Abstract
BackgroundYoung women receiving family planning services are at risk for both unintended pregnancy and herpes simplex virus type 2 (HSV-2) infection.MethodsWe performed a secondary analysis using data from a previously published randomized controlled trial evaluating access to emergency contraception on reproductive health outcomes. Women aged 15 to 24 years were recruited from two Planned Parenthood clinics and two community health clinics in San Francisco. Demographic information and sexual history were obtained by interview. HSV-2 seropositivity was determined by fingerstick blood test. New pregnancies were measured by self-report, urine testing and medical chart review. Subjects were evaluated for incident HSV-2 infection and pregnancy at a 6-month follow-up appointment. Women who were pregnant or intending to become pregnant at enrolment were excluded.ResultsAt enrolment 2,104 women were screened for HSV-2 and 170 (8.1%) were seropositive. Eighty-seven percent of initially seronegative women completed the study (n = 1,672) and 73 (4.4%) became HSV-2 seropositive. HSV-2 seroincidence was 7.8 cases per 100 person-years. One hundred and seventeen women (7%) became pregnant and 7 (6%) of these had a seroincident HSV-2 infection during the study. After adjustment for confounders, predictors of incident HSV-2 infection were African American race and having multiple partners in the last six months. Condom use at last sexual encounter was protective.ConclusionHSV-2 seroincidence and the unintended pregnancy rate in young women were high. Providers who counsel women on contraceptive services and sexually transmitted infection prevention could play an expanded role in counselling women about HSV-2 prevention given the potential sequelae in pregnancy. The potential benefit of targeted screening and future vaccination against HSV-2 needs to be assessed in this population.
Highlights
Young women receiving family planning services are at risk for both unintended pregnancy and herpes simplex virus type 2 (HSV-2) infection
Of the 2,130 women eligible for the emergency contraception study, 13 refused participation, 13 did not have HSV-2 testing at baseline, and 2,104 were enrolled in the HSV-2 study
Our findings showed condom use at the last intercourse prior to enrolment was highly protective, associated with a 44% reduction in likelihood for acquiring HSV-2 after adjustment for confounders
Summary
Young women receiving family planning services are at risk for both unintended pregnancy and herpes simplex virus type 2 (HSV-2) infection. Active young women in the United States are exposed to herpes simplex virus type 2 (HSV-2) with high frequency. HSV-2 seropositivity is a known risk factor for human immunodeficiency virus (HIV) acquisition [1,2]. HSV-2 infections are known to have especially serious clinical sequelae in neonates. Women with prepregnancy HSV-2 seropositivity have a reduced risk of neonatal transmission, attributed to the passage of transplacental antibodies to the foetus, but women with a recurrent herpes episode at delivery generally undergo caesarean section to prevent transmission to the neonate [3,4,5]. Pre-pregnancy seronegative women with an incident herpes infection are at high risk for HSV-2 transmission and neonatal complications [6]
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