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Obstetrics & Gynecology 2006;108:947-952
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Isolation of Herpes Simplex Virus From the Genital Tract During Symptomatic Recurrence on the Buttocks

Katrina Kerkering, MD2, Carolyn Gardella, MD, MPH4, Stacy Selke, MS, MA2, Elizabeth Krantz, MS2, Lawrence Corey, MD1,2,5 and Anna Wald, MD, MPH1,2,3,5

From the Departments of 1Medicine, 2Laboratory Medicine, 3Epidemiology, and 4Obstetrics & Gynecology, University of Washington; and the 5Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington.

OBJECTIVE: To estimate the frequency of isolation of herpes simplex virus (HSV) from the genital tract when recurrent herpes lesions were present on the buttocks.

METHODS: Data were extracted from a prospectively observed cohort attending a research clinic for genital herpes infections between 1975 and 2001. All patients with a documented herpes lesion on the buttocks, upper thigh or gluteal cleft ("buttock recurrence") and concomitant viral cultures from genital sites including the perianal region were eligible.

RESULTS: We reviewed records of 237 subjects, 151 women and 86 men, with a total of 572 buttock recurrences. Of the 1,592 days with genital culture information during a buttock recurrence, participants had concurrent genital lesions on 311 (20%, 95% confidence interval [CI] 14–27%) of these days. Overall, HSV was isolated from the genital region on 12% (95% CI 8–17%) of days during a buttock recurrence. In the absence of genital lesions, HSV was isolated from the genital area on 7% (95% CI 4%–11%) of days during a buttock recurrence and, among women, from the vulvar or cervical sites on 1% of days.

CONCLUSION: Viral shedding of herpes simplex virus from the genital area is a relatively common occurrence during a buttock recurrence of genital herpes, even without concurrent genital lesions, reflecting perhaps reactivation from concomitant regions of the sacral neural ganglia. Patients with buttock herpes recurrences should be instructed about the risk of genital shedding during such recurrences.

LEVEL OF EVIDENCE: II-2






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