Genital Herpes Simplex Virus Type 2 Shedding Among Adults With and Without HIV Infection in Uganda.
BACKGROUND
Despite the high prevalence of herpes simplex virus type 2 (HSV-2) in sub-Saharan Africa, the natural history of infection among Africans is not well characterized. We evaluated the frequency of genital HSV shedding in HIV-seropositive and HIV-seronegative men and women in Uganda.


METHODS
Ninety-three HSV-2-seropositive Ugandan adults collected anogenital swab specimens for HSV DNA quantification by polymerase chain reaction 3 times daily for 6 weeks.


RESULTS
HSV-2 was detected from 2484 of 11 283 swab specimens collected (22%), with a median quantity of 4.3 log10 HSV copies/mL (range, 2.2-8.9 log10 HSV copies/mL). Genital lesions were reported on 749 of 3875 days (19%), and subclinical HSV shedding was detected from 1480 of 9113 swab specimens (16%) collected on days without lesions. Men had higher rates of total HSV shedding (relative risk [RR], 2.0 [95% confidence interval {CI}, 1.3-2.9]; P < .001); subclinical shedding (RR, 1.7 [95% CI, 1.1-2.7]; P = .01), and genital lesions (RR, 2.1 [95% CI, 1.2-3.4]; P = .005), compared with women. No differences in shedding rates or lesion frequency were observed based on HIV serostatus.


CONCLUSIONS
HSV-2 shedding frequency and quantity are high among HSV-2-seropositive adults in sub-Saharan Africa, including persons with and those without HIV infection. Shedding rates were particularly high among men, which may contribute to the high prevalence of HSV-2 and early acquisition among African women.
Department of Medicine Division of Vaccine and Infectious Disease.
Warren
W
Phipps
College of Health Sciences, Makerere University STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.
Edith
E
Nakku-Joloba
Division of Vaccine and Infectious Disease.
Elizabeth M
EM
Krantz
Department of Laboratory Medicine.
Stacy
S
Selke
Department of Laboratory Medicine.
Meei-Li
ML
Huang
STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.
Fred
F
Kambugu
Uganda Cancer Institute College of Health Sciences, Makerere University.
Jackson
J
Orem
Department of Medicine Department of Epidemiology Department of Global Health, University of Washington Division of Vaccine and Infectious Disease Division of Clinical Research Division of Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Corey
C
Casper
Department of Medicine Department of Laboratory Medicine Division of Vaccine and Infectious Disease Division of Clinical Research.
Lawrence
L
Corey
Department of Medicine Department of Laboratory Medicine Department of Epidemiology Division of Vaccine and Infectious Disease.
Anna
A
Wald
D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018139:Simplexvirus / Q000502:physiology*; D014454:Uganda / Q000453:epidemiology; D017201:Virus Shedding / Q000502:physiology*; D055815:Young Adult
D004279:DNA, Viral
Africa; HSV-2; genital herpes; human herpesvirus-2; viral shedding