Genital Herpes Simplex Virus Type 2 Shedding Among Adults With and Without HIV Infection in Uganda

J Infect Dis. 2016 Feb 1;213(3):439-47. doi: 10.1093/infdis/jiv451. Epub 2015 Oct 20.


Background: Despite the high prevalence of herpes simplex virus type 2 (HSV-2) in sub-Saharan Africa, the natural history of infection among Africans is not well characterized. We evaluated the frequency of genital HSV shedding in HIV-seropositive and HIV-seronegative men and women in Uganda.

Methods: Ninety-three HSV-2-seropositive Ugandan adults collected anogenital swab specimens for HSV DNA quantification by polymerase chain reaction 3 times daily for 6 weeks.

Results: HSV-2 was detected from 2484 of 11 283 swab specimens collected (22%), with a median quantity of 4.3 log10 HSV copies/mL (range, 2.2-8.9 log10 HSV copies/mL). Genital lesions were reported on 749 of 3875 days (19%), and subclinical HSV shedding was detected from 1480 of 9113 swab specimens (16%) collected on days without lesions. Men had higher rates of total HSV shedding (relative risk [RR], 2.0 [95% confidence interval {CI}, 1.3-2.9]; P < .001); subclinical shedding (RR, 1.7 [95% CI, 1.1-2.7]; P = .01), and genital lesions (RR, 2.1 [95% CI, 1.2-3.4]; P = .005), compared with women. No differences in shedding rates or lesion frequency were observed based on HIV serostatus.

Conclusions: HSV-2 shedding frequency and quantity are high among HSV-2-seropositive adults in sub-Saharan Africa, including persons with and those without HIV infection. Shedding rates were particularly high among men, which may contribute to the high prevalence of HSV-2 and early acquisition among African women.

Keywords: Africa; HSV-2; genital herpes; human herpesvirus-2; viral shedding.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • DNA, Viral / genetics
  • Female
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • Herpes Genitalis / complications
  • Herpes Genitalis / epidemiology
  • Herpes Genitalis / virology*
  • Herpesvirus 2, Human / genetics
  • Herpesvirus 2, Human / physiology*
  • Humans
  • Male
  • Middle Aged
  • Simplexvirus / physiology*
  • Uganda / epidemiology
  • Virus Shedding / physiology*
  • Young Adult


  • DNA, Viral