HIV Infection, Should They Be Exposed, Than HSV-2 Seronegative Persons

HIV infection, should they be exposed, than HSV-2 seronegative persons 1

On average, a person with genital HSV-2 infection sheds virus on 15 of days; HIV infection, should they be exposed, than HSV-2 seronegative persons. An episode of genital HSV-1 disease is indistinguishable from genital HSV-2 disease, but genital HSV-1 recurrences and viral shedding occur less often than with genital HSV-2 infection. Persons with HIV infection who are HSV-2 seronegative should consider asking their partners to be tested using type-specific serology before initiating sexual activity, because disclosure of HSV-2 in heterosexual HIV-negative HSV-2-discordant couples was associated with reduced risk of transmission of HSV-2 (BII). The dose, duration, timing, and efficacy of antiviral prophylaxis after known or suspected exposure to HSV have not been evaluated. No laboratory monitoring is needed in patients receiving episodic or suppressive therapy unless they have advanced renal impairment. HSV-2 infection enhances HIV-1 acquisition, as well as transmission. In addition, both sexual and perinatal transmission can occur during asymptomatic viral shedding. Recurrence is typically milder and less prolonged than primary infection with itching and pain confined to a single, relatively small mucocutaneous site.

My first culture did come back positive for hsv-1 2Most people with HSV-2 do not realize that they are infected. Genital herpes can be more difficult to diagnose than oral herpes, since most HSV-2-infected persons have no classical symptoms. Clinical Practice from The New England Journal of Medicine Herpes Zoster. 0 cases per 1000 person-years among HIV-seronegative controls.6 Since herpes zoster may occur in HIV-infected persons who are otherwise asymptomatic, serologic testing may be appropriate in patients without apparent risk factors for shingles (e. Patients should keep the cutaneous lesions clean and dry to reduce the risk of bacterial superinfection. These symptoms generally last for less than six hours, followed within 24 to 48 hours by the appearance of painful vesicles, typically at the vermillion border of the lip (Figure 2). If a person with preexisting HSV-1 antibody acquires HSV-2 genital infection, a first-episode nonprimary infection ensues. Extensive necrosis of the nail and digit has been seen in HIV patients. SEM disease will experience any neurologic sequelae if they receive optimal diagnostic and therapeutic support during the acute period.

More than one etiologic agent (e.g., herpes and syphilis) can be present in a genital, anal, or perianal ulcer. HIV testing should be performed on all persons with genital, anal, or perianal ulcers who are not known to have HIV infection (see Diagnostic Considerations, sections on Syphilis, Chancroid, and Genital Herpes Simplex Virus). As a result, the majority of genital herpes infections are transmitted by persons unaware that they have the infection or who are asymptomatic when transmission occurs. When exposed to HIV, HSV-2 seropositive persons are at increased risk for HIV acquisition. The importance of screening all HIV-infected persons for hepatitis C virus (HCV) is emphasized (BIII). Often symptoms are triggered by exposure to the sun, fever, menstruation, emotional stress, a weakened immune system, or an illness. However, some people may have one outbreak and then never have another one. Although there is no cure for genital herpes, an infected person can take steps to prevent spreading the disease, and can continue to have a normal sex life. HSV-2 is 3 times higher among HIV-infected adults compared to the general population.

