Increased Genital Shedding of Herpes Simplex Virus Type 2 in HIV-Seropositive Women

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ObjectiveTo compare the prevalence of genital herpes simplex virus type 2 (HSV-2) shedding in human immunodeficiency virus (HIV)-seropositive women and HIV-seronegative women.DesignCross-sectional studySettingA major inner-city medical center.Patients106 women who were HIV-seropositive and HSV-2-seropositive and 70 women who were HIV-seronegative and HSV-2-seropositive were enrolled from various primary care settings.MeasurementsHerpes simplex virus type 2 antibody determinations were done for all patients. Regardless of symptoms, vulvar and cervical HSV cultures were obtained from all HIV-seropositive women and from a randomly selected subgroup of HIV-seronegative women.ResultsThe prevalence of HSV-2 shedding was nearly four times greater in HIV-seropositive than in HIV-seronegative women (13.2% compared with 3.6%; P equals 0.04; odds ratio, 4.1 [95% Cl, 1.0 to 27.4]) when the serum antibody for HSV-2 was present. Seventy-nine percent of viral shedding among HIV-seropositive women was asymptomatic. Overall viral shedding increased significantly as the CD4 cell count decreased.ConclusionsWomen with HIV infection, particularly those with low CD4 cell counts, shed HSV-2 from the vulva and cervix more commonly than women not infected with HIV. Most of this shedding is asymptomatic.Ann Intern Med. 1995;123:845-847.

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