Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men

Background. Previous studies using viral cultures rarely reported herpes simplex virus type 2 (HSV-2) isolation from the mouth. We sought to characterize oral HSV-2 shedding as detected by HSV DNA polymerase chain reaction among HSV-2-seropositive men. Methods. Participants collected daily swabs from oral and anogenital areas for HSV detection with a quantitative polymerase chain reaction assay. Results. A total of 109 HSV-2-seropositive men ( 59 of whom were human immunodeficiency virus [HIV] negative, and 50 of whom were HIV positive) were sampled for a median of 64 consecutive days. Forty-four (40.4%) had HSV-2 detected from oral swabs on at least 1 day. Oral HSV-2 was detected on 148 (2.3%) of 6422 days, genital HSV-2 was detected on 1110 (17%) of 6505 days, oral HSV-1 was detected on 220 (5.5%) of 4018 days, and genital HSV-1 was detected on 88 (2.2%) of 4073 days. Oral HSV- 2 shedding was never associated with an oral lesion, but it was often concurrent with genital HSV- 2 shedding. Both oral and genital HSV- 2 were detected on 90 (61%) of 148 days with oral HSV- 2 shedding. Oral HSV- 2 shedding occurred on 90 (8.2%) of 1110 days with genital HSV- 2 shedding, versus 58 (1.1%) of 5316 days without genital HSV- 2 shedding (P <.001). The HIV-positive men shed HSV- 2 orally more frequently than did the HIV-negative men (odds ratio, 2.7 [95% confidence interval, 1.1-7.1]). Conclusions. Oral HSV-2 reactivation was common (especially among HIV-positive men), was always asymptomatic, and often occurred on days of genital HSV- 2 reactivation.