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Timothy Schacker, MD; Alexander J. Ryncarz, PhD; James Goddard; Kurt Diem; Mary Shaughnessy, RN; Lawrence Corey, MD

JAMA. 1998;280:61-66.

Context.— Genital ulcer disease has been epidemiologically linked as a risk factor in the transmission of the human immunodeficiency virus 1 (HIV-1). While herpes simplex virus 2 (HSV-2) is the most common cause of genital ulcers, no study has systematically evaluated the frequency or titer of HIV-1 virus in HSV-2 lesions.

Objective.— To compare lesional HIV-1 RNA levels during and after genital HSV-2 reactivation and to evaluate the frequency, titer, and duration of HIV-1 RNA shedding in lesions due to HSV-2.

Design.— Convenience sample.

Setting.— Sexually transmitted disease research clinic at the University of Washington, Seattle.

Patients.— Twelve HIV-infected men with a history of symptomatic HSV-2 infection who underwent daily sampling of genital lesions for HIV-1 RNA by polymerase chain reaction assay and HSV-2 by culture.

Main Outcome Measure.— Detection of lesional HIV RNA and HSV-2.

Results.— HIV-1 RNA was detected from lesional swabs in 25 of 26 consecutively studied HSV-2 episodes and on 67% of days in which genital lesions were noted. The HIV-1 RNA titers in lesional swabs exceeded 10000 copies/mL of swab sample in 75% of samples (range, 2.2-3.2x10⁵ copies/mL of swab sample). HIV-1 RNA in genital lesion swabs was seen in persons with high and low titers of plasma HIV-1 RNA and was not associated with plasma HIV-1 RNA levels.

Conclusions.— HIV-1 virions can consistently be detected in genital ulcers caused by HSV-2, which suggests that genital herpes infection likely increases the efficiency of the sexual transmission of HIV-1.

From the Departments of Medicine (Drs Schacker and Corey) and Laboratory Medicine (Drs Ryncarz and Corey, Messrs Goddard and Diem, and Ms Shaughnessy), University of Washington, and the Program in Infectious Diseases, Fred Hutchinson Cancer Research Center (Drs Ryncarz and Corey), Seattle, Wash. Dr Schacker is now with the Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis.

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