Skip Navigation LinksHome > February 2003 - Volume 30 - Issue 2 > Natural History of Genital Herpes Simplex Virus Type 1 Infec...
Sexually Transmitted Diseases:
Article

Natural History of Genital Herpes Simplex Virus Type 1 Infection

ENGELBERG, REBECCA BA*; CARRELL, DAVID PhD*; KRANTZ, ELIZABETH MS*; COREY, LAWRENCE MD*†§; WALD, ANNA MD, MPH*†‡

Free Access
Article Outline
Collapse Box

Author Information

From the Departments of *Laboratory Medicine, †Medicine, and ‡Epidemiology, University of Washington, and §Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington

Supported by a grant from the National Institutes of Health (no. AI-30731).

Reprint requests: Anna Wald, MD, MPH, University of Washington Virology Research Clinic, 600 Broadway, Suite 400, Seattle, WA 98122. E-mail: annawald@u.washington.edu

Received March 27, 2002,

revised June 5, 2002, and accepted June 6, 2002.

Collapse Box

Abstract

Background: Herpes simplex virus type 1 (HSV-1) has been increasingly reported as a cause of genital herpes, yet there have been few studies on the long-term natural history of this infection.

Goal: The goal was to examine the clinical course of genital HSV-1 infection.

Study Design: This was a cohort study of patients presenting with culture-proven primary genital HSV-1 infection.

Results: The median follow-up of the 77 patients was 736 days. The overall rate of recurrences was 1.3/year in the first year of infection, decreasing to 0.7/year in the second year. In the first year of infection, 43% of study patients did not have a recurrence. In the second year of infection, 67% of study patients did not have a recurrence.

Conclusion: Genital HSV-1 recurs infrequently in most patients, and the rate decreases further in the subsequent years of infection. Because the prognoses of genital HSV-1 and HSV-2 infections differ, determination of the viral type is important for patient counseling.

GENITAL HERPES INFECTIONS are among the most prevalent sexually transmitted infections in the United States. 1 Recent data from the United States, Europe, and Asia show a shift from predominantly HSV-2 as a main cause to a large proportion of genital herpes caused by HSV-1 infection. 2–4 Several studies have shown that recurrence rates for genital HSV-1 after acquisition of infection are lower than recurrence rates for genital HSV-2. 5,6 However, these studies involved small numbers of persons followed for a limited time. In this article, we report on a cohort of patients with documented primary genital HSV-1 who were followed for a median of 2 years from acquisition of genital herpes.

Back to Top | Article Outline

Methods

Patients and Setting

We reviewed the records of patients with documented primary genital HSV-1 infection seen at the University of Washington Virology Research Clinic (VRC), in Seattle, between November 1975 and July 2000. Patients included in the study had an observed first episode of infection, HSV-1 isolated from the genital region, no serologic or other evidence of HSV-2 infection, and at least 6 months of follow-up. HSV Western blotting was used to document HSV-1 antibody status. 7 Only patients with documented primary genital HSV-1 infection, defined as newly acquired HSV-1 infection in persons without prior antibody to HSV, were included. Viral isolation was performed as previously described, and all isolates were typed with monoclonal antibodies. 8

Back to Top | Article Outline
Data Collection and Statistical Methods

At each clinic visit, information regarding onset and resolution date of recurrence, details of clinical examination during the visit, and treatment were noted on a standardized data form. Data on timing of intercurrent episodes were also collected on each visit. Patient-reported data were used in conjunction with clinician observations to establish episode frequency. Episode duration data are based on clinician-observed episodes only.

We defined an episode of genital HSV-1 as the presence of herpes lesions in the genital region or other sites below the waist. Episode duration was defined as the number of days from the first appearance of lesions to complete reepithelialization. An episode was considered to be culture-positive if virus was isolated from at least one specimen during the episode. If new lesions appeared before complete healing of other lesions, all were considered part of the same episode. Time to first recurrence was defined as the number of days from complete clearing of the primary HSV-1 infection to the first appearance of signs or symptoms of the next episode. 6

Recurrence rates per person-year were calculated for the first, second, and combined third through fifth years following primary infection. The minimum required time of follow-up for inclusion in the year 1 rate calculation was 6 months, and the minimum follow-up required for inclusion in the year 2 rate was 100 days in the second year of infection (i.e., ≥465 days). Recurrence rates were calculated as the sum of all recurrences for all persons meeting the minimum follow-up requirements for a given time period, divided by the sum of all follow-up days for the same group of persons during the same time period, expressed in person-years. For calculations of duration of episodes, the duration was averaged for each person; person means were then used to calculate group statistics. Poisson models were used to calculate relative risks for recurrences by year of follow-up, age, and gender.

