Cancer chemotherapy associated symptomatic stomatitis: role of Herpes simplex virus (HSV)

The relationship between oral shedding of Herpes simplex virus (HSV) and cytotoxic cancer chemotherapy was studied. HSV seropositive outpatients receiving cytotoxic chemotherapy had HSV recovered from throat washings in eight of 114 patients (7.0%), significantly more often than HSV seropositive outpatients with malignancy who were not receiving cytotoxic chemotherapy (one of 91 patients; 1.1%; P = 0.04). Twenty-eight HSV seropositive chemotherapy patients and 11 HSV seropositive healthy hospital personnel were studied serially 2-3 times per week over a 3-4 week period for oral HSV shedding. Although a comparable percentage of each group shed HSV at least once (57.1% of chemotherapy patients versus 36.4% of controls), chemotherapy patients had a strikingly higher incidence of multiple positive cultures: 40/218 attempts (18.7%) versus 4/156 attempts (2.6%) for controls (P less than 10(-5)). Among chemotherapy patients who developed clinically evident stomatitis, 12 of 14 (85.7%) had HSV recovered compared to four of 14 (28.6%) without lesions (P = 0.004). We conclude that while oral mucosal HSV infection is associated with symptomatic stomatitis following chemotherapy, HSV does not account for all mucosal lesions in chemotherapy patients.