Frequent Genital HSV-2 Shedding Among Women During Labor in Soweto, South Africa

Abstract

Background: Despite high herpes simplex virus type 2 (HSV-2) incidence and prevalence in Africa, we are unaware of published neonatal herpes reports. To assess the potential for neonatal transmission we investigated the frequency of established risk factors including HSV acquisition in late pregnancy and HSV shedding during labor in South Africa. Methods: Women in labor at a Soweto hospital underwent HSV serologic testing and genital swab collection for HSV PCR. Women initially HSV-2 seronegative were assessed for seroconversion 4-6 weeks post-partum. Results: Of 390 women enrolled, 58.7% were HSV-2 seropositive. Genital HSV was detected in 22.6% of HIV-coinfected vs. 11.8% of HSV-2-positive/HIV-negative women (RR,1.91; 95% CI,1.04-3.53; P=0.038). We identified no women who recently acquired HSV-2. Conclusion: HSV-2 reactivation occurs frequently among South African women during labor. Lack of reported neonatal herpes despite exposure during delivery suggests the possibility of virologic or immunologic differences that decrease the risk of neonatal infection.