Herpes Simplex

Among white persons in the recent National Health and Nutrition Study (NHANES III), 15 of men and 20 of women were HSV-2 seropositive. HSV and HIV-1 InfectionGenital herpes increases the risk of acquisition of HIV-1 as a result of breaks in the genital mucosal barrier and the recruitment of CD4+ lymphocytes into areas of HSV replication (38,39, 72). Those with prior antibodies to HSV-1 are at lower risk than HSV-seronegative individuals of acquiring HSV-2 genital infections; however, this protection is only partial (53). Therefore, patients who can be taught to recognize subtle symptoms accompanying HSV reactivation can also recognize at least some of the periods during which they are at higher risk of shedding virus without experiencing symptoms. The risk of acquiring HIV is greater with recent HSV-2 infections than with chronic infections 4. The women were enrolled if they were pregnant, willing to undergo HIV counseling and testing, had no history of complications with the current pregnancy and were planning to deliver at any of the three randomly selected clinics. HSV-2 was tested at baseline and samples that were HSV-2 seronegative were tested for HSV-2 seroconversion at nine months after childbirth. Incidence, as a percentage and expressed as person years at risk (PYAR) was calculated for everyone and restricted analysis was done on participants that reported having resumed sexually activity after childbirth. Nonetheless, clarifying the determinants of protection against HIV infection is a high priority that will require careful selection of high-risk uninfected cohorts, who should undergo targeted studies of plausible mediators and broad screening for unexpected determinants of protection. In 1 small study, higher levels of TRIM5 RNA were found in unseparated peripheral blood mononuclear cells fromhigh-risk persons who escaped HIV infection than in cells from persons who did not escape infection 29. Exposed seronegative persons by definition do not have systemic antibodies reactive with HIV proteins. Herpes zoster as becoming blood brothers An infected mother can transmit HIV to her child. The viral envelope then fuses with the host cell, allowing release of the viral core into the host cell. On average, infected persons lose 40 to 80 CD4+ cells/mm3/year. The risk of HIV transmission depends on the exposure and degree of viremia of the source. Infections such as active tuberculosis, recurrent community-acquired pneumonia, esophageal candidiasis, undifferentiated interstitial lung disease, and either multidermatomal herpes zoster or zoster in younger adults should lead to HIV testing.

Genital Herpes: Review Of The Epidemic And Potential Use Of Type-specific Serology

In Study 1, Subjects Were Seronegative For Herpes Simplex Virus Type 1 (HSV-1) And HSV-2

In Study 1, subjects were seronegative for herpes simplex virus type 1 (HSV-1) and HSV-2 1

Herpes simplex virus type 1 (HSV-1) has been recognized as a potential pathogen of cardiovascular diseases. The following potential risk factors for diabetes were analyzed in this study: age, cigarette smoking, physical inactivity, BMI, hypertension, dyslipidemia, coronary artery disease, and immunoglobulin G (IgG) seropositive status to HSV-1. Herpes simplex virus (HSV) types 1 (HSV-1) and 2 (HSV-2) and cytomegalovirus (CMV) are ubiquitous pathogens that frequently infect children and young adults 1, 2. Separate HSV-2 attack rates were calculated for girls who were HSV-1 seronegative and for those who were HSV-1 seropositive and were compared by computing a relative risk. A 3:1 matched ratio of control subjects to case subjects was used to evaluate HSV-2 seropositivity over time, after the evaluation of the relationship of race to HSV-2 seropositivity. Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) cause prevalent, chronic infections that have serious outcomes in some individuals. Formal studies demonstrating that infection of lymphoid and myeloid cells is dependent on HveA have not been reported. In general, the breadth and magnitude of anti-HSV immune responses were found, in mice, to increase as viruses expressing additional temporal subsets of HSV proteins were used as vaccines (195). Use of MF59 adjuvant in HSV-seronegative subjects produced neutralizing-antibody levels at or above the levels measured in HSV-2-infected persons (57, 143).

In Study 1, subjects were seronegative for herpes simplex virus type 1 (HSV-1) and HSV-2 2Seroprevalence of herpes simplex virus types 1 and 2 in HIV-infected and uninfected homosexual men in a primary care setting. The subjects completed a questionnaire, and sera were sent for total IgG HSV testing and testing by Gull type-specific HSV ELISA assay. Herpes simplex virus 1 (HSV-1) and HSV-2 are medically significant pathogens. Positive antigens were classified as type specific or cross-reactive according to significance (P values of 0. 2-fold between serum samples from symptomatic and asymptomatic subjects. Phase I Study of a Herpes Simplex Virus Type 2 (HSV-2) DNA Vaccine Administered to Healthy, HSV-2-Seronegative Adults by a Needle-Free Injection System. Half of the participants were HSV-1 seronegative and HSV-2 seronegative (HSV seronegative), and half were HSV-1 seropositive and HSV-2 seronegative, as determined by Western blotting (2). All subjects who received at least one study injection were included in the safety analysis.

Glycoprotein-D-adjuvant vaccine to prevent genital herpes. In Study 1, subjects were seronegative for herpes simplex virus type 1 (HSV-1) and HSV-2; in Study 2, subjects were of any HSV serologic status. HSV-1 more commonly causes oral infections while HSV-2 more commonly causes genital infections. Herpes simplex is divided into two types; HSV-1 causes primarily mouth, throat, face, eye, and central nervous system infections, whereas HSV-2 causes primarily anogenital infections. Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes and is almost always sexually transmitted. Design, Settings, and ParticipantsCross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys NHANES ), were used to compare national seroprevalence estimates from 1999-2004 with those from 1988-1994, and changes in HSV-1 and HSV-2 seroprevalence since 1976-1980 were reviewed.

