Presented by: Larry Corey. University of Washington, Seattle, WA, USA.

While many studies have utilized polymerase chain reaction (PCR) detection of herpes simplex virus (HSV) DNA to define mucosal reactivation rates in the human genital tract, considerably less information is available on oral–labial reactivation. We have recently reviewed the data on the oral specimens from 238 HSV-seropositive persons who collected oral samples for over 17 300 days.

Among 109 HSV-2-seropositive men (59 HIV–/50 HIV+), 40% had HSV-2 detected from oral swabs on at least 1 day. Oral HSV-2 was detected on 23% of 6422 days, a rate that was 7.4 times less than HSV-2 was detected in genital swabs (17% vs 2.3%). Oral HSV-2 shedding was 2.7 times more frequent in HIV+ vs HIV– men. Oral HSV-2 shedding often accompanied genital HSV-2 shedding, especially in HIV+ men (O.R. 2.7). We have to date sampled 129 HSV-1 and HSV-2+ men (81 HIV–, 47 HIV+) for 11 117 days; HSV-1 was detected on 2.7% of days in HIV– and 5.0% of days in the HIV+ persons. Concomitant rates of genital HSV-1 were 1.4% and 1.9%, respectively, for HIV– and HIV+ persons. Both HSV-1 and HSV-2 were detected in 0.36% of oral samples, dual infections mostly in HIV+ patients.

Conclusions: Oral HSV shedding as detected by PCR is frequent; however, oral labial HSV shedding rates are substantially less than genital HSV-2 shedding rates. Oral HSV-2 shedding may be more common than previously appreciated. Concomitant shedding from oral and genital sites occurs, especially in HIV+ persons.