Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons

Background: Most persons who have serologic evidence of infection with herp es simplex virus (HSV) type 2 (HSV-2) are asymptomatic. Historically, it ha s been assumed that these persons have less frequent viral reactivation tha n those with symptomatic infection. Methods: We conducted a prospective study to investigate genital shedding o f HSV among 53 subjects who had antibodies to HSV-2 but who reported having no history of genital herpes, and we compared their patterns of viral shed ding with those in a similar cohort of 90 subjects with symptomatic HSV-2 i nfection. Genital secretions of the subjects in both groups were sampled da ily and cultured for HSV for a median of 94 days. Results: HSV was isolated from the genital mucosa in 38 of the 53 HSV-2-ser opositive subjects (72 percent) who reported no history of genital herpes, and HSV DNA was detected by the polymerase-chain-reaction assay in cultures prepared from genital mucosal swabs in 6 additional subjects. The rate of subclinical shedding of HSV in the subjects with no reported history of gen ital herpes was similar to that in the subjects with such a history (3.0 pe rcent vs. 2.7 percent). Of the 53 subjects who had no reported history of g enital herpes, 33 (62 percent) subsequently reported having typical herpeti c lesions; the duration of their recurrences in these subjects was shorter (median, three days vs. five days; P<0.001) and the frequency lower (median , 3.0 per year vs. 8.2 per year; P<0.001) than in the 90 subjects with prev iously diagnosed symptomatic infection. Only 1 of these 53 subjects had no clinical or virologic evidence of HSV infection. Conclusions: Seropositivity for HSV-2 is associated with viral shedding in the genital tract, even in subjects with no reported history of genital her pes. (N Engl J Med 2000;342:844-50.) (C)2000, Massachusetts Medical Society .