Back to Top | Article Outline

Results

Seventy-seven patients presenting with primary HSV-1 met all study inclusion criteria. The participants included 48 women (62%), and 71 (92%) patients were white (Table 1). The median age at onset of primary genital herpes was 23 years (range, 17–46). The median duration of follow-up was 736 days (interquartile range [IQR]: 426–1337). All 77 patients were followed for at least 6 months, and 54 patients were followed for at least the first 100 days in year 2.

Table 1
Table 1
Image Tools
Back to Top | Article Outline
Recurrence Rates

The median time to first recurrence was 280 days, with a median of 195 days among women and 567 days among men (Table 2 and Figure 1). Overall, we noted 179 recurrent episodes during follow-up. The rate of recurrences was 1.30 per year in the first year of infection, decreasing to 0.70 per year in the second year (Table 2). However, in both years the rate was higher for women (1.63 and 0.94) than for men (0.76 and 0.33). In the first year of infection, 43% of all patients had no recurrences, 30% had 1 recurrence, and 27% had 2 or more recurrences (Figure 2). In the second year of infection, 67% of patients had no recurrences, 19% had 1 recurrence, and 15% had 2 or more recurrences. A propensity for recurrences appeared to persist in some persons during follow-up. Of the 29 patients who experienced a recurrence in the first year of infection and were followed for at least 100 days into year 2, 15 (52%) also reported a recurrence in the second year. Among the 54 patients followed for at least 2 years, only 6 patients (11%) had 2 or more recurrences in both the first and the second year of infection, and only 1 patient (2%) had 4 or more recurrences in both years. Conversely, among patients followed for 2 years, 22 (88%) of the 25 who were recurrence-free in year 1 were also recurrence-free in year 2. Longer follow-up in a small subset of patients showed that frequent recurrences many years after infection are possible but rare: 11 of 23 patients followed into the 4th year reported a recurrence in that year, with 8 reporting a single recurrence and 1 each reporting 2, 3, and 4 recurrences.

Table 2
Table 2
Image Tools
Fig. 1
Fig. 1
Image Tools
Fig. 2
Fig. 2
Image Tools

In multivariate analysis, the risk of having a recurrence in year 2 was 0.54 (95% CI, 0.36–0.82), compared with the risk of having a recurrence in year 1, controlling for the effects of gender (Table 3). In both year 1 and year 2, women were at greater risk of having a recurrence than were men, with an adjusted relative risk of 2.29 (95% CI, 1.30–4.04). In an analysis confined to 44 patients who had one or more recurrences in year 1, the adjusted relative risk of recurrence in year 2 was 0.49 (95% CI, 0.32–0.76), and women again were at greater risk of having a recurrence, with an adjusted relative risk of 1.78 (CI, 1.19–2.68). Acyclovir therapy for primary genital herpes was administered to 50 (75%) of the 67 patients for whom treatment data are available; the time to first recurrence did not differ for treated versus untreated patients (data not shown).

Table 3
Table 3
Image Tools

Because patients were followed for varying periods of time beyond our 6-month eligibility criterion, we tested for selection bias by comparing the year 1 recurrence rate reported for all patients with the year 1 recurrence rate for patients with at least 100 days of follow-up in year 2. The year 1 recurrence rate for 54 patients followed for ≥100 days in year 2 was similar to the rate for all patients: 1.20 versus 1.30, respectively. The gender distribution between these two groups is also similar (61% versus 62% women, respectively). However, the year 1 recurrence rate for patients followed into the third year is somewhat higher than the rate for all patients (1.51 versus 1.30 recurrences per year, respectively), suggesting that people with more frequent recurrences were more likely to have follow-up beyond 2 years.

