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O03.1 Natural history of genital and oral herpes simplex virus-1 (HSV-1) shedding after first episode genital HSV-1 infection
  1. Christine Johnston1,
  2. Amalia Magaret2,
  3. Michael Stern1,
  4. M Huang2,
  5. Stacy Selke3,
  6. Keith Jerome4,
  7. David Koelle1,
  8. Anna Wald1
  1. 1University of Washington, Medicine, Seattle, USA
  2. 2University of Washington, Laboratory Medicine, Seattle, USA
  3. 3University of Washington, Seattle, USA
  4. 4Fred Hutchinson Cancer Research Center, Vaccine And Infectious Disease Division, Seattle, USA


Background Genital HSV-1 has surpassed HSV-2 as a cause of first episode genital herpes in high-income settings. To inform counseling messages regarding prevention of genital HSV-1 transmission, we assessed oral and genital shedding patterns among persons with laboratory documented first episode genital HSV-1 infection.

Methods Participants with virologic evidence of first episode genital HSV-1 infection self-collected oral and genital swabs for HSV PCR and completed symptom diaries for 30 days at 2 and 11 months after the first episode. Questionnaires about sexual practices were completed. Blood samples were collected at serial timepoints to assess antibody and cellular immune responses to HSV-1. HSV serostatus was determined using the HSV Western Blot, and those who were HSV seronegative at the time of enrollment had primary infection. The per-participant risk of oral and genital HSV-1 shedding during the first and second collection periods was determined.

Results Of 62 participants who completed both swabbing sessions, 42 (68%) were women and 36 (58%) had primary HSV-1 infection. Of 54 who responded, 44 (81%) had a sex partner of the opposite gender and 43 (80%) had a single partner within 4 weeks prior to symptom onset. Genital HSV was detected on 205 (12.2%) of 1684 days at 2 months and declined significantly to 92 (5.5%) of 1668 days at 11 months (RR=0.45, 95% CI=0.24–0.85). On days when genital HSV was detected, the median quantity was higher at 11 months (4.2 log10 copies/ml) as compared to 2 months (3.2 log10 copies/ml), p<0.0001). HSV was detected from the mouth on 4.1% of days and stable over the first year. Genital lesions were rare during both periods (104 (2.8%) of 3687 days).

Conclusion HSV-1 genital shedding is rapidly contained after the first year of genital HSV-1 infection. Genital HSV-1 shedding is relatively infrequent, but does persist, one year after first episode infection.

Disclosure No significant relationships.

  • HSV

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