REPLY
Recurrence Rates of Genital Herpes
Lawrence Corey;
Jacqueline Benedetti; and
Rhoda Ashley
1 June 1995 | Volume 122 Issue 11 | Page 883
IN RESPONSE:
Drs. Marshall and Purnell are correct that our study group had a low seroprevalence of HSV-1 infection. Most serosurveys suggest that approximately half of the persons with HSV-2 antibody also have HSV-1 antibodies [1]. In our cohort of patients with a first episode of genital herpes, only 13% were seropositive for HSV-1 infection. As we have shown [2], previous HSV-1 infection lessens the severity of HSV-2 infection and increases the frequency of unrecognized genital HSV infection. As such, we would expect this distribution of HSV antibodies in a study designed to evaluate the natural history of first-episode infections that are clinically symptomatic. One of the points of our paper was that previous HSV-1 infection, although it influences the clinical severity of the first episode, does not appear to influence the subsequent frequency of clinical reactivations of HSV-2 infection, at least during the initial years of disease observation [3]. The subclinical shedding rates among persons seropositive for HSV-2 and those who are seropositive for HSV-1 and HSV-2 are also similar [4].
Most persons who are seropositive for HSV-2 will, when instructed about the clinical manifestations of genital herpes, subsequently report genital lesions that were previously clinically unrecognized [5]. On follow-up, such persons have reactivation rates similar to those identified in our study.
The spectrum of HSV-2 infection is clinically diverse, and the patients who participated in our study were likely to represent the more severe end of the spectrum of first-episode disease, as described in our paper. Physicians tend to minimize the morbidity of a chronic infection that causes discomfort and psychological distress to our patients. However, objective data indicate that HSV-2 reactivations are frequent and that a continuing epidemic of this infection is occurring worldwide. More accurate counseling by health care personnel about the frequent reactivation rate of HSV-2 and the potential such reactivation plays in transmission is prudent medical practice.
|
Author and Article Information
|
|---|
Royal Perth Hospital, Perth, Western Australia 6001, Australia. University of Washington School of Medicine, Seattle, WA 98144.
1. Johnson RE, Nahmias AJ, Magder LS, Lee FK, Brooks CA, Snowden CB. A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. N Engl J Med. 1989; 321:7-12.
2. Koutsky LA, Ashley RL, Holmes KK, Stevens CE, Critchlow CW, Kiviat N, et al. The frequency of unrecognized type 2 herpes simplex virus infection among women. Implications for the control of genital herpes. Sex Trans Dis. 1990; 17:90-4.
3. Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994; 121:847-54.
4. Wald A, Zeh J, Selke S, Ashley RL, Corey L. Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med. 1995; (In press).
5. Langenberg A, Benedetti J, Jenkins J, Ashley R, Winter C, Corey L. Development of clinically recognizable genital lesions among women previously identified as having "asymptomatic" herpes simplex virus type 2 infection. Ann Intern Med. 1980; 110:882-7.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
