Reinfection is an uncommon occurrence in patients with symptomatic recurrent genital herpes

O. W. Schmidt, K. H. Fife, L. Corey

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Restriction endonuclease digestion of viral DNA has been demonstrated to be a sensitive technique for typing and for detecting different strains from the two subtypes of herpes simplex virus (HSV) [1-4]. Buchman et al. described two patients (of eight studied) from whom genital HSV-2 isolates obtained 3 and 10 months apart varied in their Kpn-1 digestion patterns, an observation which suggests that these two patients had acquired exogenous reinfection with a new viral strain [1]. To evaluate the frequency of exogenous reinfection among patients with frequently recurring symptomatic genital herpes, we subjected sequentially obtained isolates to restriction endonuclease digestion. In order to optimize the likelihood of demonstrating exogenous reinfection with new strains of HSV, we selected for analysis only those patients in whom reinfection occurred and who also reported new sex partners during the interval between obtaining the sequential HSV isolates. Twenty-three patients whose first genital HSV isolate was obtained during their acute episode of primary genital herpes (19 with HSV-2 and 4 with HSV-1) and 22 patients with a history of recurrent genital ulcerations (recurrent genital HSV-2 infection) were analyzed. Forty-three of the 45 patients were white, all were heterosexual, their median age was 28 years, and 24 were women. During the study period the contraceptive method used by either the patient or sex partner was the intrauterine device in 50%, oral contraceptive in 25%, and foam and/or condoms in 25%. Restriction endonucleases were purchased from Bethesda Research Laboratories (Bethesda, Md) and digestions carried out under the conditions specified by the supplier [3]. Each isolate was digested with at least four enzymes (mean 5.4, range 4-11). At least one restriction enzyme that cleaved outside the inverted repeat region was used for each isolate [4]. The enzymes used and the percentages of isolates subjected to digestion by each enzyme included Hpa-1 (100%), Bam H-1 (100%), Sal-1 (78%), Kpn-1 (89%), Bgl-2 (58%), Pvu-2 (38%), Hind-3 (16%), EcoR-1 (11%), Xho-1 (9%), Pst-1 (9%). Bal-1 (9%), One-hundred fifty-two HSV isolates were examined; 67 vulvar, 13 cervical, 68 penile, 2 lip, and 2 buttock isolates (table). The mean number of isolates examined per patient was 3.4. Isolates were examined from the same anatomic sites in all 45 patients and from separate anatomic sites in seven patients (cervix and vulva in five, lip and vulva in one, and buttocks and penis in one). The mean number of months between the first and last isolate examined was 14.9 among patients followed after their first episode and 22.5 among those who presented with recurrent genital herpes. The mean number of recurrences between the isolates was 6.8 in patients with first episode and 13.5 in those with recurrent genital herpes. Patients with recurrent genital herpes reported a mean value of 2.8 new sex partners, and those with first episode disease had 2.0 new sex partners during the interval between examination of the isolates. Twenty percent of these new sex partners were reported to have genital herpes; overall, 33% of the patients with recurrent genital herpes and 17% of those with first-episode primary genital herpes were exposed to new sex partners who reported genital herpes to them. The first genital HSV isolate was different in each of the 45 patients by restriction endonuclease analysis. In contrast, all isolates obtained from the same patients were similar, i.e., no sequentially obtained isolates in any individual patient demonstrated a loss or gain of a restriction endonuclease site with any of the enzymes. In the Bam H-1 digest, small differences in the migration pattern of the terminal and subterminal fragments (z and a' fragments) were observed in five patients (three male and two female). These variations were observed in one of six external genital isolates in two patients, one of three vulvar isolates in one patient, and in two of five genital isolates in another two patients. One male who demonstrated a slight difference in the migration pattern between two penile isolates in the Bam H-1 digestion also showed a similar variation in the same region with the enzyme Sal-1.

Original languageEnglish (US)
Pages (from-to)645-646
Number of pages2
JournalJournal of Infectious Diseases
Issue number4
StatePublished - Jan 1 1984
Externally publishedYes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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