美国华盛顿大学医学中心Christine Johnston团队研究了生殖器HSV-1感染后的病毒脱落情况。这一研究成果发表在2022年10月22日出版的《美国医学会杂志》上。

1型单纯疱疹病毒（HSV-1）是许多国家首发生殖器疱疹的主要病因。该研究旨在报道有关生殖器HSV-1传播的咨询信息，评估首发生殖器感染者的口腔和生殖器病毒传播模式。还对HSV特异性抗体和T细胞反应的发展轨迹进行了表征。前瞻性队列随访长达2年，在2013至2018年间随访了82名参与者。参与者来自华盛顿西雅图的性健康和初级保健诊所。研究组招募实验室记录的第一次生殖器HSV-1感染者，均无HIV感染或怀孕。暴露因素为第一次生殖器HSV-1感染。

主要结局为首次生殖器HSV-1感染后2个月、11个月和最多2年，生殖器和口腔HSV-1脱落和损伤率。参与者在诊断出生殖器HSV-1后的2个月和11个月以及2年内，自行收集口腔和生殖器拭子进行HSV聚合酶链反应检测30天。在连续时间点采集血样以评估对HSV-1的免疫应答。使用华盛顿大学HSV Western Blot将原发性HSV-1感染定义为基线时无HSV抗体或抗体谱演变。γ酶联免疫斑点检测HSV特异性T细胞应答。

82名参与者的中位年龄为26岁，54名（65.9%）为女性，42名（51.2%）为原发性HSV-1感染。在2个月时，53名参与者（64.6%）的生殖道和24名参与者（29.3%）的口腔中检测到HSV-1。2个月时2264天中有275天（12.1%）检测到生殖器HSV-1脱落，11个月时显著下降至1719天中有122天（7.1%）（模型预测率，2个月时为6.2%，而11个月为3.2%；相对风险为0.52）。

生殖器损伤很少见，2个月时2497天中有65天（2.6%）发生，11个月时1872天中有72天（3.8%）发生。2个月时，在2247天中有88天（3.9%）检测到口腔HSV-1脱落。与非原发性感染者相比，原发性HSV-1感染者生殖器病毒脱落率更高（模型预测率分别为7.9%与2.9%；相对风险为2.75）。多功能HSV特异性CD4+和CD8+T细胞应答在随访期间得以维持。

研究结果表明，首次感染生殖器HSV-1后，生殖器的HSV-1脱落率高，尤其是在原发感染者中，并且在感染后的第一年内迅速下降。

附：英文原文

Title: Viral Shedding 1 Year Following First-Episode Genital HSV-1 Infection

Author: Christine Johnston, Amalia Magaret, Hyunju Son, Michael Stern, Molly Rathbun, Daniel Renner, Moriah Szpara, Sarah Gunby, Mariliis Ott, Lichen Jing, Victoria L. Campbell, Meei-li Huang, Stacy Selke, Keith R. Jerome, David M. Koelle, Anna Wald

Issue&Volume: 2022-10-22

Abstract:

Importance  Herpes simplex virus type 1 (HSV-1) is the leading cause of first-episode genital herpes in many countries.

Objective  To inform counseling messages regarding genital HSV-1 transmission, oral and genital viral shedding patterns among persons with first-episode genital HSV-1 infection were assessed. The trajectory of the development of HSV-specific antibody and T-cell responses was also characterized.

Design, Setting, and Participants  Prospective cohort followed up for up to 2 years, with 82 participants followed up between 2013 and 2018. Participants were recruited from sexual health and primary care clinics in Seattle, Washington. Persons with laboratory-documented first-episode genital HSV-1 infection, without HIV infection or current pregnancy, were referred for enrollment.

Exposures  First-episode genital HSV-1 infection.

Main Outcomes and Measures  Genital and oral HSV-1 shedding and lesion rates at 2 months, 11 months, and up to 2 years after initial genital HSV-1 infection. Participants self-collected oral and genital swabs for HSV polymerase chain reaction testing for 30 days at 2 and 11 months and up to 2 years after diagnosis of genital HSV-1. Blood samples were collected at serial time points to assess immune responses to HSV-1. Primary HSV-1 infection was defined as absent HSV antibody at baseline or evolving antibody profile using the University of Washington HSV Western Blot. HSV-specific T-cell responses were detected using interferon γ enzyme-linked immunospot.

Results  Among the 82 participants, the median (range) age was 26 (16-64) years, 54 (65.9%) were women, and 42 (51.2%) had primary HSV-1 infection. At 2 months, HSV-1 was detected from the genital tract in 53 participants (64.6%) and in the mouth in 24 participants (29.3%). Genital HSV-1 shedding was detected on 275 of 2264 days (12.1%) at 2 months and declined significantly to 122 of 1719 days (7.1%) at 11 months (model-predicted rate, 6.2% [95% CI, 4.3%-8.9%] at 2 months vs 3.2% [95% CI, 1.8%-5.7%] at 11 months; relative risk, 0.52 [95% CI, 0.29-0.93]). Genital lesions were rare, reported on 65 of 2497 days (2.6%) at 2 months and 72 of 1872 days (3.8%) at 11 months. Oral HSV-1 shedding was detected on 88 of 2247 days (3.9%) at 2 months. Persons with primary HSV-1 infection had a higher risk of genital shedding compared with those with nonprimary infection (model-predicted rate, 7.9% [95% CI, 5.4%-11.7%] vs 2.9% [95% CI, 1.7%-5.0%]; relative risk, 2.75 [95% CI, 1.40-5.44]). Polyfunctional HSV-specific CD4+ and CD8+ T-cell responses were maintained during the follow-up period.

Conclusions and Relevance  Genital HSV-1 shedding was frequent after first-episode genital HSV-1, particularly among those with primary infection, and declined rapidly during the first year after infection.

DOI: 10.1001/jama.2022.19061

Source: https://jamanetwork.com/journals/jama/fullarticle/2797619