Recurrences after Oral and Genital Herpes Simplex Virus Infection

• Published in: The New England journal of medicine Vol. 316; no. 23; pp. 1444 - 1449
• Main Authors: Lafferty, William E, Coombs, Robert W, Benedetti, Jacqueline, Critchlow, Cathy, Corey, Lawrence
• Format: Journal Article
• Language: English
• Published: Boston Massachusetts Medical Society 04.06.1987
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198706043162304

We prospectively followed 39 adults with concurrent primary herpes simplex virus (HSV) infection (12 with HSV type 1 and 27 with HSV type 2) of the oropharynx and genitalia, caused by the same virus in each person, to evaluate the influence of viral type (HSV-1 vs. HSV-2) and site of infection (oropharyngeal vs. genital) on the frequency of recurrence. The subsequent recurrence patterns of HSV infection differed markedly according to viral type and anatomical site. Oral–labial recurrences developed in 5 of 12 patients with HSV-1 and 1 of 27 patients with HSV-2 (P<0.001). Conversely, genital recurrences developed in 24 of 27 patients with HSV-2 and 3 of 12 patients with HSV-1 (P<0.01). The mean rate of subsequent genital recurrences (due to HSV-1 and HSV-2) was 0.23 per month, whereas the mean rate of oral–labial recurrences was only 0.04 per month (P<0.001). The mean monthly frequencies of recurrence were, in order, genital HSV-2 infections, 0.33 per month; oral–labial HSV-1 infections, 0.12 per month; genital HSV-1 infections, 0.020 per month; and oral HSV-2 infections, 0.001 per month (P<0.01 for each comparison). We conclude that the likelihood of reactivation of HSV infection differs between HSV-1 and HSV-2 infections and between the sacral and trigeminal anatomical sites. The six-fold more frequent clinical recurrence rate of genital HSV infections as compared with oral–labial HSV infections may account for the relatively rapid increase in the prevalence of clinically recognized genital herpes in recent years. (N Engl J Med 1987; 316:1444–9.) THE long-term natural history and risk factors associated with recurrences of mucocutaneous infections with herpes simplex virus (HSV) are largely unknown. 1 2 3 Great variability among individual patients in the clinical recurrence rate of oral and genital herpes has been reported. 4 5 6 7 To evaluate how viral type (HSV type 1 vs. HSV type 2) and anatomical site of infection (oropharyngeal vs. genital) influence the recurrence of disease, we prospectively followed a cohort of young adults who acquired concurrent oropharyngeal and genital primary HSV infections. Methods Study Design Patients were selected from a review of the 557 consecutive persons with first episodes of genital . . .