Herpes simplex virus type 2 detection by culture and polymerase chain reaction and relationship to genital symptoms and cervical antibody status during the third trimester of pregnancy,☆☆,,★★

https://doi.org/10.1016/S0002-9378(97)70513-1Get rights and content

Abstract

OBJECTIVES: Our goal was to define the frequency of asymptomatic herpes simplex virus type 2 shedding by culture and polymerase chain reaction and to correlate our findings with cervical anti–herpes simplex virus type 2 immunoglobulin A production.

STUDY DESIGN: Women who were seropositive for herpes simplex virus type 2 collected daily genital tract samples during the third trimester for culture and deoxyribonucleic acid quantitation by polymerase chain reaction. Cervical secretions were collected weekly for anti–herpes simplex virus type 2 immunoglobulin A. Asymptomatic shedding by culture versus polymerase chain reaction and anti–herpes simplex virus type 2 immunoglobulin A detection with and without genital shedding were compared by means of McNemar's χ2 test.

RESULTS: Asymptomatic shedding was more frequent by polymerase chain reaction than by culture (13.8% vs 2.3%, p < 0.0001). When cervical anti–herpes simplex virus type 2 immunoglobulin A was present, patients were more likely to have negative results by polymerase chain reaction than positive results (66.7% vs 26.7%, p = 0.001). Anti–herpes simplex virus type 2 immunoglobulin A was detected beyond 37 weeks in only one subject.

CONCLUSIONS: Polymerase chain reaction was more sensitive than culture for detecting asymptomatic genital herpes simplex virus. The role of immunoglobulin A in clearing genital herpes simplex virus remains to be determined. (Am J Obstet Gynecol 1997;176:443-51.)

Section snippets

Patient population

Pregnant women obtaining prenatal care at the University of Washington have HSV serum antibodies determined by Western blot. Between Sept. 1 and Dec. 31, 1994, all human immunodeficiency virus–negative women between 26 and 31 weeks' gestation with serum antibodies to HSV-2 or to both herpes simplex virus type 1 (HSV-1) and HSV-2 were asked to enroll. Approval was obtained from the University of Washington Institutional Review Board, and written consent was obtained from all subjects. Patients

Results

Thirty-six pregnant women were eligible to participate; 13 enrolled and 9 completed specimen collection. The reasons for nonparticipation were time requirements (n = 17), loss to follow-up (n = 4), and termination of pregnancy (n = 2). The median age of the subjects was 32 years (range 20 to 37 years). Eight (88.9%) of 9 were married and 8 (88.9%) were white. Four (44.4%) were nulliparous and 2 (22.2%) were smokers. Eight (88.9%) woman had only anti-HSV-2 serum antibody, and 1 woman had both

Comment

Detailed sampling of the genital tract revealed several new observations about the natural history of asymptomatic genital HSV during the third trimester of pregnancy. Asymptomatic HSV genital shedding by PCR was common and occurred equally in women with no history of genital herpes and those with a history of symptoms, emphasizing the risk of asymptomatic shedding even among women who are unaware that they have genital herpes. Women without a history of genital herpes could potentially be at a

Acknowledgements

We thank Anne Cent and Julie Dalessio for laboratory support and Dr. John Boggess for assistance with preparation of figures.

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    From the Departments of Obstetrics and Gynecologya and Laboratory Medicine,b University of Washington Medical Center.

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    Supported by National Institute of Allergy and Infectious Diseases training grant AI-01740-17 and Program Project grant AI-30731-04.

    Reprint requests: Kim A. Boggess MD, Department of Obstetrics and Gynecology, Duke University Medical Center, Box 3967, Durham, NC 27710.

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