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背景自商业提供了2型单纯疱疹病毒(HSV-2)抗体检测以来,经血清学检测所了解的患有生殖器疱疹的人数有所增多。血清阳性无症状者的HSV-2自然史病程尚不清楚。目的评估有症状及无症状HSV-2感染者生殖器HSV病毒脱落及临床过程。设计、设施和受试者将1992年3月至2008年4月,美国华盛顿大学西雅图病毒研究诊所及奥勒冈州波特兰韦斯托弗高地诊所,498例免疫活性HSV-2血清阳性者纳入前瞻性研究。每位参试者自用拭子采集生殖器分泌物至少30 d。主要结果测量对生殖器拭子HSV-DNA做实时荧光定量聚合酶链反应检测病毒脱落率。结果 将410例有症状HSV-2感染者生殖器4 753/23 683 d检出HSV-2[20.1%,95%CI(18.3%,22.0%)]与88例无症状感染者519/5 070 d进行比较(P<0.001)。临床症状不明显者比无症状感染者病毒脱落率要高,2 708/20 735 d[13.1%,95%CI(11.5%,14.6%)]对434/4 929 d[8.8%,95%CI(6.3%,11.5%)](P<0.001)。然而,亚临床症状脱落发生时HSV检出量相似,有症状感染组中位数4.3(四分位间距,3.1～5.6)log10 copies对无症状感染组4.2(四分位间距,2.9～5.5)(P=0.27)。有生殖器病毒脱落计算病变天数,有症状生殖器HSV-2感染者为2 045/4 753 d[43.0%,95%CI(39.8%,46.5%)]与无症状感染者85/519 d[16.4%,95%CI(11.2%,23.9%)]相比(P<0.001)。结论 与有症状感染者相比,无症状HSV-2感染者生殖道内病毒脱落频次要少,但由于病毒脱落伴发于病变,所致差异大部分可归因于生殖器发生的病变少所致。
Background Since the commercial availability of herpes simplex virus type 2 (HSV-2) antibodies, there has been an increase in the number of people diagnosed with genital herpes following serological testing. The history of natural history of HSV-2 in seropositive asymptomatic patients is not clear. Objective To assess the genital HSV virus shedding and clinical course in symptomatic and asymptomatic HSV-2 infected patients. Design, Facilities, and Subjects From March 1992 to April 2008, 498 immunocompetent HSV-2 seropositive patients at the Seattle Virus Research Clinic at Washington University in the United States and Westover Heights Clinic in Portland, Oregon Include prospective studies. Each participant collected genital secretions from swabs for at least 30 days. MAIN OUTCOME MEASURES Measurement of virus shedding was performed by real-time fluorescent quantitative polymerase chain reaction on genital swab HSV-DNA. Results In 410 cases with HSV-2 infection, HSV-2 [20.1%, 95% CI (18.3%, 22.0%)] was detected at genotype 4 753/23 683 days in 883 patients with asymptomatic infection and 519/5 070 d For comparison (P <0.001). The rate of virus shedding was significantly higher in patients with asymptomatic infection than in asymptomatic subjects at 2 708/20 735 days [13.1%, 95% CI (11.5%, 14.6%)] for 434/4 929 days [8.8%, 95% CI (6.3%, 11.5%)] (P <0.001). However, HSV was detected similarly in cases of sub-clinical shedding, with a median of 4.3 (interquartile range, 3.1-5.6) log10 copies in the symptomatic infection group 4.2 (quartile, 2.9-5.5) in the asymptomatic group (P = 0.27). There were days of genital virus shedding, the number of patients with symptomatic genital HSV-2 infection was 2045/4 753 days [43.0%, 95% CI (39.8%, 46.5%)] and asymptomatic 85-519 days [16.4% , 95% CI (11.2%, 23.9%)] (P <0.001). Conclusions Asymptomatic HSV-2 infection has fewer frequency of shedding of virus in the reproductive tract than in patients with symptomatic infection, but most of the differences due to shedding of virus can be attributed to less lesions in the genital area.