Herpes simplex virus-2 infections in pregnant women from Durban, South Africa: prevalence, risk factors and co-infection with HIV-1

Nathlee S Abbai,Makandwe Nyirenda,Shanthie Govender

doi:10.4102/sajid.v33i5.149

Abstract

Currently there is a lack of data on herpes simplex virus-2 (HSV-2) and human immunodeficiency virus-1 (HIV-1) co-infections as well as risk factors for infection in antenatal women from South Africa. The present study attempts to fill this gap. This cross-sectional study was conducted from April to August 2017 at the antenatal clinic of the King Edward VIII hospital in Durban, South Africa. In total 248 pregnant women participated in the study. Data on the women’s demographics, sexual behaviour and clinical information were collected. HIV testing was conducted using a rapid test and the HerpeSelect 2 ELISA was used to test for HSV-2. The prevalence of HSV-2 and HIV-1 was 71% and 50% and coinfection rate was 60%. In adjusted analyses, women who were aged ≥ 35 years (adjusted odds ratio [AOR]: 4.95, p = 0.01), experienced recent symptoms of genital itching/sores/warts (AOR 2.48, p = 0.05) and were HIV-positive (AOR 3.64, p0.01), were more likely to be infected with HSV-2.Older age (30–34 years old) (AOR 6.53, p 0.01) and having ≥ 4 lifetime sex partners (AOR 4.59, p = 0.03) were strongly associated with HSV-2/HIV-1 co-infections. The findings of this study call for continuous risk reduction counselling in this population.

Highlights

According to the World Health Organization (WHO) approximately 536 million people aged 15–49 years are infected with herpes simplex virus type 2 (HSV-2), the causative agent of genital herpes.[1]
HSV-2 seropositivity was higher in women who were unemployed compared with women who were employed (60.5% vs. 39%.5, p = 0.55) and a larger number of prevalent HSV-2 infections was found in women who were unmarried when compared with women who were married (84.7% vs. 15.3%, p = 0.01)
Our study shows that prevalent HSV-2 infection is high among pregnant women in South Africa when compared with other parts of the globe

Summary

Introduction

According to the World Health Organization (WHO) approximately 536 million people aged 15–49 years are infected with herpes simplex virus type 2 (HSV-2), the causative agent of genital herpes.[1]. In South Africa, HSV-2 seroprevalence among women of reproductive age is considerably higher than in the USA (30–70% vs 21%).[4] HSV-2 incidence in southern Africa remains high throughout the reproductive years, at 8.8/100 person-years among women 18–24 years of age and 5.3/100 person-years among women 35 years or older. This is higher than the USA, where estimated HSV-2 incidence is 2.25/100 person-years among women 20–29 years of age and 1.73/100 person-years among women age 30–39; of these, 1.0% of HSV-2 seronegative women seroconverted during pregnancy. Infants that are exposed to the virus may be at increased risk of neonatal fatality.[4]

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Discussion

Conclusion