VIROLOGICAL CHARACTERISTICS OF SUBCLINICAL AND SYMPTOMATIC GENITAL HERPES INFECTIONS
VIROLOGICAL CHARACTERISTICS OF SUBCLINICAL AND SYMPTOMATIC GENITAL HERPES INFECTIONS
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DOI：
10.1056/nejm199509213331205
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发表时间：
1995-09-21
影响因子：
158.5
通讯作者：
COREY, L
中科院分区：
文献类型：
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作者：
WALD, A;ZEH, J;COREY, L
背景。生殖道中单纯疱疹病毒 (HSV) 亚临床脱落的频率、模式和解剖部位，以及预测此类脱落的因素尚未得到很好的表征。方法。我们前瞻性地研究了 110 名女性生殖器疱疹的临床和病毒学病程。这些妇女记录症状日记，并每天提供外阴、子宫颈和直肠样本进行病毒培养。结果。在中位随访 105 天期间，65 名患有 2 型 HSV (HSV-2) 的女性中有 36 名 (55%) 发现了亚临床病毒排出，31 名患有 1 型 (HSV-1) 和 HSV-2 的女性中有 16 名 (52%) 发现了亚临床病毒排出，14 名仅患有 HSV-1 的女性中有 4 名 (29%) 出现了亚临床病毒排出。在生殖器 HSV-2 感染的女性中，平均有 2% 的天出现亚临床排毒。亚临床发作期间病毒排出的平均持续时间为 1.5 天，而有症状发作期间的病毒排出平均持续时间为 1.8 天。在 17% 的亚临床发作和 22% 的有症状发作中，从生殖道和直肠的多个部位分离到 HSV。一半的 HSV 亚临床脱落发生在症状复发后 7 天内。亚临床脱落的风险随着症状复发的频率而增加，每年复发次数超过 12 次的女性比无症状复发的女性更常见（比值比，3.3；95% 置信区间，1.4 至 7.9）；最近感染生殖器疱疹的女性也更常见（与感染一年或一年以上的女性相比，去年感染 HSV 的女性的优势比为 1.85；95% 置信区间为 1.1 至 3.1）。结论。在有生殖器疱疹感染史的女性中，HSV 亚临床脱落很常见，占生殖道 HSV 感染重新激活总天数的近三分之一。症状频繁复发的女性也经常出现亚临床脱落，并且传播 HSV 的风险可能很高。
Background. The frequency, pattern, and anatomical sites of subclinical shedding of herpes simplex virus (HSV) in the genital tract, along with factors that predict such shedding, have not been well characterized.Methods. We studied prospectively the clinical and virologic course of genital herpes in 110 women. The women kept symptom diaries and provided daily samples from the vulva, cervix, and rectum for viral culture.Results. During a median follow-up of 105 days, subclinical shedding of Virus was identified in 36 of 65 women (55 percent) with HSV type 2 (HSV-2), in 16 of 31 women (52 percent) with HSV type 1 (HSV-1) and HSV-2, and in 4 of 14 women (29 percent) with only HSV-1. Among women with genital HSV-2 infection, subclinical shedding occurred on a mean of 2 percent of the days. The mean duration of viral shedding during subclinical episodes was 1.5 days, as compared with 1.8 days during symptomatic episodes. HSV was isolated from several sites in the genital tract and rectum in 17 percent of subclinical episodes and 22 percent of symptomatic episodes. Half the episodes of subclinical shedding of HSV occurred within seven days of a symptomatic recurrence. The risk of subclinical shedding increased with the frequency of symptomatic recurrences, Subclinical shedding was more frequent among women with more than 12 recurrences per year than among those with no symptomatic recurrences (odds ratio, 3.3; 95 percent confidence interval, 1.4 to 7.9); it was also more frequent among women who had recently acquired genital herpes (odds ratio for women with HSV acquired in the past year as compared with those who had had the infection for a year or more, 1.85; 95 percent confidence interval, 1.1 to 3.1).Conclusions. Among women with a history of genital herpes infection, subclinical shedding of HSV is common and accounts for nearly one third of the total days of reactivation of HSV infection in the genital tract. Women with frequent symptomatic recurrences also have frequent subclinical shedding and may be at high risk for transmitting HSV.