Psychological stress and other potential triggers for recurrences of herpes simplex virus eye infections. Herpetic Eye Disease Study Group. Academic Article uri icon

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abstract

  • OBJECTIVE: To assess psychological stress and other factors as possible triggers of ocular herpes simplex virus (HSV) recurrences. DESIGN: A prospective cohort study nested in a randomized, placebo-controlled, clinical trial. SETTING: Fifty-eight community-based or university sites. PARTICIPANTS: Immunocompetent adults (N = 308), aged 18 years or older, with a documented history of ocular HSV disease in the prior year and observed for up to 15 months. EXPOSURE VARIABLES: Psychological stress, systemic infection, sunlight exposure, menstrual period, contact lens wear, and eye injury recorded on a weekly log. The exposure period was considered to be the week before symptomatic onset of a recurrence. MAIN OUTCOME MEASURE: The first documented recurrence of ocular HSV disease, with exclusion of cases in which the exposure week log was completed late after the onset of symptoms. RESULTS: Thirty-three participants experienced a study outcome meeting these criteria. Higher levels of psychological stress were not associated with an increased risk of recurrence (rate ratio, 0.58; 95% confidence interval, 0.32-1.05; P =.07). No association was found between any of the other exposure variables and recurrence. When an analysis was performed including only the recurrences (n = 26) for which the exposure week log was completed late and after symptom onset, there was a clear indication of retrospective overreporting of high stress (P =.03) and systemic infection (P =.01). Not excluding these cases could have produced incorrect conclusions due to recall bias. CONCLUSIONS: Psychological stress does not appear to be a trigger of recurrences of ocular HSV disease. If not accounted for, recall bias can substantially overestimate the importance of factors that do not have a causal association with HSV infection.

authors

  • Cohen, F
  • Cole, SR
  • Beck, RW
  • Blair, RC
  • Moke, PS
  • Kip, KE
  • Wilhelmus, KR
  • Dawson, CR
  • Barron, BA
  • Jones, DB
  • Kaufman, HE
  • Stulting, RD
  • Sugar, J
  • Cohen, EJ
  • Hyndiuk, RA
  • Asbell, PA
  • Kurinij, N
  • Edwards, K
  • Massare, SJ
  • McGovern, MS
  • Williams, D
  • Dragon, DM
  • Graul, EE
  • Insler, MS
  • Kaufman, HE
  • Lacoste, AD
  • McCaa, CS
  • Wagner, NJ
  • Yokubaitis, JA
  • Wilhelmus, KR
  • Todaro, LA
  • Woodside, SJ
  • Bowman, CB
  • Chodosh, J
  • Goosey, JD
  • Jones, DB
  • Kirkland, C
  • Lehmann, RP
  • Matoba, AY
  • Smith, SL
  • Wolf, TC
  • Yee, RW
  • Cohen, F
  • Dawson, CR
  • Banuvar, S
  • Osaki, SY
  • Barth, GP
  • Biswell, R
  • Cunningham, E
  • DeMartini, DR
  • Gritz, D
  • Hodge, W
  • Holsclaw, DS
  • Hwang, DG
  • Knox, CM
  • Lietman, T
  • Margolis, TP
  • Schwab, IR
  • Schwartz, L
  • Sherman, M
  • Silverstein, B
  • Vastine, DW
  • Volpicelli, M
  • Whitcher, JP
  • Wilson, S
  • Wong, I
  • Stulting, RD
  • DuBois, LG
  • Baldassare, R
  • Chopra, H
  • Croll, SD
  • DiIorio, RC
  • Gussler, JR
  • Hamilton, SM
  • John, GR
  • McCann, JW
  • Meyer, JC
  • Mitchell, PG
  • Palay, DA
  • Ramirez, RJ
  • Reed, RE
  • Serros, RN
  • Taub, LR
  • Thompson, KP
  • Walter, KA
  • Sugar, J
  • Rodiek, R
  • Dennis, R
  • Feder, RS
  • Hennessey, MJ
  • Lubeck, DM
  • McLeod, SD
  • Meisler, D
  • Morimoto, DD
  • Morimoto, PK
  • Rubenstein, JB
  • Tessler, HH
  • Hyndiuk, RA
  • Samson, C
  • Barney, NP
  • Brightbill, FS
  • DeCarlo, JD
  • Fogel, ES
  • Gainey, SP
  • Koenig, SB
  • Kontra, DJ
  • Krebs, DB
  • Lewellen, DR
  • Patalano, SM
  • Rice, PR
  • Sanderson, MC
  • Wienkers, KP
  • Yeomans, MM
  • Cohen, EJ
  • Marshall, SC
  • Rodriguez, IM
  • Phipps, P
  • Bailey, RJ
  • Fung, KL
  • Hannush, SB
  • Ingraham, HI
  • Kesselring, JJ
  • Kowal, VO
  • Laibson, PR
  • Martin, NF
  • Orlin, SO
  • Rapuano, CR
  • Rubinefeld, RS
  • Sulewski, M
  • Asbell, PA
  • Justin, N
  • Arroyo, M
  • Epstein, S
  • Barker, BA
  • Brocks, RE
  • D'Aversa, G
  • Dunn, MJ
  • Gorman, BD
  • Leopold, MR
  • Schwartz, WJ
  • Udell, IJ
  • Beck, RW
  • Moke, PS
  • Blair, RC
  • Cole, SR
  • Kip, K
  • Gillespie, HA
  • Lester, LA
  • Mhamdi, ML
  • Gal, RL
  • Tan, ES
  • Hauck, WW
  • Gee, L
  • Bangdiwala, Shrikant
  • Barlow, WE
  • Chandler, JW
  • Lemp, MA
  • Nesburn, AB
  • Patrick, DL
  • Sutphin, JE
  • Watson, SB

publication date

  • December 2000