Clinical and experimental| Volume 44, ISSUE 2, P261-272, August 1954

Studies on recurrent aphthae: Evidence that herpes simplex is not the etiological agent, with further observations on the immune responses in herpetic infections

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      One hundred and one sera from sixty-two subjects with histories of recurrent aphthae, herpetic infection, or both, were examined for antibodies against herpes simplex by means of the complement fixation and/or virus neutralization techniques. In addition, nineteen of the subjects were skin tested with a non-viral herpes antigen prepared from infected egg fluids.
      Forty, or 68 per cent, of fifty-nine subjects tested were found to have herpes complement-fixing antibodies. The positive group included five patients with questionable herpetic histories and ten with no knowledge of past herpetic infection, thus re-emphasizing the frequency of mild and subclinical infection with this virus.
      Subjects with herpes complement-fixing antibodies show the same variation in serum titers as found in other infectious diseases.
      The incidence of herpes complement-fixing antibodies in subjects with recurrent aphthae was not increased as compared to that of a control group with no history of this disorder.
      Sera negative for herpes antibodies by complement fixation may occasionally contain neutralizing antibodies against this virus.
      Tests with a soluble herpes skin-test antigen prepared in eggs revealed that while the presence of neutralizing antibodies against herpes was associated with a positive skin test their absence was not always associated with a negative test.
      Of thirty patients with recurrent aphthae, eleven had no demonstrable antibodies against herpes simplex. It is noteworthy that seven of these eleven patients were skin tested with herpes antigen and five failed to react. The same seven patients developed recurrences of their lesions while under study. None showed a rise in herpes antibodies during convalescence from this disorder. These findings, together with the fact that the lesions of recurrent aphthae are pathologically inconsistent with herpetic infection, make a herpetic etiology for this disorder unlikely.
      Inapparent herpetic infection may explain the occasional reported recovery of herpes simplex from patients with recurrent aphthae.
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