Oral shedding of herpes simplex virus type 2

Abstract

Objectives: Herpes simplex virus (HSV) 1 and HSV-2 reactivate preferentially in the oral and genital area, respectively. We aimed to define frequency and characteristics associated with oral shedding of HSV-2. Methods: Demographic, clinical and laboratory data of patients with documented HSV-2 infection and at least one oral viral culture obtained were selected from the University of Washington Virology Research Clinic database. Results: Of 1388 people meeting the entry criteria, 44 (3.2%) had HSV-2 isolated at least once from their mouths. In comparison with the 1344 people who did not have HSV-2 isolated from their mouth, participants with oral HSV-2 were more likely to be male (OR = 1.9, 95% CI 1.0 to 3.7), HIV positive (OR = 2.9, 95% CI 1.4 to 6.0), and homosexual (OR = 2.2, 95% CI 1.1 to 4.2), and to have collected a larger number of oral specimens (median 32 v 4, p,0.001). Of the 58 days with oral HSV-2 isolation, 15 (25%) occurred during newly acquired HSV-2 infection, 12 (21%) during a recurrence with genital lesions, three (5%) during a recurrence with oral lesions, and three (5%) during a recurrence with oral and genital lesions; 25 (43%) occurred during asymptomatic shedding. Oral HSV-2 was found less frequently than oral HSV-1 (0.06% v 1%, p,0.001) in people with HSV-1 and HSV-2 antibody, and less frequently than genital HSV-2 (0.09% v 7%, p,0.001). Conclusions: Oral reactivation of HSV-2 as defined by viral isolation is uncommon and usually occurs in the setting of first episode of genital HSV-2 or during genital recurrence of HSV-2.

Efficacy of Topical 5% Acyclovir-1% Hydrocortisone Cream (ME-609) for Treatment of Herpes Labialis: a systematic review

“…HSV-1 is mainly implicated in orofacial infections, whereas HSV-2 is predominantly associated with genital lesions (Wald et al 2004).…”

Oral viral infections and the therapeutic use of antiviral agents in dentistry

“…Interestingly, a recent study reported that, of 1388 patients with documented HSV-2 infection, 3.2 per cent had HSV-2 isolated at least once from their mouths and this usually occurred during the first episode of genital HSV-2 or during genital recurrence of HSV-2. 6 HSV-2 can cause the initial infection of primary herpetic gingivostomatitis, however it is not known how common this is, nor how common are the recurrent herpes labialis lesions caused by HSV-2. …”

Genital Herpes

“…More than 500 million people are estimated to be infected with HSV-2 worldwide, which corresponds to 16% of the world population in between the ages of 15-49. It is also estimated that 20 million new cases occur every year [5,6,9].…”

“…For this reason, detection of type-speciic HSV IgG antibodies, especially HSV-2, is very important to use type-speciic serological tests for an accurate and efective genital herpes management [6,34].…”

“…HSV-2 may cause orofacial infections as well, which cannot be clinically distinguished from HSV-1-induced infections. However, HSV-2-induced orofacial infections are very rare [5,6].…”