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Viral Shedding Common After First-Episode Genital HSV-1 Infection

Genital HSV-1 shedding often asymptomatic; genital lesions, oral lesions, and oral viral shedding less common

MONDAY, Oct. 31, 2022 (HealthDay News) — Genital viral shedding is frequent after first-episode genital herpes simplex virus type 1 (HSV-1) infection, particularly among those with primary infection, according to a study published online Oct. 22 in the Journal of the American Medical Association.

Christine Johnston, M.D., from the University of Washington in Seattle, and colleagues assessed oral and genital viral shedding patterns among persons with first-episode genital HSV-1 infection without HIV. The analysis included 82 participants followed for up to two years.

The researchers found that at two months, HSV-1 was detected from the genital tract in 64.3 percent of participants and in the mouth of 29.3 percent of participants. At two months, genital HSV-1 shedding was detected on 275 of 2,264 days (12.1 percent) and declined significantly to 122 of 1,719 days (7.1 percent) at 11 months (relative risk, 0.52). Genital lesions were only reported on 2.6 percent of days at two months and on 3.8 percent of days at 11 months. At two months, oral HSV-1 shedding was detected on 3.9 percent of days. Compared with participants with nonprimary infection, those with primary HSV-1 infection had a higher risk for genital shedding (relative risk, 2.75).

“For clinicians, these data emphasize the importance of determining the HSV viral type in persons presenting with initial episodes of genital herpes to accurately counsel patients regarding risk of clinical recurrence, the likelihood of asymptomatic shedding of virus and hence transmission, and antiviral prophylaxis,” write the authors of an accompanying editorial.

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