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Patterns of Primary Genital Herpes

Our understanding of primary genital herpes infections has been hindered by a dearth of rigorous observational studies. This report from a multicenter trial of a candidate vaccine against herpes simplex virus type 2 (HSV-2) helps to remedy the situation: Although the vaccine proved ineffective, the study accumulated useful data.

More than 2000 adults who were seronegative for HSV-2 but at high risk for new infection were followed for 18 months. Of the 155 who acquired HSV-2 during that time, 98 (63 percent) had no symptoms. Among women, rates of symptomatic and asymptomatic new infections were nearly equal, but among men, asymptomatic seroconversion was significantly more common. Participants who were seropositive for HSV-1 were far more likely to seroconvert to HSV-2 asymptomatically than symptomatically. Of 85 asymptomatic HSV-2 seroconverters who were followed for more than 45 days, 13 (15 percent) developed typical genital lesions.

Among participants with symptomatic HSV-2 seroconversion, typical genital lesions were the rule. However, 7 of 57 symptomatic seroconverters had other manifestations, including purulent vaginal or urethral discharge, dysuria, lumbar radiculitis, and aseptic meningitis. Of the 19 people who seroconverted to HSV-1 during the study, 6 had genital lesions associated with seroconversion.

Comment: This study supports a well-known paradox: Many new HSV-2 infections cause no symptoms, but new symptoms may result from old infections. It also reminds clinicians that primary herpes infections may cause unusual genital symptoms and that typical HSV-2 lesions may be caused by HSV-1.

— A Zuger

Published in Journal Watch General Medicine November 16, 1999

Citation(s):

Langenberg AGM et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. N Engl J Med 1999 Nov 4 341 1432-1438.

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