Clinical Reactivation of Herpes Simplex Virus Type 2 Infection in Seropositive Pregnant Women with No History of Genital Herpes

doi:10.1059/0003-4819-118-6-199303150-00003

Clinical Reactivation of Herpes Simplex Virus Type 2 Infection in Seropositive Pregnant Women with No History of Genital Herpes

From the Department of Pediatrics, Division of Infectious Diseases and Biomathematics, University of California, Los Angeles, California. Requests for Reprints: Lisa M. Frenkel, MD, University of Rochester, 601 Elm Avenue, Box 690, Rochester, NY 14642. Acknowledgments: The authors thank Drs. Yvonne S. Fried, Richard P. Frieder, Stephen M. Lieb, Charles E. Hamrell, Charles F. Dubin, Robert M. Friedland and their patients, without whom this project could not have been done; and Gretchen Spindel and Susan Ames for secretarial support. Grant Support: In part by a grant from the University of California, Los Angeles, Academic Senate.

Abstract

Objective: To determine the risk for genital herpes and asymptomatic herpes simplex virus (HSV) shedding in late pregnancy and delivery in a population of HSV type 2 (HSV-2)-seropositive but previously asymptomatic pregnant women.

Design: A prospective inception cohort study.

Participants: A total of 1355 pregnant women with no history of genital herpes referred from three private obstetrics practices between November 1985 and June 1988.

Main Outcome Measures: Confidential questionnaires evaluated sexual risk factors in relation to HSV-2 serologic status as determined by Western blot analysis. Herpes simplex virus shedding was determined by viral culture of the cervix and vulva and of any suspicious lesions.

Results: Antibody to HSV-2 was detected in 439 of 1355 pregnant women (32%) with no history of genital herpes. Asymptomatic HSV shedding was detected in 5 of 1160 cultures (0.43%) obtained in late pregnancy and during delivery. A first episode of clinical genital herpes was recognized by 43 of 264 HSV-2-seropositive women (16%) during their pregnancy.

Conclusions: Serologic evidence of unknown HSV-2 infection was common in pregnant women without a history of genital herpes. Asymptomatic viral shedding in these women occurred at a rate similar to that seen in women with symptomatic genital HSV-2 infection. To improve recognition of genital herpes near term, obstetricians should counsel pregnant women about the high prevalence and mild and diverse symptoms of genital HSV-2 infection.