Abstract
Background: Neonatal herpes is a condition with high morbidity and mortality. The greatest risk occurs when the mother acquires herpes simplex virus (HSV) towards the end of pregnancy. A study from Seattle has suggested that the risk of acquisition of HSV during pregnancy was 3.7%. In Australia, HSV-2 infection is less common in pregnant women than in the United States. Consequently we conducted a study to establish HSV seroprevalence and the rate of HSV seroconversion in this population.
Methods: The study was conducted at Westmead Hospital, Sydney, between June 1995 and April 1998. Women completed a questionnaire covering risk factors for the acquisition of genital herpes. A serum sample during pregnancy and a specimen of cord blood were obtained and tested for antibodies to HSV-2 using a type specific indirect enzyme linked immunosorbent assay (ELISA). Equivocal results were resolved by western blot. A subset of the paired sera was tested for antibodies to HSV-1. The data were analysed using SPSS.
Results: 326 of the 2616 (12.5%) women were HSV-2 seropositive. Three women (0.15%) acquired HSV-2 infection during pregnancy. None of the three babies of these mothers developed neonatal herpes. 416 maternal cord pairs were tested for HSV-1 antibodies and 330 (79.3%) were positive. No HSV-1 seroconversions occurred.
Conclusions: In this population, HSV acquisition was uncommon (0.34% per year) and neonatal herpes was rare. A cost effective analysis suggested that type specific serology to screen pregnant women and their partners in low prevalence communities was not cost effective.
Key Words: type specific serology; herpes simplex virus; neonatal herpes
Full Text
The Full Text of this article is available as a PDF (132.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ades A. E., Peckham C. S., Dale G. E., Best J. M., Jeansson S. Prevalence of antibodies to herpes simplex virus types 1 and 2 in pregnant women, and estimated rates of infection. J Epidemiol Community Health. 1989 Mar;43(1):53–60. doi: 10.1136/jech.43.1.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Arvaja M., Lehtinen M., Koskela P., Lappalainen M., Paavonen J., Vesikari T. Serological evaluation of herpes simplex virus type 1 and type 2 infections in pregnancy. Sex Transm Infect. 1999 Jun;75(3):168–171. doi: 10.1136/sti.75.3.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Arvin A. M., Prober C. G. Analysis of the epidemiology and pathogenesis of herpes simplex virus (HSV) infections in pregnant women and infants using the HSV-2 glycoprotein G antibody assay. Infect Agents Dis. 1993 Dec;2(6):375–382. [PubMed] [Google Scholar]
- Brown Z. A., Benedetti J. K., Watts D. H., Selke S., Berry S., Ashley R. L., Corey L. A comparison between detailed and simple histories in the diagnosis of genital herpes complicating pregnancy. Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1299–1303. doi: 10.1016/0002-9378(95)91496-x. [DOI] [PubMed] [Google Scholar]
- Brown Z. A., Selke S., Zeh J., Kopelman J., Maslow A., Ashley R. L., Watts D. H., Berry S., Herd M., Corey L. The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997 Aug 21;337(8):509–515. doi: 10.1056/NEJM199708213370801. [DOI] [PubMed] [Google Scholar]
- Brown Z. A., Vontver L. A., Benedetti J., Critchlow C. W., Sells C. J., Berry S., Corey L. Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med. 1987 Nov 12;317(20):1246–1251. doi: 10.1056/NEJM198711123172002. [DOI] [PubMed] [Google Scholar]
- Cowan F. M., Johnson A. M., Ashley R., Corey L., Mindel A. Antibody to herpes simplex virus type 2 as serological marker of sexual lifestyle in populations. BMJ. 1994 Nov 19;309(6965):1325–1329. doi: 10.1136/bmj.309.6965.1325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cunningham A. L., Lee F. K., Ho D. W., Field P. R., Law C. L., Packham D. R., McCrossin I. D., Sjögren-Jansson E., Jeansson S., Nahmias A. J. Herpes simplex virus type 2 antibody in patients attending antenatal or STD clinics. Med J Aust. 1993 Apr 19;158(8):525–528. doi: 10.5694/j.1326-5377.1993.tb121867.x. [DOI] [PubMed] [Google Scholar]
- Douglas J. M., Critchlow C., Benedetti J., Mertz G. J., Connor J. D., Hintz M. A., Fahnlander A., Remington M., Winter C., Corey L. A double-blind study of oral acyclovir for suppression of recurrences of genital herpes simplex virus infection. N Engl J Med. 1984 Jun 14;310(24):1551–1556. doi: 10.1056/NEJM198406143102402. [DOI] [PubMed] [Google Scholar]
- Fleming D. T., McQuillan G. M., Johnson R. E., Nahmias A. J., Aral S. O., Lee F. K., St Louis M. E. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997 Oct 16;337(16):1105–1111. doi: 10.1056/NEJM199710163371601. [DOI] [PubMed] [Google Scholar]
- Forsgren M., Skoog E., Jeansson S., Olofsson S., Giesecke J. Prevalence of antibodies to herpes simplex virus in pregnant women in Stockholm in 1969, 1983 and 1989: implications for STD epidemiology. Int J STD AIDS. 1994 Mar-Apr;5(2):113–116. doi: 10.1177/095646249400500207. [DOI] [PubMed] [Google Scholar]
