Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time

Ann Intern Med. 1999 Jul 6;131(1):14-20. doi: 10.7326/0003-4819-131-1-199907060-00004.


Background: Visits to physicians for genital herpes simplex virus (HSV) infection continue to increase. Most patients with symptomatic infections have recurrences, but no studies of the long-term clinical course of genital herpes are available.

Objective: To determine whether the frequency of HSV recurrences decreases over time.

Design: Observational cohort study.

Setting: University-based research clinic.

Patients: 664 persons with genital herpes followed for at least 14 months.

Measurements: Patients were classified as having initial or recurrent HSV-1 or HSV-2 infection. Patient-reported recurrences and observed recurrences were recorded in a database; more than 12,000 recurrences were analyzed.

Results: Median recurrence rates in the first year of follow-up were one and five per year in patients with newly acquired HSV-1 and HSV-2 infection, respectively; second-year rates were significantly lower in both groups. Patients presenting with recurrent HSV-2 infection had higher rates of recurrence in the first and second years and no significant decrease; significant decreases were detected with longer follow-up. One third of all patients experienced a decrease of two or more recurrences per year between years 1 and 2. Patients infected with HSV-2 who were followed for more than 4 years had a median decrease of two recurrences between years 1 and 5. However, 25% of these patients had an increase of at least one recurrence in year 5, illustrating the variability among HSV-infected persons. Decreases over time among patients who never received suppressive therapy were similar to decreases during untreated periods in patients who received suppressive therapy.

Conclusions: Herpes simplex virus type 2 infection continues to be a chronic remitting illness. Over time, however, clinically significant reductions occur in a majority of patients. Physicians may wish to periodically assess the need for continued treatment with daily suppressive antiviral chemotherapy.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acyclovir / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Herpes Genitalis / drug therapy
  • Herpes Genitalis / virology*
  • Herpesvirus 1, Human / growth & development*
  • Herpesvirus 2, Human / growth & development*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Time Factors
  • Virus Activation*


  • Antiviral Agents
  • Acyclovir