1. Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study.
- Author
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Moodley D, Sartorius B, Madurai S, Chetty V, and Maman S
- Subjects
- Adolescent, Adult, Ambulatory Care Facilities, Chlamydia Infections epidemiology, Chlamydia Infections microbiology, Chlamydia Infections physiopathology, Female, Gonorrhea epidemiology, Gonorrhea microbiology, Gonorrhea physiopathology, HIV Infections epidemiology, HIV Infections physiopathology, HIV Infections virology, Herpes Genitalis epidemiology, Herpes Genitalis physiopathology, Herpes Genitalis virology, Herpes Simplex epidemiology, Herpes Simplex physiopathology, Herpes Simplex virology, Herpesvirus 2, Human growth & development, Humans, Point-of-Care Testing, Pregnancy, Pregnancy Outcome, Randomized Controlled Trials as Topic, Retrospective Studies, South Africa, Young Adult, Herpesvirus 2, Human physiology, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious microbiology, Pregnancy Complications, Infectious physiopathology, Pregnancy Complications, Infectious virology, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases microbiology, Sexually Transmitted Diseases virology, Virus Shedding
- Abstract
Objectives: Genital herpes simplex virus-2 (HSV-2) shedding in pregnant women in association with neonatal herpes infection has been widely studied but there is limited evidence of its association with pregnancy outcomes., Methods: In t his retrospective observational study, we included a subgroup of pregnant women who were enrolled in a randomized control behavioural intervention study that was conducted in South Africa in 2008-2010. In pregnancy, women had a HIV rapid test done and a genital swab taken to test for curable STIs and HSV-2 DNA. Subsequent visits were scheduled for 6, 10, 14 weeks and 9 months post-delivery. Pregnancy outcomes were documented at the 6-week or 10-week postpartum visit. Women were treated syndromically for curable STIs., Results: Among 615 women included in this data analysis, 36.6% (n=225) tested HIV positive and 8.3% (n=51) tested positive for genital HSV-2 shedding during pregnancy. Women <24 years and HIV-1 seropositive women were 1.5 and 2.5 times more likely to test positive for HSV-2 genital shedding respectively. STI treatment records were available for 158/205 (77.1%) women; all 87 women with symptomatic STIs were treated the same day, and 50/71 (70.4%) asymptomatic women received treatment at the subsequent visit. Remaining 21 (29.6%) asymptomatic women did not receive treatment because they failed to return for antenatal follow-up. In a multivariable regression analysis, genital HSV-2 shedding, HIV-1, Neisseria gonorrhoea , Chlamydia trachomatis and Trichomanas vaginalis were not associated with preterm deliveries, still births and low birth weight. However with stratification by treatment for a STI, asymptomatic women who were not treated were 3.3 times more likely to deliver prematurely (33.3%; n=6/18) when compared to women who were treated during pregnancy (13.2%; n=15/114) (p=0.042)., Conclusions: Genital HSV-2 shedding in pregnancy does not appear to alter pregnancy outcomes. Untreated curable STIs ( T.vaginalis, C.trachomatis, N.gonorrhoea ) were more likely associated with preterm births., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Published
- 2017
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