Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.
Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.
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HSV-2感染的有症状和无症状的人中，单纯疱疹病毒的生殖器脱落。
DOI：
10.1001/jama.2011.420
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发表时间：
2011-04-13
影响因子：
120.7
通讯作者：
Wald, Anna
中科院分区：
文献类型：
--
作者：
Tronstein, Elizabeth;Johnston, Christine;Huang, Meei-Li;Selke, Stacy;Magaret, Amalia;Warren, Terri;Corey, Lawrence;Wald, Anna
由于HSV-2抗体测试已成为商业可用，越来越多的人知道他们有生殖器疱疹通过血清学检测。HSV-2在无症状、血清阳性者中的自然病程尚不确定。评价有症状和无症状HSV-2感染受试者中HSV生殖器脱落的病毒学和临床过程。1992年至2008年期间，在华盛顿西雅图的华盛顿大学病毒学研究诊所和俄勒冈州波特兰的Westover Heights诊所参加生殖器HSV散毒前瞻性研究的498名免疫活性HSV-2血清阳性患者队列。每名受试者每天采集一次自我采集的生殖器分泌物拭子，持续≥ 30天。通过定量实时荧光聚合酶链反应（PCR）测定生殖器拭子中HSV DNA的病毒脱落率。在有症状的生殖器HSV-2感染者中，23,683天中有4,753天（20.1%; 95%CI，18.3至22.0）检测到HSV，而在无症状感染者中，5,070天中有519天（10.2%; 95%CI，7.7至13.6）检测到HSV，p<0.001。有症状感染者的亚临床脱落率高于无症状感染者（20,735天中的2,708例（13.1%; 95% CI，11.5至14.6）vs. 4,929天中的434例（8.8%; 95% CI，6.3至11.5），p<0.001）。然而，在亚临床散毒发作期间检测到的HSV数量相似（症状性感染组中位4.3 [IQR 3.1-5.6] log 10拷贝vs.无症状性感染组中位4.2 [IQR，2.9-5.5]，p=0.27）。在有症状的生殖器HSV-2感染者中，有病变的天数占生殖器病毒脱落天数的2045/4753（43.0%; 95% CI，39.8 - 46.5），而在无症状感染者中，有病变的天数占生殖器病毒脱落天数的85/519（16.4%; 95% CI，11.2 - 23.9），p<0.001。无症状HSV-2感染者在生殖道中的病毒脱落频率低于有症状感染者，但大部分差异可归因于生殖器病变频率较低，因为病变伴随着频繁的病毒脱落。
Since HSV-2 antibody tests have become commercially available, an increasing number of persons learn 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 participants with symptomatic and asymptomatic HSV-2 infection. 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, Washington, and Westover Heights Clinic in Portland, Oregon, between 1992 and 2008. Each participant obtained daily self-collected swabs of genital secretions for ≥ 30 days. The rate of viral shedding measured by quantitative real-time fluorescence polymerase chain reaction (PCR) for HSV DNA from genital swabs. HSV was detected on 4,753 of 23,683 days (20.1%; 95% CI, 18.3 to 22.0) in persons with symptomatic genital HSV-2 infection compared with 519 of 5,070 days (10.2%; 95% CI, 7.7 to 13.6) in persons with asymptomatic infection, p<0.001. Subclinical shedding rates were higher in persons with symptomatic infection compared with asymptomatic infection (2,708 of 20,735 days (13.1%; 95% CI, 11.5 to14.6) vs. 434 of 4,929 days (8.8%; 95% CI, 6.3 to 11.5), p<0.001. However, the amount of HSV detected during subclinical shedding episodes was similar (median 4.3 [IQR 3.1-5.6] log10 copies in the symptomatic infection group vs. 4.2 [IQR, 2.9-5.5], p=0.27 in the asymptomatic infection group). Days with lesions accounted for 2,045 of 4,753 days (43.0%; 95% CI, 39.8 to 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 to 23.9) among persons with asymptomatic infection, p<0.001. 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, as lesions are accompanied by frequent viral shedding.
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