- Frenkel L. M., Garratty E. M., Shen J. P., Wheeler N., Clark O., Bryson Y. J. Clinical reactivation of herpes simplex virus type 2 infection in seropositive pregnant women with no history of genital herpes. Ann Intern Med. 1993 Mar 15;118(6):414–418. doi: 10.7326/0003-4819-118-6-199303150-00003. [DOI] [PubMed] [Google Scholar]
- Garland S. M. Neonatal herpes simplex: Royal Women's Hospital 10-year experience with management guidelines for herpes in pregnancy. Aust N Z J Obstet Gynaecol. 1992 Nov;32(4):331–334. doi: 10.1111/j.1479-828x.1992.tb02845.x. [DOI] [PubMed] [Google Scholar]
- Hall S. M., Glickman M. Report from the British Paediatric Surveillance Unit. Arch Dis Child. 1990 Jul;65(7):807–809. doi: 10.1136/adc.65.7.807. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ho D. W., Field P. R., Irving W. L., Packham D. R., Cunningham A. L. Detection of immunoglobulin M antibodies to glycoprotein G-2 by western blot (immunoblot) for diagnosis of initial herpes simplex virus type 2 genital infections. J Clin Microbiol. 1993 Dec;31(12):3157–3164. doi: 10.1128/jcm.31.12.3157-3164.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ho D. W., Field P. R., Sjögren-Jansson E., Jeansson S., Cunningham A. L. Indirect ELISA for the detection of HSV-2 specific IgG and IgM antibodies with glycoprotein G (gG-2). J Virol Methods. 1992 Mar;36(3):249–264. doi: 10.1016/0166-0934(92)90056-j. [DOI] [PubMed] [Google Scholar]
- Kulhanjian J. A., Soroush V., Au D. S., Bronzan R. N., Yasukawa L. L., Weylman L. E., Arvin A. M., Prober C. G. Identification of women at unsuspected risk of primary infection with herpes simplex virus type 2 during pregnancy. N Engl J Med. 1992 Apr 2;326(14):916–920. doi: 10.1056/NEJM199204023261403. [DOI] [PubMed] [Google Scholar]
- Malm G., Berg U., Forsgren M. Neonatal herpes simplex: clinical findings and outcome in relation to type of maternal infection. Acta Paediatr. 1995 Mar;84(3):256–260. doi: 10.1111/j.1651-2227.1995.tb13625.x. [DOI] [PubMed] [Google Scholar]
- Mindel A., Estcourt C. Public and personal health implications of asymptomatic viral shedding in genital herpes. Sex Transm Infect. 1998 Dec;74(6):387–389. [PubMed] [Google Scholar]
- Mindel A., Weller I. V., Faherty A., Sutherland S., Hindley D., Fiddian A. P., Adler M. W. Prophylactic oral acyclovir in recurrent genital herpes. Lancet. 1984 Jul 14;2(8394):57–59. doi: 10.1016/s0140-6736(84)90237-x. [DOI] [PubMed] [Google Scholar]
- Nahmias A. J., Lee F. K., Beckman-Nahmias S. Sero-epidemiological and -sociological patterns of herpes simplex virus infection in the world. Scand J Infect Dis Suppl. 1990;69:19–36. [PubMed] [Google Scholar]
- Persson K., Månsson A., Jönsson E., Nordenfelt E. Decline of herpes simplex virus type 2 and Chlamydia trachomatis infections from 1970 to 1993 indicated by a similar change in antibody pattern. Scand J Infect Dis. 1995;27(3):195–199. doi: 10.3109/00365549509019008. [DOI] [PubMed] [Google Scholar]
- Randolph A. G., Washington A. E., Prober C. G. Cesarean delivery for women presenting with genital herpes lesions. Efficacy, risks, and costs. JAMA. 1993 Jul 7;270(1):77–82. [PubMed] [Google Scholar]
- Straus S. E., Takiff H. E., Seidlin M., Bachrach S., Lininger L., DiGiovanna J. J., Western K. A., Smith H. A., Lehrman S. N., Creagh-Kirk T. Suppression of frequently recurring genital herpes. A placebo-controlled double-blind trial of oral acyclovir. N Engl J Med. 1984 Jun 14;310(24):1545–1550. doi: 10.1056/NEJM198406143102401. [DOI] [PubMed] [Google Scholar]
- Sullivan-Bolyai J., Hull H. F., Wilson C., Corey L. Neonatal herpes simplex virus infection in King County, Washington. Increasing incidence and epidemiologic correlates. JAMA. 1983 Dec 9;250(22):3059–3062. [PubMed] [Google Scholar]
- Vonau B., Low-Beer N., Barton S. E., Smith J. R. Antenatal serum screening for genital herpes: a study of knowledge and attitudes of women at a central London hospital. Br J Obstet Gynaecol. 1997 Mar;104(3):347–349. doi: 10.1111/j.1471-0528.1997.tb11466.x. [DOI] [PubMed] [Google Scholar]
- Wald A., Zeh J., Barnum G., Davis L. G., Corey L. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):8–15. doi: 10.7326/0003-4819-124-1_part_1-199601010-00002. [DOI] [PubMed] [Google Scholar]
- Weinberg A., Canto C. L., Pannuti C. S., Kwang W. N., Garcia S. A., Zugaib M. Herpes simplex virus type 2 infection in pregnancy: asymptomatic viral excretion at delivery and seroepidemiologic survey of two socioeconomically distinct populations in São Paulo, Brazil. Rev Inst Med Trop Sao Paulo. 1993 May-Jun;35(3):285–290. doi: 10.1590/s0036-46651993000300011. [DOI] [PubMed] [Google Scholar]
- Whitley R., Arvin A., Prober C., Burchett S., Corey L., Powell D., Plotkin S., Starr S., Alford C., Connor J. A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection. Infectious Diseases Collaborative Antiviral Study Group. N Engl J Med. 1991 Feb 14;324(7):444–449. doi: 10.1056/NEJM199102143240703. [DOI] [PubMed] [Google Scholar]