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Sex Transm Infect 2004;80:272-276 doi:10.1136/sti.2003.007823
  • Herpes

Oral shedding of herpes simplex virus type 2

  1. A Wald1,2,3,
  2. M Ericsson4,
  3. E Krantz3,
  4. S Selke3,
  5. L Corey1,3,5
  1. 1Departments of Medicine, University of Washington, Seattle, WA, USA
  2. 2Departments of Epidemiology, University of Washington, Seattle, WA, USA
  3. 3Departments of Laboratory Medicine, University of Washington, Seattle, WA, USA
  4. 4Odontologiska Institutionen, Karolinska Institutet, Hudding, Sweden
  5. 5Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA
  1. Correspondence to:
 Anna Wald MD MPH
 University of Washington Virology Research Clinic, 600 Broadway, Suite 400, Seattle, WA 98122, USA; annawaldu.washington.edu
  • Accepted 9 January 2004

Abstract

Objectives: Herpes simplex virus (HSV) 1 and HSV-2 reactivate preferentially in the oral and genital area, respectively. We aimed to define frequency and characteristics associated with oral shedding of HSV-2.

Methods: Demographic, clinical and laboratory data of patients with documented HSV-2 infection and at least one oral viral culture obtained were selected from the University of Washington Virology Research Clinic database.

Results: Of 1388 people meeting the entry criteria, 44 (3.2%) had HSV-2 isolated at least once from their mouths. In comparison with the 1344 people who did not have HSV-2 isolated from their mouth, participants with oral HSV-2 were more likely to be male (OR = 1.9, 95% CI 1.0 to 3.7), HIV positive (OR = 2.9, 95% CI 1.4 to 6.0), and homosexual (OR = 2.2, 95% CI 1.1 to 4.2), and to have collected a larger number of oral specimens (median 32 v 4, p<0.001). Of the 58 days with oral HSV-2 isolation, 15 (25%) occurred during newly acquired HSV-2 infection, 12 (21%) during a recurrence with genital lesions, three (5%) during a recurrence with oral lesions, and three (5%) during a recurrence with oral and genital lesions; 25 (43%) occurred during asymptomatic shedding. Oral HSV-2 was found less frequently than oral HSV-1 (0.06% v 1%, p<0.001) in people with HSV-1 and HSV-2 antibody, and less frequently than genital HSV-2 (0.09% v 7%, p<0.001).

Conclusions: Oral reactivation of HSV-2 as defined by viral isolation is uncommon and usually occurs in the setting of first episode of genital HSV-2 or during genital recurrence of HSV-2.

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