Clinical Reactivation of Genital Herpes Simplex Virus Infection Decreases in Frequency over Time

Clinical Reactivation of Genital Herpes Simplex Virus Infection Decreases in Frequency over Time

From the University of Washington, Seattle, Washington.

Abstract

Background: Visits to physicians for genital herpes simplex virus (HSV) infection continue to increase. Most patients with symptomatic infections have recurrences, but no studies of the long-term clinical course of genital herpes are available.

Objective: To determine whether the frequency of HSV recurrences decreases over time.

Design: Observational cohort study.

Setting: University-based research clinic.

Patients: 664 persons with genital herpes followed for at least 14 months.

Measurements: Patients were classified as having initial or recurrent HSV-1 or HSV-2 infection. Patient-reported recurrences and observed recurrences were recorded in a database; more than 12 000 recurrences were analyzed.

Results: Median recurrence rates in the first year of follow-up were one and five per year in patients with newly acquired HSV-1 and HSV-2 infection, respectively; second-year rates were significantly lower in both groups. Patients presenting with recurrent HSV-2 infection had higher rates of recurrence in the first and second years and no significant decrease; significant decreases were detected with longer follow-up. One third of all patients experienced a decrease of two or more recurrences per year between years 1 and 2. Patients infected with HSV-2 who were followed for more than 4 years had a median decrease of two recurrences between years 1 and 5. However, 25% of these patients had an increase of at least one recurrence in year 5, illustrating the variability among HSV-infected persons. Decreases over time among patients who never received suppressive therapy were similar to decreases during untreated periods in patients who received suppressive therapy.

Conclusions: Herpes simplex virus type 2 infection continues to be a chronic remitting illness. Over time, however, clinically significant reductions occur in a majority of patients. Physicians may wish to periodically assess the need for continued treatment with daily suppressive antiviral chemotherapy.

Article and Author Information

Acknowledgments: The authors thank the patients and staff at the University of Washington Virology Research Clinic for their cooperation and help during the conduct of these studies; Michael Remington and Carol Winter; Stacy Selke for data management; and Dr. Anna Wald for thoughtful discussion.
Grant Support: In part by the National Institutes of Health (grants AI-30731 and AI-30619).
Requests for Reprints: Lawrence Corey, MD, 1100 Fairview Avenue North (D3-100), Box 19024, Seattle, WA 98109-1024.
Current Author Addresses: Dr. Benedetti: University of Washington, Department of Biostatistics, Box 357232, Seattle, WA 98195.
Dr. Zeh: University of Washington, Department of Statistics, Box 354322, Seattle, WA 98195.
Dr. Corey: 1100 Fairview Avenue North (D3-100), Box 19024, Seattle, WA 98109-1024.