Back to Top | Article Outline
Duration of Recurrences

The median duration of the 147 recurrences observed in the clinic, experienced by 44 patients, was 7.0 days (IQR, 5.9–8.9), which is similar to the median recurrence duration of 8.5 days (IQR, 7.0–11.0) observed for 205 persons with genital HSV-2 infection followed in the same manner (unpublished data from Benedetti 6). One or more viral culture specimens were collected during 121 (67.6%) of the 179 recurrent episodes in this cohort. Fifty-six (46.3%) of these episodes were culture-positive, which is comparable to the culture-positivity rate for HSV-2 recurrences.

Back to Top | Article Outline
Nongenital Recurrences

The 179 recurrent episodes included 174 (97%) with genital lesions and 5 (3%) of buttock or leg/hip lesions. The 5 recurrences involving only nongenital lesions (2 on the buttock and 3 in the leg/hip area) were experienced by 2 people. The two buttock episodes were the first and third of 7 recurrences in 3.7 years of follow-up for a 28-year-old woman. Her primary infection and fourth and fifth episodes also involved buttock lesions, but they were secondary to genital lesions. The three leg/hip episodes were the first, second, and fourth of 4 recurrences in 1.1 years of follow-up for a 29-year-old man whose primary infection also involved secondary leg/hip lesions.

Back to Top | Article Outline

Discussion

This study, involving the largest cohort of persons with genital HSV-1, indicates the relatively mild natural history of genital HSV-1 infection. Our study showed that genital HSV-1 recurs infrequently and that the rate of recurrences decreases rapidly over time, with a median recurrence rate declining by about 50% from the first to the second year of infection.

Our data support previous findings that patients with genital HSV-1 are less likely to experience recurrences than patients with genital HSV-2. 9–12 With use of the same definitions and study procedures, the recurrence rate for genital HSV-1 during the first year of infection was about 20% of the recurrence rate reported for genital HSV-2 infection in the first year of infection. Furthermore, the rapid decrease in the frequency of recurrences between the first and second year of infection contrasts with the slow decline in HSV-2 recurrence rates, a decline that does not become apparent until 3 to 5 years after primary infection. 6 This site-specific tropism of HSV-1 versus HSV-2 reactivation in the oral and genital area has also been noted in animal models of infection. 13 Despite the lower rate of reactivation of genital HSV-1 infection, reported both for symptomatic recurrences and asymptomatic shedding, the duration of episodes is similar to that for HSV-2. This implies that the mechanism controlling reactivation of HSV in the genital area is particular to the viral type, while the mucosal events that occur after symptomatic reactivation are independent of the viral type.

In both years 1 and 2 following primary genital HSV-1 infection, men were at lower risk of having a recurrence than were women. It is possible that men were less likely to visit a clinic or to report recurrences than were women. However, the proportion of men in the cohort remained constant in subgroups of patients with at least 180, 465, and 730 days of follow-up, suggesting that adherence to clinic visits was not the source of the gender difference.

The varying amounts of follow-up in our cohort may have overestimated the recurrence rates if patients ceased to return to the clinic when they no longer experienced recurrences. Conversely, patients who did not experience a decrease in recurrences may also have stopped attending the clinic. A comparison of recurrence rates for subgroups of patients with at least 1, 2, and 3 years of follow-up suggested that patients with fewer recurrences may have been less likely to continue clinic visits. These effects are unlikely to alter the marked difference in recurrence rates between HSV-1 and HSV-2.

These data indicate that clinical strategies for genital HSV-1 should differ from those for HSV-2. Few if any of our patients with genital HSV-1 meet current criteria for suppressive antiviral therapy. Data reported here indicate episodic antiviral therapy for recurrent episodes may be more appropriate for patients with genital HSV-1. Because the prognoses of genital HSV-1 and HSV-2 infections differ greatly, knowing the viral type is important for prognosis, treatment, and patient counseling. Thus, all patients with genital herpes should know which viral subtype causes their lesions.

Back to Top | Article Outline

References

1. Cates W. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sex Transm Dis 1999; 14: 679–689.

2. Lafferty WE, Downey L, Celum C, Wald A. Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis 2000; 181: 1454–1457.

3. Lavery HA, Connolly JH, Russell JD. Incidence of herpes genitalis in Northern Ireland: 1973–83 and herpes simplex types 1 and 2 isolated 1982–4. Genitourin Med 1986; 62: 24–27.

