title: Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study.
abstract: 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.
  
  
  
  Inthis 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.
  
  
  
  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 trachomatisandTrichomanas vaginaliswere 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).
  
  
  
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Dhayendre
authors.initials: D
authors.lastname: Moodley
authors.affiliation: Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Benn
authors.initials: B
authors.lastname: Sartorius
authors.affiliation: Global Clinical Virology Laboratory, Durban, South Africa.
authors.forename: Savithree
authors.initials: S
authors.lastname: Madurai
authors.affiliation: Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Vani
authors.initials: V
authors.lastname: Chetty
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D015658:HIV Infections / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D006558:Herpes Genitalis / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D006561:Herpes Simplex / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D018258:Herpesvirus 2, Human / Q000254:growth & development / Q000502:physiology*; D006801:Humans; D000067716:Point-of-Care Testing; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology / Q000821:virology; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D013019:South Africa; D017201:Virus Shedding; D055815:Young Adult
keywords: CHLAMYDIA TRACHOMATIS; GENITAL HERPES; NEISSERIA GONORRHOEA; TRICHOMONAS