Immunology

Antibodies to the herpes viruses last throughout the patient's lifetime. An antigen common to both HSV-1 and HSV-2 produces crossreacting antibodies to both strains that can be differentiated immunologically by immunofluorescence and microneutrali-zation tests. Antibody to one type, however, precludes neither an infection with the other nor the development of specific antibodies to the second infection. Yet previous infection with HSV-1 does mitigate the clinical manifestations of the first episode of genital herpes caused by HSV-2. The antibodies that respond to an initial herpes simplex virus infection are complement-fixing, neutralizing, cytotoxic, pre-

YEARS

600-550-500 450

Figure VIII.64.2. Number of con- f 400

sultations, all five office visits, 3 350

and first of five visits for genital £ _

herpes, United States, 1966-83. ~ All consultations (solid line) in- k 250 elude any type of patients [2 200

physician interaction, such as telephone calls, house calls, and office visits. [From U.S. Public Health 100

Service. Centers for Disease Con- 50

trol. 1984. Morbidity and Mortality Weekly Reports, Annual Sum- J< mary (March) 33: 90.]

cipitating, and nonprecipitating antibodies, and appear early in the infection. Lawrence Corey (1984) has stated that although complement-fixing and neutralizing "antibodies usually are maintained and in high titer, and inactivate extracellular virus, continued replication of virus by cell to cell transfer ensues. These data help explain frequent reactivation of the disease in the presence of high levels of antibody titer." The relation of humoral antibodies to reactivation of disease is unclear. Whereas the humoral immune response remains at high levels, the in vitro cellular immune response to HSV antigens appears to fluctuate.

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