Self-collected genital swabs compared with cervicovaginal lavage for measuring HIV-1 and HSV-2 and the effect of acyclovir on viral shedding

Abstract

HIV-1 and HSV-2 are frequent genital co-infections in women. To determine how self-collected genital swabs compare to provider-collected cervicovaginal lavage, paired self-collected genital swabs and cervicovaginal lavage from women co-infected with HIV-1 and HSV-2 were evaluated. Women were in an acyclovir clinical trial and their samples were tested for HIV-1 RNA (361 samples) and HSV-2 DNA (378 samples). Virus shedding, quantity and acyclovir effect were compared. HIV-1 and HSV-2 were more frequently detected in self-collected genital swabs: 74.5% of self-collected genital swabs and 63.6% of cervicovaginal lavage had detectable HIV-1 (p ≤ 0.001, Fisher’s exact test) and 29.7% of self-collected genital swabs and 19.3% of cervicovaginal lavage had detectable HSV-2 (p ≤ 0.001) in the placebo month. Cervicovaginal lavage and self-collected genital swabs virus levels were correlated (Spearman’s rho, 0.68 for HIV; 0.61 for HSV-2) and self-collected genital swabs levels were generally higher. In multivariate modeling, self-collected genital swabs and cervicovaginal lavage could equally detect the virus-suppressive effect of acyclovir: for HIV-1, proportional odds ratios were 0.42 and 0.47 and for HSV-2, they were 0.10 and 0.03 for self-collected genital swabs and cervicovaginal lavage, respectively. Self-collected genital swabs should be considered for detection and measurement of HIV-1 and HSV-2 in clinical trials and other studies as they are a sensitive method to detect virus and can be collected in the home with frequent sampling.

Self-collected versus clinician-collected samples for HSV-2 and HSV-2/HPV screening in HIV-infected and -uninfected women in the Tapajós region, Amazon, Brazil

“…This finding corroborates other studies, where self-collected samples that could be collected easily at home were a sensitive and efficient method to molecularly detect virus. 28–31 Such inclusion of genital sites other than the cervix can be important.…”

Duration of protection from live attenuated vs. sub unit HSV-2 vaccines in the guinea pig model of genital herpes: Reassessing efficacy using endpoints from clinical trials

“…the development of antibody to HSV proteins other than gD are used in the guinea pig model, then over 50% of animals without acute disease have serologic evidence of HSV infection and thus would be assessed as vaccine failures [33]. However, when comparing protection, one should also consider that the challenge dose used in our model is almost assuredly more than occurs in human transmission, where shedding is rarely at the level of 10 6 pfu [34, 35]. Thus, it is possible that complete vaccine protection can be overwhelmed in the models at these high challenge doses.…”

Genital Herpes: Synergy between Serology and Polymerase Chain Reaction in Laboratory Diagnosis among Pregnant Women Attending the Antenatal Clinic of Federal Medical Centre, Yenagoa Nigeria

“…Samples were thawed and mixed prior to use. The pregnant women were instructed to self-collect vagina swab as described by McNicholl et al [11], by inserting a sterile Dacron swab stick (Boen Healthcare Co., Ltd., Suzhou, China) 2cm into the vagina, rotate and given back. The swab tips were then broken off and inserted into a viral transport media containing phosphate buffered saline.…”