{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T21:08:52Z","timestamp":1794258532603,"version":"4.9.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"Importance<\/jats:title>Herpes simplex virus type 1 (HSV-1) is the leading cause of first-episode genital herpes in many countries.<\/jats:p><\/jats:sec>Objective<\/jats:title>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.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>First-episode genital HSV-1 infection.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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 \u03b3 enzyme-linked immunospot.<\/jats:p><\/jats:sec>Results<\/jats:title>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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2022.19061","type":"journal-article","created":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T15:30:38Z","timestamp":1666452638000},"page":"1730","source":"Crossref","is-referenced-by-count":47,"title":["Viral Shedding 1 Year Following First-Episode Genital HSV-1 Infection"],"prefix":"10.1001","volume":"328","author":[{"given":"Christine","family":"Johnston","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Washington, Seattle"},{"name":"Departments of Laboratory Medicine and Pathology, University of Washington, Seattle"},{"name":"Vaccine and Infectious Diseases 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