4. Cheong WK, Thirumoorthy T, Doraisingham S, Ling AE. Clinical and laboratory study of first episode genital herpes in Singapore. Int J STD AIDS 1990; 1: 195–198.

5. Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med 1994; 121: 847–854.

6. Benedetti J, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med 1999; 131: 14–20.

7. Ashley RL, Militoni J, Lee F, Nahmias A, Corey L. Comparison of Western blot (immunoblot) and glycoprotein G-specific immunodot enzyme assay for detecting antibodies to herpes simplex virus types 1 and 2 in human sera. J Clin Microbiol 1988; 26: 662–667.

8. Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L. Recurrences after oral and genital herpes simplex virus infection: influence of site of infection and viral type. N Engl J Med 1987; 316: 1444–1449.

9. Koelle DM, Benedetti J, Langenberg A, Corey L. Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes. Ann Intern Med 1992; 116: 433–437.

10. Reeves WC, Corey L, Adams H, Vontver LA, Holmes KH. Risk of recurrence after first episodes of genital herpes: relation to HSV type and antibody response. N Engl J Med 1981; 305: 315–319.

11. Corey L, Mindel A, Fife K, Sutherland S, Benedetti J, Adler MW. Risk of recurrence after treatment of first-episode genital herpes with intravenous acyclovir. Sex Transm Dis 1985; 12: 215–218.

12. Mindel A, Weller IV, Faherty A, Sutherland S, Fiddian AP, Adler MW. Acyclovir in first attacks of genital herpes and prevention of recurrences. Genitourin Med 1986; 62: 28–32.

13. Lekstrom-Himes JA, Pesnicak L, Straus SE. The quantity of latent viral DNA correlates with the relative rates at which herpes simplex virus types 1 and 2 cause recurrent genital herpes outbreaks. J Virol 1998; 72: 2760–2764.

Cited By:

This article has been cited 39 time(s).

Seminars in Respiratory and Critical Care Medicine
DNA Viral Infections Complicating Lung Transplantation
Clark, NM; Lynch, JP; Sayah, D; Belperio, JA; Fishbein, MC; Weigt, SS
Seminars in Respiratory and Critical Care Medicine, 34(3): 380-404.
10.1055/s-0033-1348473
CrossRef
Annual Review of Medicine
Herpes simplex: Insights on pathogenesis and possible vaccines
Koelle, DM; Corey, L
Annual Review of Medicine, 59(): 381-395.
10.1146/annurev.med.59.061606.095540
CrossRef
Journal of Infectious Diseases
The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic
Sizemore, JM; Lakeman, F; Whitley, R; Hughes, A; Hook, EW
Journal of Infectious Diseases, 193(7): 905-911.

Jama-Journal of the American Medical Association
Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States
Xu, FJ; Sternberg, MR; Kottiri, BJ; McQuillan, GM; Lee, FK; Nahmias, AJ; Berman, SM; Markowitz, LE
Jama-Journal of the American Medical Association, 296(8): 964-973.

Diagnostic Microbiology and Infectious Disease
Reconsideration of viral protein immunoblotting for differentiation of human herpes simplex viruses
Bowles, RN; Yedowitz, JC; Blaho, JA
Diagnostic Microbiology and Infectious Disease, 62(2): 167-176.
10.1016/j.diagmicrobio.2008.06.005
CrossRef
Journal of Clinical Microbiology
Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States
Pena, KC; Adelson, ME; Mordechai, E; Blaho, JA
Journal of Clinical Microbiology, 48(1): 150-153.
10.1128/JCM.01336-09
CrossRef
Lancet
Sexually transmissible infections other than HIV
Donovan, B
Lancet, 363(): 545-556.

International Journal of Std & AIDS
Audit of the management of genital herpes simplex infection
Matin, RN; Brady, M; Poulton, M
International Journal of Std & AIDS, 17(): 851-853.

Pediatric Emergency Care
Update on Sexually Transmitted Infections, 2008
Akhter, S; Beckmann, K; Gorelick, M
Pediatric Emergency Care, 25(9): 608-615.

