南非队列研究中与包括生殖器疱疹病毒2型排毒在内的性传播感染相关的妊娠结局

Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study.

作者信息

Moodley Dhayendre, Sartorius Benn, Madurai Savithree, Chetty Vani, Maman Suzanne

机构信息

Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa.

Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

出版信息

Sex Transm Infect. 2017 Nov;93(7):460-466. doi: 10.1136/sextrans-2017-053113. Epub 2017 Apr 10.

DOI:10.1136/sextrans-2017-053113

PMID:28396556

Abstract

OBJECTIVES

Genital herpes simplex virus-2 (HSV-2) shedding in pregnant women in association with neonatal herpes infection has been widely studied but there is limited evidence of its association with pregnancy outcomes.

METHODS

In his retrospective observational study, we included a subgroup of pregnant women who were enrolled in a randomized control behavioural intervention study that was conducted in South Africa in 2008-2010. In pregnancy, women had a HIV rapid test done and a genital swab taken to test for curable STIs and HSV-2 DNA. Subsequent visits were scheduled for 6, 10, 14 weeks and 9 months post-delivery. Pregnancy outcomes were documented at the 6-week or 10-week postpartum visit. Women were treated syndromically for curable STIs.

RESULTS

Among 615 women included in this data analysis, 36.6% (n=225) tested HIV positive and 8.3% (n=51) tested positive for genital HSV-2 shedding during pregnancy. Women <24 years and HIV-1 seropositive women were 1.5 and 2.5 times more likely to test positive for HSV-2 genital shedding respectively. STI treatment records were available for 158/205 (77.1%) women; all 87 women with symptomatic STIs were treated the same day, and 50/71 (70.4%) asymptomatic women received treatment at the subsequent visit. Remaining 21 (29.6%) asymptomatic women did not receive treatment because they failed to return for antenatal follow-up. In a multivariable regression analysis, genital HSV-2 shedding, HIV-1, , and were not associated with preterm deliveries, still births and low birth weight. However with stratification by treatment for a STI, asymptomatic women who were not treated were 3.3 times more likely to deliver prematurely (33.3%; n=6/18) when compared to women who were treated during pregnancy (13.2%; n=15/114) (p=0.042).

CONCLUSIONS

Genital HSV-2 shedding in pregnancy does not appear to alter pregnancy outcomes. Untreated curable STIs () were more likely associated with preterm births.

摘要

目的

孕妇单纯疱疹病毒2型（HSV - 2）排毒与新生儿疱疹感染的相关性已得到广泛研究，但关于其与妊娠结局相关性的证据有限。

方法

在这项回顾性观察研究中，我们纳入了一组孕妇亚组，她们参加了2008 - 2010年在南非进行的一项随机对照行为干预研究。在孕期，女性接受了HIV快速检测，并采集了生殖器拭子以检测可治愈的性传播感染和HSV - 2 DNA。随后的随访安排在产后6周、10周、14周和9个月。妊娠结局在产后6周或10周的随访中记录。对可治愈的性传播感染，女性接受症状性治疗。

结果

在纳入此次数据分析的615名女性中，36.6%（n = 225）HIV检测呈阳性，8.3%（n = 51）在孕期生殖器HSV - 2排毒检测呈阳性。年龄<24岁的女性和HIV - 1血清阳性女性生殖器HSV - 2排毒检测呈阳性的可能性分别是其他女性的1.5倍和2.5倍。158/205（77.1%）名女性有性传播感染治疗记录；所有87名有症状性传播感染的女性在当天接受了治疗，50/71（70.4%）名无症状女性在随后的随访中接受了治疗。其余21名（29.6%）无症状女性未接受治疗，因为她们未返回进行产前随访。在多变量回归分析中，生殖器HSV - 2排毒、HIV - 1等与早产、死产和低出生体重无关。然而，按性传播感染治疗情况分层后，未接受治疗的无症状女性早产的可能性是孕期接受治疗女性的3.3倍（33.3%；n = 6/18），而孕期接受治疗的女性早产率为13.2%（n = 15/114）（p = 0.042）。