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Prospective cohort study showing persistent HSV-2 shedding in women with genital herpes 2 years after acquisition
  1. Meena Ramchandani1,
  2. Stacy Selke2,
  3. Amalia Magaret2,3,4,
  4. Gail Barnum2,
  5. Meei-Li Wu Huang2,
  6. Lawrence Corey1,2,4,
  7. Anna Wald1,2,4,5
  1. 1 Department of Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
  3. 3 Department of Biostatistics, University of Washington, Seattle, Washington, USA
  4. 4 The Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  5. 5 Department of Epidemiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Meena Ramchandani, Division of AID, University of Washington, Seattle, WA 98104, USA; meenasr{at}


Objectives Herpes simplex virus type 2 (HSV-2) is a prevalent infection with great variability in clinical and virological manifestations among individuals. This prospective cohort study aims to evaluate the natural history of HSV-2 reactivation in the genital area in the same group of women over time.

Methods Eighteen immunocompetent HSV-2 seropositive women were evaluated for viral shedding for 70 consecutive days within a median of 8 months (range 1–24 months) of HSV-2 acquisition and again approximately 2.5 years later from the original study. Participants obtained daily swabs of genital secretions for HSV PCR and recorded genital symptoms.

Results The viral shedding rate was 29% during the initial study and 19% in the follow-up study (32% reduction, P=0.019). Subclinical shedding rate also decreased from 24% to 13% (37% reduction, P=0.032), as did the rate of days with genital lesions from 22% to 15% (33% reduction, P=0.24). The mean copy number during viral shedding remained unchanged over time at 4.8 log10 c/mL (SD=2.0 and 1.6 during each study, respectively, P=0.33). Women with high viral shedding rates in the past were likely to continue to have high shedding rates (r=0.63, P=0.005).

Conclusions Despite some reduction, high viral shedding rates persist in women with genital HSV-2 greater than 2 years after acquisition.

  • herpes simplex virus type 2
  • genital herpes
  • viral shedding
  • natural history

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  • Handling editor Jackie A Cassell

  • Contributors SS, AM, GB, LC and AW designed the study. M-LWH contributed to analysis of specimens. AM developed the statistical analysis plan and performed the statistical analysis. MR contributed to analysis of the data and writing of the manuscript. All authors contributed to approval of the final manuscript. The authors designed and executed the study, had full access to the raw data, performed all analyses, wrote the manuscript and had final responsibility for the decision to submit for publication.

  • Funding This work was supported by grants from the National Institutes of Health: T32 AI007044-38 (MR); P01 AI030731 (AW, SS, AM and LC); K24AI071113 (AW).

  • Competing interests AW has received research grants from Genocea and Vical and is a consultant for Aicuris and GSK. LC is on the scientific advisory board for and holds stock (<1% of the company) in Immune Design Corp and is a coinventor listed on several patents involving potential HSV vaccine development. AM is a consultant for Aicuris and Immune Design. For the remaining authors, none were declared.

  • Ethics approval Ethical approval was obtained from the Ethics Committee and Institutional Review Board at University of Washington. Approval number IRB no. 00001279.

  • Provenance and peer review Not commissioned; externally peer reviewed.