Consequences of genital herpes simplex virus infection among vulnerable populations

Genital herpes simplex type 1 (HSV-1) and 2 (HSV-2) infections are among the most prevalent sexually transmitted infections in the world. Genital HSV-2 increases the risk of HIV acquisition, likely via mucosal disruption and recruitment of CD4+ T-cells. We evaluated the relationship between HSV-2 and HIV acquisition among high-risk men who have sex with men (MSM) participating in a behavioral intervention. Sexual behavior data were obtained by computer-assisted self-interview and sera were collected semiannually for HSV-2 and HIV serology. Baseline HSV-2 prevalence was 20.3% and incidence was 1.9/100 person-years (95% confidence interval (CI): 1.6-2.2). The behavioral intervention did not reduce HSV-2 acquisition (adjusted hazard ratio (aHR): 1.2 (95% CI: 0.9-1.6)). HIV incidence was 1.9/100 person-years (95% CI: 1.7, 2.2) and was elevated among MSM with recent incident HSV-2 (aHR=3.6, 95% CI: 1.7, 7.8), remote incident HSV-2 (aHR=1.7, 95% CI: 0.8, 3.3), and prevalent HSV-2 infection (aHR=1.5, 95% CI: 1.1, 2.1) compared with HSV-2 seronegative participants. HIV intervention strategies targeting HSV-2 prevention and suppression among MSM should be evaluated.; Another population suffering severe consequences of HSV is infants infected by HSV in the maternal genital tract during delivery, who have a high morbidity and mortality rate even with treatment. We assessed risk factors for neonatal herpes by pooling data from the United States and Sweden. The risk of neonatal HSV-2 infection was similar in infants born to HSV seronegative women compared with HSV-1 seropositive women (OR: 1.6, 95% CI: 0.6-4.0), indicating a lack of protection by heterologous antibodies. The risk of neonatal HSV was elevated in the presence of exposure to maternal HSV-1 versus HSV-2 (adjusted OR: 19.2, 95% CI: 5.8-63.6). We evaluated the relationship between maternal HSV antibody avidity and risk of neonatal herpes using avidity tests based on the commercially-available Focus HerpeSelect ELISA kits. Among women shedding HSV at term, 4 of 8 (50%) of women with avidity ≤40 transmitted HSV to the neonate, compared with only 12 of 97 (12%) of women with avidity > 40 (p=0.02). Further studies of the potential role of maternal HSV avidity testing in predicting and preventing neonatal HSV infection are needed.