Sex Transm Dis. 2008 Feb;35(2):124-128.
Does Frequency of Genital Herpes Recurrences
Predict Risk of Transmission? Further Analysis
of the Valacyclovir Transmission Study.
Kim HN, Wald A, Harris J, Almekinder J, Heitman
C, Corey L. From the *Department of Medicine, Division of
Allergy and Infectious Diseases; ?Department of
Epidemiology; ?Department of Laboratory
Medicine, University of Washington, Seattle,
Washington; ?GlaxoSmithKline, Triangle Park,
North Carolina; and ∥Fred Hutchinson Cancer
Research Center, University of Washington,
Seattle, Washington.
Background:
The benefit of suppressive antiviral therapy for reducing the risk of
herpes simplex virus (HSV)-2 transmission to sex
partners may be enhanced if persons at high risk
for transmission can be identified.
Objectives:
To determine whether frequency of genital herpes
recurrences is associated with increased risk of
HSV-2 transmission.
Methods:
Analysis of
recurrence frequency and shedding frequency
(subset) among participants in a randomized
controlled trial of valacyclovir 500 mg qd
versus placebo for reducing the risk of HSV-2
transmission.
Results:
Overall, 1484 monogamous
HSV-2-serodiscordant couples participated and 41
HSV-2 transmissions occurred during the 8-month
trial; 40 were able to provide a history of
recurrence frequency. The rate of recurrences
per year before study entry did not differ
between source partners who transmitted and
those who did not, 4.8 versus 5.1, respectively.
Similarly, the mean frequency of recurrences
observed during the study also did not differ
among those who transmitted versus those who did
not for placebo recipients (4.4 vs. 4.8) or
valacyclovir recipients (1.4 vs. 1.3). Among the 40 source partners who transmitted HSV-2, 8 of
27 placebo recipients and 7 of 13 valacyclovir
recipients had no recurrences during the study.
Conclusion:
Clinical assessment of HSV-2
disease severity as defined by the frequency of
genital herpes recurrences does not predict the risk of transmission to sexual partners. Though
patients with frequent recurrences are most
likely to benefit clinically from suppressive therapy, frequency of recurrences is not helpful
in identifying persons who are most likely to
transmit HSV-2.