Seroprevalence Of Herpes Simplex Virus Types 1 And 2 In Hiv-infected And Uninfected Homosexual Men In A Primary Care Setting

In Study 1, subjects were seronegative for herpes simplex virus type 1 (HSV-1) and HSV-2 3Herpes simplex virus type 2 (HSV-2) is the major cause of genital herpes, one of the most common sexually transmitted infections worldwide and a significant risk factor of HIV acquisition. All study participants (2 HSVneg, 30 HSV-2+) provided two cervical cytobrush samples spaced approximately 1 month apart. Considering only those subjects with samples containing HSV-2-specific LP responses, of the subjects who were seropositive for HSV-1 and HSV-2 (n 5), 1 (20 ) had no LP responses to HSV-1, whereas 4 (80 ) had LP responses to both HSV-1 and HSV-2. To assess the frequency of shedding of herpes simplex virus type 1 (HSV-1) DNA in tears and saliva of asymptomatic individuals. Serum samples from all subjects were tested for HSV IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and for HSV-1 by neutralization assay. Thus far, studies have focused on quantifying HSV-1 and -2 antibody titers and/or frequency of shedding in patients with active herpesvirus lesions or immediately after the time of active lesions. None of the five seronegative individuals had positive oral swabs at any time. Herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) are two of the eight known viruses which comprise the human herpesvirus family. If a person with preexisting HSV-1 antibody acquires HSV-2 genital infection, a first-episode nonprimary infection ensues. Herpes simplex virus type 2 (HSV-2) is one of the most prevalent sexually transmitted infections worldwide. Thus, although the components of protective immunity remain unknown, the tools to perform studies to correlate immunity with phenotype are now largely in place: immunocompetent subjects can be phenotyped for shedding frequency, the viral proteome is manageably sized for comprehensive immune studies, and specimens can include infected tissues as well as blood. Discuss the link between HSV-2 and increased HIV transmission. HSV-2 and HIV-1 Transmission and Disease ProgressionConclusionsReferencesTables Table 1. Recommended Regimens for Treatment of Herpes Simplex Virus in HIV-1-Infected IndividualsRelated ResourcesRelated Knowledge Base ChaptersJournal ArticlesGuidelines and Best PracticesConference Reports and ProceedingsOnline Books and ChaptersSlide SetsImagesLinks IntroductionHerpes simplex virus (HSV) infection is a common cause of ulcerative mucocutaneous disease in both immunocompetent and immunocompromised individuals. Classically, HSV type 1 (HSV-1) is acquired in childhood and causes orolabial ulcers, whereas HSV type 2 (HSV-2) is transmitted sexually and causes anogenital ulcers.

Medline ® Abstract For Reference 35 Of ‘prevention Of Genital Herpes Virus Infections’

The study will enroll approximately 7550 healthy women. Seroconversion to HSV-1 and/or HSV-2 was defined as a positive HSV-1 and/or HSV-2 Western blot in a subject with a previously negative Western blot result for the corresponding HSV type. Number of Subjects With Newly Acquired Herpes Simplex Virus (HSV)-2 Infection Confirmed by Either Virus Culture or HSV-2 Seroconversion. 2 and 20 in healthy adult women who were initially HSV-1 and HSV-2 seronegative. Study Design: Randomized controlled trial (double-blinded). One trial involved 847 patients who were seronegative for herpes simplex virus (HSV) types 1 and 2, and the other trial included 2,491 subjects, 1,867 of whom were seronegative for HSV-2. All of the study subjects had partners with HSV-2 infection. Although herpes simplex virus (HSV)-1 and HSV-2 may co-exist and interact, some epidemiologic features including geographical distribution, secular trends, route of transmission, and established risk factors may distinguish these HSV sub-types. Socio-demographic and behavioral correlates of herpes simplex virus type 1 and 2 infections and co-infections among adults in the USA. Herpes Simplex Virus Type-2 Glycoprotein-Subunit Vaccine: Tolerance and Humoral and Cellular Responses in Humans. Both HSV-neutralizing antibody and antibody effective in antibody-dependent cell-mediated cytotoxicity were detected in serum samples of 12 of the 13 initially seronegative subjects by week 8. HSV-neutralizing antibody remained detectable in serum samples of seven of the 10 initially seronegative subjects assayed seven months after dose 3. HSV-2 titers of 1:4, and all seropositive subjects.

