have sex with men. Subjects collected dai ly HSV culture samples from genital, perianal, and oral areas for 100 days and maintained diaries of signs and symptoms. Sixteen men (53.3%) shed HSV- 2, and 9 (56.3%) of 16 men who were also HSV type 1 (HSV-1)-seropositive sh ed HSV-1, Overall, HSV-2 was isolated on 3.1% of the days; 68% of the isola tions were on days that lesions did not occur. HSV-2 shedding was predomina ntly perianal (83.3%). HSV-1 was isolated on 2.1% of the days; 23 of 24 HSV -1 isolates were from oral areas. Rates of perianal or genital shedding wer e 6.6% on the days that participants reported prodromal symptoms and 1.9% o n the days that participants did not report prodromal symptoms (P < .001), Men seropositive for both HSV-1 and HSV-2 were significantly more likely to shed HSV-2 (odds ratio, 4.1; 95% confidence interval, 1.4-11.9) than were HSV-2-seropositive men. HSV-2-seropositive men who have sex with men have f requent subclinical HSV-2 shedding, usually from the perianal area, and mor e frequent prodromal HSV-2 shedding.