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Use of the designation "shedder" in mucosal detection of herpes simplex virus DNA involving repeated sampling
  1. Amalia Magaret (amag{at}u.washington.edu)
  1. University of Washington, United States
    1. Christine Johnston
    1. University of Washington, United States
      1. Anna Wald
      1. University of Washington, United States

        Abstract

        Objectives: We evaluated two methods to describe detection of HSV from the genital mucosa.

        Methods: We assessed genital swabs from HSV-2 seropositive persons participating in longitudinal studies of HSV DNA detection at the University of Washington Virology Research Clinic. We determined the length of observation period necessary to ensure some HSV detection for most persons. We compared two measures to assess differences in shedding according to HIV status, the shedding rate ratio, defined as the proportion of total samples with detectable HSV in HIV-1 seropositive versus HIV-1 seronegative persons, and the ratio of "shedders", defined as the proportion of persons with any shedding over the interval in HIV-1 seropositive versus HIV-1 seronegative persons.

        Results: While only 17% (51/308) of HSV-2 seropositive persons shed on their first day on study, 77% (238/308) had some genital shedding over 30 days (any HSV DNA detected on genital swabs). Shedding rate ratios for HIV-seropositive versus HIV-seronegative persons varied from SRR=1.42 using 10 samples to SRR=1.35 using 50 samples. The ratio of "shedders" approached 1 as the observation period increased (RS=1.13 using 10 samples to RS=1.01 using 50 samples). In a hypothetical case, the ratio of "shedders" was shown to exceed one when shedding rates were equal.

        Conclusions: Most HSV-2 seropositive persons shed HSV from the genital mucosa. Dichotomization of persons into “shedders” and “nonshedders” or “high” and “low” shedders yields inferences that depend upon sampling interval length. Overall shedding rates provide consistent measures regardless of the number of swabs collected.

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