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Wednesday, May 10, 2006
271

Predictors and pregnancy in incident Herpes simplex type 2 infections in young women using community clinics

Nicholas Moss1, Cynthia Harper2, Katherine Ahrens1, Charlotte K. Kent1, Katherine C. Scott1, Susan Kao1, Sally Liska3, Corinne Rocca2, Richard Fisher4, Nancy Padian2, Tina Raine2, Philip Darney2, and Jeffrey D. Klausner1. (1) STD Prevention and Control Services, San Francisco Department of Public Health, 1360 Mission St, Suite 401, San Francisco, CA, USA, (2) Deptartment of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Center for Reproductive Health Research and Policy, San Francisco, CA, (3) San Francisco Public Health Laboratory, 101 Grove St, Rm 419, San Francisco, CA, USA, (4) Planned Parenthood Mar Monte, San Jose, CA


Background:
Young women are at increased risk for Herpes simplex virus type 2 (HSV-2) and newly acquired HSV-2 infection during pregnancy increases the risk for neonatal complications.

Objective:
To determine current predictors of incident genital HSV-2 infection in young women attending community clinics in San Francisco, 2001-2003.

Method:
Fifteen to 24 year-old women were recruited from two Planned Parenthood clinics and two community teen clinics to participate in a cohort study of emergency contraception. Demographic information and sexual history were obtained by interview. HSV-2 antibody screening was performed using a fingerstick blood test (POCkit HSV-2 Rapid Test, Diagnology Inc, Dublin Ireland) at enrollment and at a six-month follow-up. New pregnancies were measured by self-report, clinic records and by urine testing (Clearview One Step, Unipath Diagnostics, Waltham, Mass).

Result:
Of 2104 women tested at baseline---31% White, 22% Asian/Pacific Islander, 20% Latina, 15% African American, 12% other---170 (8.1%) were HSV-2 seropositive. Of 1672 women initially seronegative, 73 (4.4%) became HSV-2 antibody positive at follow-up. Incidence was 8.7 cases per 100 person-years. Also, 117 women became pregnant: 7 (6%) of these had seroincident HSV-2 infection giving a rate of 12.0 cases per 100 person-years. In a multivariate model predictors of incident infection African American race and multiple partners in the 6 months prior to enrollment. Condom use at the last sexual encounter before enrollment was protective.

Conclusion:
Incidence of HSV-2 seroconversion in young women attending community clinics in San Francisco was high. This is concerning given the pregnancy rate in this population. Effective prevention interventions such as condom use should be promoted to decrease HSV-incidence in those at most risk.

Implications:
Clinicians should be aware of the risk for HSV-2 infection in young women who may become pregnant. Our study demonstrates a need for interventions aimed at preventing acquisition of HSV-2 infection during pregnancy.

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