Journal of Pediatrics
Rethinking herpes simplex virus infections in children and adolescents
Gutierrez, KM
Journal of Pediatrics, 151(4): 336-338.
10.1016/j.jpeds.2007.05.052
CrossRef
Sexually Transmitted Infections
Genital herpes
Geretti, AM
Sexually Transmitted Infections, 82(): 31-34.
10.1136/sti.2006.023200
CrossRef
Sexually Transmitted Diseases
Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students
Roberts, CM; Pfister, JR; Spear, SJ
Sexually Transmitted Diseases, 30(): 797-800.
10.1097/01.OLQ.0000092387.58746.C7
CrossRef
Sexually Transmitted Infections
The epidemiology of genital infection with herpes simplex virus types 1 and 2 in genitourinary medicine attendees in inner London
Ramaswamy, M; McDonald, C; Sabin, C; Tenant-Flowers, M; Smith, M; Geretti, AM
Sexually Transmitted Infections, 81(4): 306-308.
10.1136/sti.2004.011643
CrossRef
Sexually Transmitted Infections
Epidemiology of recurrent genital herpes simplex virus types 1 and 2
Solomon, L; Cannon, MJ; Reyes, M; Graber, JM; Wetherall, NT; Reeves, WC
Sexually Transmitted Infections, 79(6): 456-459.

Lancet
Genital herpes
Gupta, R; Warren, T; Wald, A
Lancet, 370(): 2127-2137.

Infectious Disease Clinics of North America
Counseling the patient who has genital herpes or genital human papillomavirus infection
Warren, T; Ebel, C
Infectious Disease Clinics of North America, 19(2): 459-+.
10.1016/j.idc.2005.03.011
CrossRef
Expert Opinion on Pharmacotherapy
Genital herpes: antiviral therapy a for symptom relief and prevention of transmission
Gupta, R; Wald, A
Expert Opinion on Pharmacotherapy, 7(6): 665-675.
10.1517/14656566.7.6.665
CrossRef
Clinical and Vaccine Immunology
Rapid, sensitive, and specific lateral-flow immunochromatographic point-of-care device for detection of herpes simplex virus type 2-specific immunoglobulin G antibodies in serum and whole blood
Laderman, EI; Whitworth, E; Dumaual, E; Jones, M; Hudak, A; Hogrefe, W; Carney, J; Groen, J
Clinical and Vaccine Immunology, 15(1): 159-163.
10.1128/CVI.00218-07
CrossRef
Journal of Virological Methods
Rapid isolation of HSV-1 and HSV-2 from OneSwab (R) cervicovaginal specimens
Pena, KC; Adelson, ME; Mordechai, E; Blaho, JA
Journal of Virological Methods, 159(2): 146-151.
10.1016/j.jviromet.2009.03.014
CrossRef
Current Opinion in Investigational Drugs
Vaccines for herpes simplex virus infections
Koelle, DM
Current Opinion in Investigational Drugs, 7(2): 136-141.

Cleveland Clinic Journal of Medicine
Managing genital herpes infections in pregnancy
Gardella, C; Brown, ZA
Cleveland Clinic Journal of Medicine, 74(3): 217-224.

Sexually Transmitted Diseases
Factors predicting the acceptance of herpes simplex virus type 2 antibody testing among adolescents and young adults
Zimet, GD; Rosenthal, SL; Fortenberry, JD; Brady, RC; Tu, WZ; Wu, JW; Bernstein, DI; Stanberry, LR; Stone, KM; Leichliter, JS; Fife, KH
Sexually Transmitted Diseases, 31(): 665-669.
10.1097/01.olq.0000143089.77493.c2
CrossRef
Disease Management & Health Outcomes
Management of genital herpes - Defining the role of valaciclovir
Wagstaff, AJ; Keam, SJ; Figgitt, DP
Disease Management & Health Outcomes, 12(2): 103-120.

