Herpes simplex virus type 1 (HSV-1) is a ubiquitous pathogen infecting most individuals worldwide. The majority of HSV-1-infected individuals have no clinical symptoms but shed HSV-1 asymptomatically in saliva. Recent phylogenetic analyses of HSV-1 have defined three genetic clades (A-C) and recombinants thereof. These data have all been based on clinical HSV-1 isolates and do not cover genetic variation of asymptomatically shed HSV-1. The primary goal of this study was to investigate such variation. A total of 648 consecutive saliva samples from five HSV-1-infected volunteers was collected. Asymptomatic shedding was detected on 7.6 % of the days from four subjects. The HSV-1 genome loads were quantified with real-time PCR and varied from 1¾10 2 to 2.8¾10 6 copies of virus DNA (ml saliva). Phylogenetic network analyses and bootscanning were performed on asymptomatically shed HSV-1. The analyses were based on DNA sequencing of the glycoprotein I gene, and also of the glycoprotein E gene for putative recombinants. For two individuals with clinical HSV-1 infection, the same HSV-1 strain was shed asymptomatically as induced clinical lesions, and sequence analyses revealed that these strains clustered distinctly to clades A and B, respectively. For one of the subjects with no clinical HSV-1 infection, a recombinant strain was identified. The other truly asymptomatic individual shed evolutionarily distinct HSV-1 strains on two occasions. The first strain was classified as a recombinant and the other strain clustered in clade A. High replication rates of different strains in the same person may facilitate the creation of recombinant clinical HSV-1 strains.
INTRODUCTIONHerpes simplex virus type 1 (HSV-1) is a DNA virus belonging to the family Herpesviridae encompassing more than 100 herpesviruses. The clinical spectrum of HSV-1 infection includes rare, severe manifestations such as encephalitis and disseminated neonatal infection, oral and genital clinical lesions, and asymptomatic shedding. Recrudescent disease has been estimated to occur in 32 % of blood donors resident in England (Cowan et al., 1996), and in Sweden, a recent study demonstrated that 26 % of HSV-1-infected individuals presented oral lesions (Lowhagen et al., 2002). Thus, a minority of HSV-1-infected subjects have clinical lesions. It is well-known that HSV-1-infected individuals shed virus in saliva during episodes of herpes labialis as well as during asymptomatic phases, and that asymptomatic oral shedding of HSV-1 is essential for transmission (Scott et al., 1997). The molecular basis for asymptomatic shedding is not well understood, i.e. the difference between subclinical reactivation with asymptomatic shedding and reactivation leading to clinical lesions.Although most HSV-1-infected individuals have an asymptomatic infection, recent phylogenetic analyses of HSV-1 based on DNA sequencing have been exclusively from HSV-1 isolates derived from clinical lesions. These analyses identified three evolutionary clades (A-C) with a genetic distance between t...