Sex Transm Infect 87:406-411 doi:10.1136/sti.2010.048496
  • Clinical

Patterns of herpes simplex virus shedding over 1 month and the impact of acyclovir and HIV in HSV-2-seropositive women in Tanzania

Open Access
  1. Deborah Watson-Jones1,5
  1. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2National Institute for Medical Research (NIMR), Mwanza, Tanzania
  3. 3Laboratoire de Microbiologie, Hôpital Saint Louis, Paris, France
  4. 4Départment de Microbiologie, Laboratoire de Virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris, France
  5. 5African Medical and Research Foundation (AMREF), Mwanza, Tanzania
  1. Correspondence to Dr Clare Tanton, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK; c.tanton{at}
  1. Contributors CT, HAW, DWJ, JC, RJH and DAR designed the study. CT, DWJ and JC contributed to the data collection. JLG and LB advised on and oversaw the laboratory analyses. Statistical analyses were performed by CT with guidance from HAW, TCC and RJH. CT, HAW and DWJ wrote the initial draft of the paper. All authors contributed to the interpretation of the results and the revision of the manuscript.

  • Accepted 3 May 2011
  • Published Online First 8 June 2011


Objectives Few studies have examined the frequency and duration of genital herpes simplex virus (HSV) shedding in sub-Saharan Africa. This study describes HSV shedding patterns among a sample of HSV-2-seropositive women enrolled in a placebo-controlled trial of HSV suppressive therapy (acyclovir 400 mg twice a day) in Tanzania.

Methods Trial participants were invited to participate in a substudy involving 12 clinic visits over 4 weeks. At each visit, cervical, vaginal and external skin swabs were taken and analysed for HSV DNA using inhouse real-time PCR.

Results HSV shedding was mainly subclinical (90%; 57/63 shedding days in the placebo arm). The most frequent shedding site was the external skin, but HSV DNA was detected from all three sites on 42% (27/63) of shedding days. In HIV-negative women, HSV DNA was detected on 3% (9/275) of days in the acyclovir versus 11% (33/309) in the placebo arm, while in HIV-positive women, detection was on 14% (23/160) versus 19% (30/155) of days, respectively.

Conclusions HSV shedding was common, varying greatly by individual. Shedding rates were similar to studies in African and non-African settings. Among HIV-negative women, shedding rates were lower in the acyclovir arm; however, acyclovir did not substantially impact on HSV shedding in HIV-positive women.


  • Findings from this study have previously been presented at the 18th meeting of the International Society for Sexually Transmitted Disease Research (ISSTDR), London 2009 (Abstract no P4.15).

  • Funding This study was funded by the UK Medical Research Council (MRC, grant no G0400456). The trial within which it was nested was funded by the Wellcome Trust (grant no 066688), the UK Medical Research Council (MRC, grant no G0400456) and the UK Department for International Development.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the London School of Hygiene and Tropical Medicine ethics committee and the Medical Research Coordinating Committee of Tanzania.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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