IgG Seropositive Group Than The HSV-1 IgG Seronegative Group (16

IgG seropositivity to HSV-1 indicated prior infection of HSV-1. More women than men have been shown to have acquired the virus. IgG antibodies while 1 (0.6) was seronegative for anti-HSV-1& HSV02 IgG antibodies. A 7-day follow-up appointment was then arranged, and free appropriate STD treatment was provided. Cell-free fractions of CVS were tested for IgA or IgG antibodies to HSV-1- or HSV-2-infected cell-protein mixtures by enhanced chemiluminescence Western blotting (ECL-WB) as described in detail in reference 10. Group I comprised 34 HSV-2-seropositive, HIV-seronegative women who all had HSV-2 DNA in their genital secretions.

These symptoms generally last for less than six hours, followed within 24 to 48 hours by the appearance of painful vesicles, typically at the vermillion border of the lip (Figure 2). In the latter group, a negative HSV serology result means that genital herpes can be ruled out as the cause of ulceration (10, 54, 130). Normally, intrathecally synthesized IgG antibodies are measured in the postacute stage of HSE from day 10 to day 12 of the disease, reaching maximum values over a one month period of time and then persisting for several years (135, 161, 196, 231, 232). Six patients were HSV-2 seropositive and HSV-1 seronegative, 5 of whom were healthy and asymptomatic (no history of recurrent HSV disease). A control group, comprising 47 HSV-1- and HSV-2-seronegative individuals, was also enrolled to establish baseline responses for each antigen. For example, HSV-2 infection suggests a stronger likelihood of recurrent genital outbreaks and asymptomatic viral shedding than HSV-1 infection. Individuals who are seronegative for HSV-1 and/or HSV-2 are at risk for acquiring infection from seropositive partners; seronegative women who become infected with either HSV-1 or HSV-2 during pregnancy are the most likely group of HSV-infected patients to pass on the virus to their neonate.

We assayed HSV1 immunoglobulin G (IgG) antibody in serum samples from 30 patients and 44 healthy subjects and obtained structural magnetic resonance imaging scans from the same individuals. Next, we examined differences in IgG antibody ratios as well as group differences in seropositivity for HSV1. MCI patients had a higher anti-HSV-1 IgG antibody avidity index than AD patients or healthy controls implying that HSV-1 reactivation occurs more frequently in the MCI group than in the AD group or healthy control group. (MRI) of the brain compared to the HSV-1 seronegative control group 34. HSV-2 seropositivity, on the other hand, suggests a stronger likelihood of recurrent genital outbreaks and viral shedding, even when asymptomatic. HSV-1 or HSV-2 during pregnancy are the most likely group of HSV-infected patients to pass on the virus to their neonate. Women who are seropositive for both types early in pregnancy have a lower likelihood of neonatal transmission than do women who have a first-episode outbreak later in pregnancy, but a greater likelihood of transmission than women who remain uninfected throughout pregnancy.

Molecular Psychiatry

The current analysis used questionnaire data and serum samples from 3757 HIV seronegative subjects in order to determine the relative importance of HPV-16 in relation to risk of a number of cancer types. This enhanced ELISA uses serum at a 1:100 dilution instead of a previous 1:20 dilution 19. Observations: 53.33 of the 75 cases and 25 of control group were seropositive. IgM appears in the first week of infection, increases rapidly and then declines at variable rates. For transplant recipients (seropositive donor and seronegative recipient) – trimethoprim/sulfamethoxazole prophylaxis is effective. Flegr J, Preiss M, Klose J; Toxoplasmosis-associated difference in intelligence and personality in men depends on their Rhesus blood group but not ABO blood group. They found that CMV-specific serum IgG antibody levels were associated with NFT of AD brain, as, also, was CSF interferon, which was detected only in CMV-seropositive patients; also, the percentage of senescent T cells was significantly higher in CMV-seropositive than in seronegative patients. (2012), who infected 2 month-old male and female wild-type and APOE-knock-out mice, and studied them over the following 16 months.