Emergency Medicine Clinics of North America
Management of oral and genital herpes in the emergency department
Mell, HK
Emergency Medicine Clinics of North America, 26(2): 457-+.
10.1016/j.emc.2008.02.001
CrossRef
Journal of Clinical Virology
Famciclovir treatment options for patients with frequent outbreaks of recurrent genital herpes: The RELIEF trial
Bartlett, BL; Tyring, SK; Fife, K; Gnann, JW; Hadala, JT; Kianifard, F; Berber, E
Journal of Clinical Virology, 43(2): 190-195.
10.1016/j.jcv.2008.06.004
CrossRef
American Journal of Transplantation
Herpes Simplex Virus Infections in Solid Organ Transplant Recipients
Zuckerman, R; Wald, A
American Journal of Transplantation, 9(): S104-S107.
10.1111/j.1600-6143.2009.02900.x
CrossRef
Scandinavian Journal of Infectious Diseases
Sexually transmitted herpes simplex viruses
Jonsson, MK; Wahren, B
Scandinavian Journal of Infectious Diseases, 36(2): 93-101.
10.1080/00365540310018905
CrossRef
Sexually Transmitted Infections
Changing epidemiology of genital herpes simplex virus infection in Melbourne, Australia, between 1980 and 2003
Tran, T; Druce, JD; Catton, MC; Kelly, H; Birch, CJ
Sexually Transmitted Infections, 80(4): 277-279.
10.1136/sti.2004.009753
CrossRef
Sexually Transmitted Infections
Genital HSV-1 infections
Wald, A
Sexually Transmitted Infections, 82(3): 189-190.
10.1136/sti.2006.019935
CrossRef
Expert Opinion on Pharmacotherapy
Famciclovir for the treatment of recurrent genital herpes: a clinical and pharmacological perspective
Vinh, DC; Aoki, FY
Expert Opinion on Pharmacotherapy, 7(): 2271-2286.
10.1517/14656566.7.16.2271
CrossRef
American Journal of Perinatology
Maternal and Neonatal Herpes Simplex Virus Infections
Pinninti, SG; Kimberlin, DW
American Journal of Perinatology, 30(2): 113-119.
10.1055/s-0032-1332802
CrossRef
American Journal of Transplantation
Herpes Simplex Virus in Solid Organ Transplantation
Wilck, MB; Zuckerman, RA
American Journal of Transplantation, 13(): 121-127.
10.1111/ajt.12105
CrossRef
American Journal of Transplantation
Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV) in Solid Organ Transplant Patients
Zuckerman, RA; Limaye, AP
American Journal of Transplantation, 13(): 55-66.
10.1111/ajt.12003
CrossRef
Obstetrics & Gynecology
Genital Herpes Complicating Pregnancy
Brown, ZA; Gardella, C; Wald, A; Morrow, RA; Corey, L
Obstetrics & Gynecology, 106(4): 845-856.
10.1097/01.AOG.0000180779.35572.3a
PDF (559) | CrossRef
The Journal of Perinatal & Neonatal Nursing
Living With Genital Herpes: How Effective Is Antiviral Therapy?
Roe, VA
The Journal of Perinatal & Neonatal Nursing, 18(3): 206-215.

PDF (88)
Sexually Transmitted Diseases
Trends in Herpes Simplex Virus Type 1 and 2 Infections Among Patients Diagnosed With Genital Herpes in a Finnish Sexually Transmitted Disease Clinic, 1994–2002
Kortekangas-Savolainen, O; Vuorinen, T
Sexually Transmitted Diseases, 34(1): 37-40.
10.1097/01.olq.0000222725.81045.62
PDF (187) | CrossRef
Sexually Transmitted Diseases
Herpes Simplex Virus Type 1 Remains the Principal Cause of Initial Anogenital Herpes in Edinburgh, Scotland
MANAVI, K; MCMILLAN, A; OGILVIE, M
Sexually Transmitted Diseases, 31(5): 322-324.

PDF (838)
Sexually Transmitted Diseases
Duplex Real-Time Polymerase Chain Reaction Assay for Detection and Quantification of Herpes Simplex Virus Type 1 and Herpes Simplex Virus Type 2 in Genital and Cutaneous Lesions
FILÉN, F; STRAND, A; ALLARD, A; BLOMBERG, J; HERRMANN, B
Sexually Transmitted Diseases, 31(6): 331-336.

PDF (276)
Sexually Transmitted Diseases
Suppressive Therapy With Valacyclovir in Early Genital Herpes: A Pilot Study of Clinical Efficacy and Herpes-Related Quality of Life
Handsfield, HH; Warren, T; Werner, M; Phillips, JA
Sexually Transmitted Diseases, 34(6): 339-343.
10.1097/01.olq.0000243620.13718.56
PDF (281) | CrossRef
Back to Top | Article Outline

© Copyright 2003 American Sexually Transmitted Diseases Association

Login