Viral Shedding Rate Research Articles

The Spectrum of Genital Herpes Simplex Virus Infection in Men Attending a Sexually Transmitted Disease Clinic

The spectrum of genital herpes (GH) has been understudied in men, especially African American men. Consecutive men attending a sexually transmitted diseases clinic were enrolled in a study of GH epidemiology. Consenting participants answered questionnaires detailing their sexual and social activities and underwent serological testing for herpes simplex virus types 1 and 2 (HSV-1 and -2) and collection of genital swabs for viral detection. Of the 516 men enrolled, 465 (90%) were African American. Antibodies to HSV-1 were present in 315 (61%) of participants, and 233 (45%) had antibodies to HSV-2. Factors associated with HSV-2 infection included older age and African American race. HSV was detected in genital swabs from 52 men; 43 (82.7%) swabs were HSV-2 positive, and 9 (17.3%) were HSV-1 positive. The overall viral shedding rate among men (n = 247) with evidence of GH (HSV-1 or HSV-2 infection) was 21.1%, and the asymptomatic shedding rate in this same group was 5.2%. The sensitivities of culture for detection of HSV-1 and HSV-2 were .22 and .58, respectively, compared with that of polymerase chain reaction. Genital HSV infections are common and largely unrecognized among this segment of the population. HSV-1 infection constitutes a nontrivial proportion of GH in these men.

Analysis of Shedding of 3 β‐Herpesviruses in Saliva from Patients with Connective Tissue Diseases

Whether an association exists between infection with beta -herpesviruses and connective tissue diseases remains unclear, as are the mechanisms for the regulation of these infections in the salivary glands. Human herpesvirus (HHV)-7 was isolated and viral DNA was quantified by real-time polymerase chain reaction (PCR) in serially collected saliva samples, to determine whether viral load correlated with infectivity. Then, to examine the role played by beta -herpesviruses in connective tissue diseases, cytomegalovirus, HHV-6, and HHV-7 DNA loads were examined by real-time PCR in serially collected saliva samples from 21 patients with connective tissue diseases. Although subjects with frequent HHV-7 shedding were more likely to have a high viral load than were other subjects, high viral loads were detected in saliva samples from a portion of the subjects with low viral shedding rates. No significant difference between the quantity of HHV-7 DNA in saliva samples from which active virus was isolated and that amplified from samples without detectable virus was observed. Patients with adult-onset Still disease consistently had high HHV-7 DNA loads, in contrast to patients with other connective tissue diseases (P=.0003) and healthy adults (P=.0224). The mean HHV-6 (P=.012) and HHV-7 (P<.0001) DNA loads in patients with connective tissue diseases were lower than those in healthy adults. These data suggest that a number of host factors in patients with adult-onset Still disease may function to accelerate HHV-7 replication in the salivary glands.

Type‐specific screening for asymptomatic herpes infection in pregnancy: a decision analysis

To evaluate the merits of serum screening for herpes simple virus (HSV) in pregnant women with no history of prior HSV infection. Clinical decision analysis. Hypothetical cohort of pregnant women in first trimester with no clinical history of HSV infection. We used decision analysis techniques to compare three strategies for antepartum screening for HSV in women with no history of infection: (1) universal screening; (2) targeted screening in women estimated to be at high risk for infection; and (3) current care (no screening). For the screening strategies, we considered screening at 35 weeks of gestation, with prophylactic antiviral therapy for seropositive women. For all women, we assumed caesarean delivery in the setting of symptomatic infection at delivery. We performed a literature review of English-language publications to derive probability estimates for the rate of HSV seropositivity in asymptomatic pregnant women, and the risks of symptomatic HSV infection and asymptomatic shedding at the time of delivery. We determined the modification of rates of viral shedding, symptomatic lesions and caesarean section with the use of prophylactic suppression therapy for seropositive women based on available data. We chose neonatal herpes with severe sequelae, neonatal death, as well as caesarean delivery as clinically relevant outcomes. Number of cases of neonatal death, neonatal HSV with severe sequelae, neonatal HSV with moderate sequelae, patients screened, patients treated and caesarean section with each strategy. Universal maternal screening reduced the total number of deaths and severe sequelae secondary to neonatal HSV. Universal screening required treatment of 3849 women to prevent one case of neonatal death or disease with severe sequelae from HSV. Targeted screening of high risk women treatment of 2277 women to prevent one death or case of severe disease. Universal screening reduced the rate of neonatal HSV attributable to recurrent HSV by 79.3%. Caesarean delivery was reduced with both screening strategies. We used one-way sensitivity analyses to evaluate the robustness of our model. Maternal screening reduced the number of cases of neonatal HSV. Screening also reduced the rate of caesarean delivery. However, employing universal screening will likely result in a significant expenditure of medical resources because the number needed to treat to avert a single case of neonatal herpes is high.

Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome

SummarySevere acute respiratory syndrome (SARS) is thought to be caused by a novel coronavirus, SARS-associated coronavirus. We studied viral shedding of SARS coronavirus to improve diagnosis and infection control. Reverse-transcriptase PCR was done on 2134 specimens of different types. 355 (45%) specimens of nasopharyngeal aspirates and 150 (28%) of faeces were positive for SARS coronavirus RNA. Positive rates peaked at 6–11 days after onset of illness for nasopharyngeal aspirates (87 of 149 [58%], to 37 of 62 [60%]), and 9–14 days for faeces (15 of 22 [68%], to 26 of 37 [70%]). Overall, peak viral loads were reached at 12–14 days of illness when patients were probably in hospital care, which would explain why hospital workers were prone to infection. Low rate of viral shedding in the first few days of illness meant that early isolation measures would probably be effective.

Genetic characterization of viral quasispecies in blood and cervical secretions of HIV-1- and HIV-2-infected women.

We evaluated cervical samples from 11 HIV-1- and 25 HIV-2-infected individuals. The rate of viral shedding was 36.4% for HIV-1 and 16% for HIV-2, after repeat PCRs. We sequenced multiple clones of the C2-C3 env region from cervical secretions and PBMC samples from three HIV-2-infected individuals, and the C2-V3 env region from four HIV-1-infected individuals. In most cases, phylogenetic analysis showed that the viral sequences from blood and genital secretions were intermingled and subclusters did not segregate according to sample site. In rare cases, however, tissue-specific sequences were observed, suggesting a complex relationship between quasispecies in the two sites where preferential transmission of HIV variants may be due to multiple factors.

A Randomized, Placebo-Controlled Trial of Oral Acyclovir for the Prevention of Cytomegalovirus Disease in Recipients of Renal Allografts

Cytomegalovirus is a major viral pathogen in patients who undergo renal transplantation, and cytomegalovirus disease is difficult to treat. We therefore conducted a randomized, placebo-controlled, double-blind trial of acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts from cadavers. Acyclovir was given orally in doses of 800 to 3200 mg per day, according to the patients' estimated level of renal function. Patients took the first dose of either acyclovir or placebo six hours before transplantation and continued to take the assigned medication for 12 weeks. Of 118 patients enrolled in the study, 104 completed at least 30 days on the study medication and were included in our analysis of the results. During the first year after transplantation, 4 of 53 patients (7.5 percent) in the acyclovir group had symptomatic cytomegalovirus disease, as compared with 15 of 51 (29 percent) in the placebo group (P = 0.002). There was a single case of cytomegalovirus pneumonia in the acyclovir group, as compared with nine in the placebo group. The greatest prophylactic benefit of acyclovir was observed among seronegative patients who had received a kidney from a seropositive donor; only one of six such patients in the acyclovir group had cytomegalovirus disease, as compared with all seven in the placebo group. Acyclovir decreased the incidence of documented cytomegalovirus infection (with or without symptomatic disease) to 36 percent from 61 percent among the patients who received the placebo (P = 0.011). Among the patients who received acyclovir, the rates of recovery of virus from the blood and urine were significantly reduced, but the rate of viral shedding from the pharynx was not significantly different from that in the placebo group. There were no differences between the groups in the frequency of adverse events or in the rate of survival of either grafts or patients. We conclude that the oral administration of acyclovir, beginning before the transplantation of a renal allograft from a cadaver, reduces the rate of cytomegalovirus infection and disease without affecting the survival rate of either grafts or patients.

Shedding of herpes simplex virus type 1 into saliva.

The shedding of herpes simplex virus Type 1 (HSV-1) into saliva was studied in 110 healthy individuals, 55 patients who were undergoing oral surgery, and 21 immunocompromised patients in an asymptomatic Japanese population. Specimens were collected regularly for up to 2 months from each individual. Virus was recovered on at least one occasion from 4.5% of the healthy individuals, 20% of the patients undergoing oral surgery and 38% of the immunocompromised patients. In those individuals that shed virus, the duration of shedding varied from a mean of 1.2 days in the healthy individuals to 5.8 days in patients undergoing oral surgery, and was 3 days in the immunocompromised patients. The majority of oral surgery patients shed HSV-1 into saliva within 7 days after surgery and immunocompromised patients shed virus almost continuously. The role of surgery in triggering the reactivation of latent HSV-1, and the differences in rates of viral shedding between American and Japanese are discussed.

Group day care and cytomegaloviral infections of mothers and children.

Cytomegalovirus (CMV), the leading cause of congenital viral infection, occurs commonly among children in group day care. Urinary or salivary excretion of CMV was found frequently among children in three centers serving mostly middle-income white families. Although there was center-to-center variation, CMV excretion was uncommon among infants under one year of age; peak rates of viral shedding, ranging from 44% to 100%, were noted for two-year-olds. A longitudinal study at a single center indicated that children usually acquired CMV during their second year of life and usually shed virus for two years or longer. The high prevalence of silent CMV infection among the children in day care argues against the exclusion of any child known to have CMV infection; such children have sometimes been excluded because of the potential risk of CMV transmission to pregnant workers.