Molecular Psychiatry

Herpes Simplex Infections Can Be Primary- The First Infection In A Previously Seronegative Patient Or Recurrent

First-episode infections include true primary infections in patients with seronegative results who have never been infected with any type of herpes and nonprimary first-episode infections in patients who have been infected before and have serum antibody and humoral immunity, an example being genital infection with type 2 in adolescence after orolabial infection with type 1 in childhood. In recurrent vulvar herpes, virus can be isolated from the cervix in 10 to 15 of patients. The transmission of herpes simplex virus (HSV) infection is dependent upon intimate, personal contact of a susceptible seronegative individual with someone excreting HSV. The transmission of herpes simplex virus (HSV) infection is dependent upon intimate, personal contact of a susceptible seronegative individual with someone excreting HSV. Virus must come in contact with mucosal surfaces or abraded skin for infection to be initiated. HSV-1 or HSV-2) can experience a first infection with the opposite virus type (namely, HSV-2 or HSV-1, respectively). The histopathologic characteristics of a primary or recurrent HSV (Fig. Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicles. (HSV seropositive) can pass the virus to an HSV seronegative person. When lesions do not appear inside the mouth, primary orofacial herpes is sometimes mistaken for impetigo, a bacterial infection.

These medications have been proven to lessen the itching and pain caused by herpes outbreak 2Herpes simplex infections can be primary- the first infection in a previously seronegative patient or recurrent. The two are separated by a latent phase. As with primary HSV-1 infection, recurrent infection may occur in the absence of clinical symptoms. As compared with recurrent episodes of genital herpes, first episodes of genital herpes infection may have associated systemic symptoms, involve multiple sites including nongenital sites, and have longer lesion duration and viral shedding (49). HSV-2 seropositive women without previously recognized genital HSV infection can begin to recognize atypical signs and symptoms as being associated with HSV recurrences (78, 129). Genital herpes simplex virus infection is a recurrent, lifelong disease with no cure. First-episode infections are more extensive: primary lesions last two to six weeks versus approximately one week for lesions in recurrent disease. Serologic testing can be useful in persons with a questionable history. The first is a nonprimary clinical eruption in a patient who has been infected previously with any type of HSV.

How can mother-to-child transmission be prevented to improve outcomes? Without acquired immunity, initial primary infections are generally more severe than recurrences. The disease course after initial infection is variable; some patients have recurrent infections, and others never experience a second episode. Genital herpes can result from infection with either HSV type 2 or type 1, mainly HSV type 2 in this country, which typically causes more recurrent and severe manifestations of disease. Intermittent Episodic Therapy or Recurrent Labial Herpes. Neonatal HSV infection is a rare, but potentially fatal, disease of babies, occurring within the first 4-6 weeks of life. A minority with late intrauterine HSV infection will present at delivery with skin or eye lesions. 46,47 The greatest risk of perinatal transmission is when a previously seronegative woman has a primary first episode of genital herpes near or at the time of delivery.

Herpes Simplex

Herpes simplex virus infection, latency, and recurrence. Most HSV is acquired from an infected but asymptomatic person. Neonatal infection: risk 40 if primary genital HSV infection in mother during third trimester. Recurrent disease can result in damage to the cornea and uvea with scarring and vision loss. Herpetic Eye Disease Study Group has shown that oral acyclovir suppression following initial ocular herpes decreases recurrence by 45 in the 1st year; the greatest suppressive effect may be seen in those with concomitant history of atopy. Initial anogenital HSV infection can be a painful illness characterized by vesicular and ulcerative skin lesions and neurologic and urologic complications. In contrast, only 1 gD2/AS04-immunized guinea pig developed recurrences, the same guinea pig that had previously experienced symptomatic primary infection. HIV Care for the Primary Care Physician Online Medical Reference – from definition and diagnosis through risk factors and treatments. Human immunodeficiency virus infection was first described in 1981 when an epidemic of Pneumocystis jiroveci (formerly identified as Pneumocystis carinii) pneumonia was noted in homosexual men. Although not present in all patients, oral or genital ulcers can be an important diagnostic clue. Recurrent or severe lesions of herpes simplex virus may be indicative of underlying HIV infection. Characterize the epidemiology of herpes simplex virus (HSV) infection, including mode of transmission, incubation period, and period of communicability. Both primary and recurrent HSV infections can manifest on any mucocutaneous surface. Periodically, the virus will reactivate to produce reinfection. The clinical course of primary genital herpes simplex virus infection. Some patients have multiple recurrent infections in the first year.

