RT Journal Article SR Electronic T1 Prospective cohort study showing persistent HSV-2 shedding in women with genital herpes 2 years after acquisition JF Sexually Transmitted Infections JO Sex Transm Infect FD BMJ Publishing Group Ltd SP 568 OP 570 DO 10.1136/sextrans-2017-053244 VO 94 IS 8 A1 Meena Ramchandani A1 Stacy Selke A1 Amalia Magaret A1 Gail Barnum A1 Meei-Li Wu Huang A1 Lawrence Corey A1 Anna Wald YR 2018 UL http://sti.bmj.com/content/94/8/568.abstract AB 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.