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Herpes Simplex Virus Type 2 Infection in Young Adult Women: Risk Factors for Infection and Frequency of Viral Shedding

Fife, Kenneth H. MD, PHD*†; Williams, James A. BS*; Thomas, Allyson L. MD*; Ofner, Susan MS*; Katz, Barry P. PHD*; Fortenberry, J. Dennis MD, MS

Sexually Transmitted Diseases: April 2010 - Volume 37 - Issue 4 - p 248-252
doi: 10.1097/OLQ.0b013e3181d4f866
Original Study

Background: Population-based studies suggest that acquisition of herpes simplex virus 2 (HSV 2) is most common between ages 20 and 29, especially in minority women. We examined HSV 2 infection and viral shedding in a cohort of young women.

Methods: Women, age 18 to 24 (median 21), who were part of an observational cohort enrolled between ages 14 to 17, had blood obtained for HSV 2 antibody. Intensive diary collections on sexual behavior and genital symptoms and weekly vaginal swabs were obtained at regular intervals.

Results: HSV 2 antibodies were detected in 43 of 127 participants (33.9%), only 4 of whom were previously known to be positive. Factors associated with a positive test included older age, years of sexual activity, and number of lifetime partners. Testing for HSV 2 DNA by polymerase chain reaction on weekly vaginal swabs from a 13-week sampling period for each HSV 2 antibody positive participant showed 32 of 43 (74.4%) were positive at least once. The positive predictive value of pain for viral shedding was poor.

Conclusions: HSV 2 infection is very common among young adult women, but symptomatic genital herpes is not. Shedding of HSV 2 DNA can be detected in most antibody positive persons. Early intervention strategies will be needed to control HSV 2 infection.

Asymptomatic herpes simplex virus 2 infection was common among young adult women and was associated with age and sexual behavior. Most herpes simplex virus 2 positive women shed virus from the genital tract.

From the Departments of *Medicine, †Microbiology and Immunology, and ‡Pediatrics, Indiana University School of Medicine, Indianapolis, IN

The authors thank Patricia Brooks and Mabel Peterson for their assistance with this study, Dr. Barbara Van Der Pol for helpful comments on the manuscript, and Dr. Donald Orr who initiated the cohort study. We would also like to thank the study participants whose dedication to this project was essential to its completion.

Supported in part by an investigator-initiated grant from GlaxoSmithKline (Val R-137) to KHF and by NIH grant AI 31494.

Presented in part at the 48th ICAAC/46th IDSA Joint Meeting, Washington, DC, October 2008.

Correspondence: Kenneth H. Fife, MD, PhD, Indiana University School of Medicine, 545 Barnhill Dr., Room 435, Indianapolis, IN 46202. E-mail:

Received for publication June 15, 2009, and accepted December 12, 2009.

© Copyright 2010 American Sexually Transmitted Diseases Association