Accessmedicine

Transmission Of HSV From The Patient To A Seronegative Partner Can Occur During Asymptomatic Shedding

Transmission of HSV from the patient to a seronegative partner can occur during asymptomatic shedding 1

In addition, both sexual and perinatal transmission can occur during asymptomatic viral shedding. A key determinant of transmission is the nature of HSV-2 shedding in the source partner. In comparison to symptomatic HSV-2 shedding episodes, asymptomatic episodes tend to be shorter duration (we have documented episodes lasting two hours), and have lower peak HSV copy number 4. Most patients with genital herpes do not have truly asymptomatic infection; There is no day that a person can tell his or her sexual partner today I will not infect you. Neonatal infection with HSV can also occur in the setting of recurrent herpes.

Transmission of HSV from the patient to a seronegative partner can occur during asymptomatic shedding 2The transmission of herpes can occur in the absence of lesions and during asymptomatic shedding. Occasionally, patients can get herpes lesions at distant parts of their body. A large portion of new herpes infections occur from partners who are shedding the virus asymptomatically. (i.e. the male partner is HSV II seropositive and the pregnant mom is seronegative), then measures to limit transmission during pregnancy need to be implemented. Knowledge of the causative type has important implications for patient management. The rate of asymptomatic genital tract shedding in 43 women with primary HSV-1 infection, was 11. HSV asymptomatic shedding occurs at some time in most individuals infected with herpes. 38 Antivirals also help prevent the development of symptomatic HSV in infection scenarios, meaning the infected partner will be seropositive but symptom-free by about 50. 51 Women seropositive for only one type of HSV are only half as likely to transmit HSV as infected seronegative mothers.

Primary infection: Genital herpes in a patient seronegative for antibody to HSV-1 or HSV-2. Transmission may occur when a partner is shedding virus asymptomatically. Nearly everyone, both men and women, with genital HSV-2 infection sheds virus from time-to-time without symptoms, which is why sexual transmission can occur during asymptomatic periods. If direct HSV tests are repeatedly negative and the symptoms are recurring, the patient should be advised to have type-specific herpes serology. Also, some do not sero convert and reversal from sero positive to sero negative status may occur if there is minimal antigenic stimulation. Virus can be isolated from the saliva of asymptomatic children as well. As with primary HSV-1 infection, recurrent infection may occur in the absence of clinical symptoms. Transmission to a sexual partner may occur during such periods of subclinical shedding (188). Given that 20-25 of the United States population is infected with HSV-2, as discussed above, subclinical viral shedding likely accounts for the majority of spread of genital herpes.

Frequently Asked Questions About Herpes

Transmission of HSV from the patient to a seronegative partner can occur during asymptomatic shedding 3Many primary genital infections are asymptomatic, however. About 10 of HSV-2 seronegative women have HSV-2 seropositive partners. Genital herpes, however, is often asymptomatic, although viral shedding may still occur during periods of remission and therefore it is possible to transmit the disease during remission. Patients with immature or suppressed immune systems, for example newborn infants, transplant recipients, and AIDS patients are prone to severe complications from HSV infections. In HSV-1 infected individuals, seroconversion after an oral infection will prevent additional HSV-1 infections such as whitlow, genital, and keratitis. Asymptomatic shedding occurs most frequently in the first year after the primary episode. Notably, primary genital HSV-2 occurring in an HIV-1-infected person is a marker for ongoing unsafe sexual practices. The Importance of Asymptomatic HSV ReactivationMost HSV-2-infected individuals, regardless of HIV-1 serostatus, shed HSV in oral or genital secretions, and most shedding is asymptomatic. (12) Frequent and high-titer HSV-2 shedding, regardless of whether it is associated with symptomatic disease, likely increases the risk of HSV-2 transmission to sexual partners. (17) Among HIV-1-infected persons, rates of acyclovir resistance are also generally low ( 5 ), but drug-resistant disease can be a significant problem for severely immunocompromised patients, in whom a poor response to escalating doses of HSV antivirals may indicate acyclovir resistance.

Adolescent Health Care: A Practical Guide