Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study

Abstract

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][2009][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.

Asymptomatic Bacterial Vaginosis in Pregnancy and Missed Opportunities for Treatment: A Cross-Sectional Observational Study

“…BV in pregnancy is clinically significant because of its association with pre-term labor and delivery, pre-mature, pre-labor rupture of membranes, spontaneous miscarriage, and infections post-delivery [3][4][5][6]. BV may also pose a risk for the acquisition of sexually transmitted infections (STIs) such as HIV, N. gonorrhoeae, C. trachomatis, and HSV-2 that are independently associated with preterm delivery if untreated [7][8][9][10][11][12].…”

Prevalence and genetic diversity of Trichomonas vaginalis clinical isolates in a targeted population in Xinxiang City, Henan Province, China

“…The pathogen infects not only women but also men, and the infection is frequently asymptomatic in both women and men. In women, the disease may range from the absence of symptoms (in up to 50% of women) to severe vaginitis and urethritis symptoms, and patients infected with TV are at high risk of cervical cancer and adverse pregnancy outcomes [ 2 ]. Although men are often asymptomatic carriers of T. vaginalis , dysuria and discharge have also been reported, and T. vaginalis infection also increases the risk of infertility and prostate cancer in men [ 3 ].…”

Prevalence, risk factors, and pregnancy outcomes of cervical cell abnormalities in the puerperium in a hyperendemic HIV setting

“…The present findings appear reassuring and indicate that HIV and LGSIL or HGSIL do not alter pregnancy outcomes. We have previously shown that untreated sexually transmitted infections in pregnancy could contribute to adverse pregnancy outcomes …”

“…We have previously shown that untreated sexually transmitted infections in pregnancy could contribute to adverse pregnancy outcomes. 25 There…”