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Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study
  1. Dhayendre Moodley1,
  2. Benn Sartorius2,
  3. Savithree Madurai3,
  4. Vani Chetty1,
  5. Suzanne Maman4
  1. 1 Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
  2. 2 Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
  3. 3 Global Clinical Virology Laboratory, Durban, South Africa
  4. 4 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Dhayendre Moodley, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa 4013; moodleyd1{at}


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 this 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.


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  • Handling editor Jackie A Cassell

  • Contributors DM conceptualised the substudy, interpreted the statistical analysis and wrote the manuscript. BS performed the statistical analysis and contributed to the development of the manuscript. SM and VC coordinated the laboratory tests, interpreted the data and reviewed the manuscript. Susanne Maman was the principal investigator of the primary study, conceptualised the substudy and helped write the manuscript.

  • Funding This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R01HD050134) and The Open Society Institute and Elton John Foundation (grant number 20020472/20030878).

  • Competing interests None declared.

  • Ethics approval The main study was approved by the institutional review boards of the University of KwaZulu-Natal (E129/06) and the University of North Carolina at Chapel Hill (07-1070) and the University of KwaZulu-Natal ethics committee.

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

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