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Clinical reactivation of herpes simplex virus type 2 infection of seropositive pregnant women with no history of genital herpes
JNhf’sEditorialBowd is happy to onnounce the birth of JoumalReuiews. The format of this new column will include both Qsynopsis and o critique of selected articles rebfeuedfmm the mastrecentpm&siondjoumolf We encourage our readers to contribute to this column and thank the contrfbutors who mode this&i columnpossible. Submissions should be in accordonce with JNM Publication Guidelinex Frtmhl LM. Garratty EM. Shen JP. Wheeler N, Clark 0. Bnyson YJ. Clinical reactivation of herpes simplex virus type 2 infection of seropxitive pregnant women with no history of g&al herpes. Ann Intern Med 1993;18:414-8. Revfawd by: Betty Chem-Hughes, CNM, MS, Staff Nurse-Midwife, Fort D&nco Indian Hospital, Fort Da? awe, AZ.
SWWThis was a prospective fnceptton cohort study of 1,355 mostly white, upper-middle-class. married women from three private obstetric practices in Los Angela From 19535-1989. routine serolo@c testing for herpes simplex virus (HSV) (Western blot).
as well as third-timester and intmparturn genital cultures from pregnant women with no prior history of genital herpes were obtained. Selfcompleted patient and partner demoqraphic-sexual practices quationnaires were a!so bbtained. Analysis of the results disclosed that seroprevalence of HSV-2 infection was high (32%) in this group, and asymptomatic tlSV shedding was infrequent (0.4381. Foriy-three of 264 sempaitive women 116%). many of whom were near term, rec. ognized herpetic genital lesions for the first time during their pregnancy. Risk factors for fiSV-2 &r&i&ity included younger age at first intercourse. a greater number of sexual partners, and a history of sexually transmitted diseases. Study participants also reported that they had a history of yeast infections and a pan 01 present sexual partner with genital herpes. However, the &stic reyres_ sion of dsk factors only predicted seropositivity in 68% of the participants and seronegativity in 62%.
model analysis
Commentary Because this study primarily consisted of middle class, white women, further study with a more diverse population is needed.
Serolcqic testing for HSV-2 as a valid. reliable test for screann3 and diagnosis has yet to be demonstrated. CNMs wad to be aware of the clinical relevance of the t&s they consider. In addition, clinical relevance and cost-effectiveness need further investigation. The finding of posittw serologic an&or viral culture results in asymp tomatic women at delivery have not been shown to increase morbidity in the newborn. The study authors awee that until advames allow rauid aid accurate diagnosis or pwndon of HSV at delivery, it is recommended that all pregnant wmen be educated regardirg the higb prevalence of HSV-2 infection. Because it is dif6cult to diasnw bv sexual risk factors ai by li&ued s&logic tests, wxnen should be encouraged to bring suspected kstons to the attention of their health care provider. Lucas MJ. Lowe TW. Bowe L, M&tire DD. Class A-l gestational diabetes: a meaningful diagnosis? Gbstet Gynecol1993$32:260-5. Reviewed by: Laura Zeidenstein, CNM.MSN,Assistant Professor, NurseMidwifery Education Program. SUNY/Health Science Center at Brooklyn; Pdvat? Practice. NurseMidwifery Associates, Brooklyn. New YOdi.
SWWThis was a prospective fnceptton cohort study of 1,355 mostly white, upper-middle-class. married women from three private obstetric practices in Los Angela From 19535-1989. routine serolo@c testing for herpes simplex virus (HSV) (Western blot).
as well as third-timester and intmparturn genital cultures from pregnant women with no prior history of genital herpes were obtained. Selfcompleted patient and partner demoqraphic-sexual practices quationnaires were a!so bbtained. Analysis of the results disclosed that seroprevalence of HSV-2 infection was high (32%) in this group, and asymptomatic tlSV shedding was infrequent (0.4381. Foriy-three of 264 sempaitive women 116%). many of whom were near term, rec. ognized herpetic genital lesions for the first time during their pregnancy. Risk factors for fiSV-2 &r&i&ity included younger age at first intercourse. a greater number of sexual partners, and a history of sexually transmitted diseases. Study participants also reported that they had a history of yeast infections and a pan 01 present sexual partner with genital herpes. However, the &stic reyres_ sion of dsk factors only predicted seropositivity in 68% of the participants and seronegativity in 62%.
model analysis
Commentary Because this study primarily consisted of middle class, white women, further study with a more diverse population is needed.
Serolcqic testing for HSV-2 as a valid. reliable test for screann3 and diagnosis has yet to be demonstrated. CNMs wad to be aware of the clinical relevance of the t&s they consider. In addition, clinical relevance and cost-effectiveness need further investigation. The finding of posittw serologic an&or viral culture results in asymp tomatic women at delivery have not been shown to increase morbidity in the newborn. The study authors awee that until advames allow rauid aid accurate diagnosis or pwndon of HSV at delivery, it is recommended that all pregnant wmen be educated regardirg the higb prevalence of HSV-2 infection. Because it is dif6cult to diasnw bv sexual risk factors ai by li&ued s&logic tests, wxnen should be encouraged to bring suspected kstons to the attention of their health care provider. Lucas MJ. Lowe TW. Bowe L, M&tire DD. Class A-l gestational diabetes: a meaningful diagnosis? Gbstet Gynecol1993$32:260-5. Reviewed by: Laura Zeidenstein, CNM.MSN,Assistant Professor, NurseMidwifery Education Program. SUNY/Health Science Center at Brooklyn; Pdvat? Practice. NurseMidwifery Associates, Brooklyn. New YOdi.