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

Michael Augenbraun, MD; Joseph Feldman, DrPH; Keith Chirgwin, MD; Jonathan Zenilman, MD; Lorraine Clarke, PhD; Jack DeHovitz, MD, MPH; Sheldon Landesman, MD; and Howard Minkoff, MD
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From the State University of New York-Health Science Center at Brooklyn, Brooklyn, New York; and the Johns Hopkins University School of Medicine, Baltimore, Maryland. Grant Support: In part by NIH AI31834-03, CDC/CONRAD CSA-92-100, and NIAID NO1-AI-95014. Requests for Reprints: Michael H. Augenbraun, MD, Box 56 SUNYHSCB, 450 Clarkson Avenue, Brooklyn, NY 11203. Current Author Addresses: Dr. Augenbraun, Box 56 SUNY-HSCB, 450 Clarkson Avenue, Brooklyn, NY 11203.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(11):845-847. doi:10.7326/0003-4819-123-11-199512010-00006
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Objective: To compare the prevalence of genital herpes simplex virus type 2 (HSV-2) shedding in human immunodeficiency virus (HIV)-seropositive women and HIV-seronegative women.

Design: Cross-sectional study

Setting: A major inner-city medical center.

Patients: 106 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.

Measurements: Herpes 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.

Results: The 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 = 0.04; odds ratio, 4.1 [95% CI, 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.

Conclusions: Women 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.





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