The Effect of Hormonal Contraception and Menstrual Cycle Timing on Genital Herpes Simplex Virus-2 Shedding and Lesions

Sex Transm Dis. 2019 Jan;46(1):58-62. doi: 10.1097/OLQ.0000000000000907.


Background: The effect of female sex hormones on herpes simplex virus (HSV)-2 shedding and lesion frequency is poorly understood. Previous studies suggest that hormonal contraception may increase the frequency of HSV-2 shedding.

Methods: We studied HSV-2 seropositive women who performed daily genital swabbing for HSV DNA and completed diaries for genital lesions and menses. We used Poisson mixed effects models to determine if HSV detection varied throughout the menstrual cycle, or in response to hormonal contraception. We used the Wilcoxon signed-rank test and rank-sum test to determine if lesion frequency differed by cycle phase or hormonal contraceptive use.

Results: In 189 women aged 19 to 46 years who collected swabs on 10,715 days and were not using hormonal contraception, HSV-2 DNA was detected on 20.9% of days in the follicular phase and 17.8% of days in the luteal phase (rate ratio, 1.19; 95% confidence interval, 1.03-1.37, P = 0.02). Genital lesions did not differ in the follicular versus luteal phase (12.8% vs. 10.7%, P = 0.07). In analyses of hormonal contraception, including 244 women, HSV-2 DNA was detected on 19.0% of days for women not using hormonal contraception and 18.3% of days for those using hormonal contraception (P = 0.50). Lesions were present on 11.1% of days for women not using hormonal contraception, and 8.7% of days for those using hormonal contraception (P = 0.66).

Conclusions: In women with genital HSV-2 infection who are not using hormonal contraception, the follicular phase of the cycle may be associated with a higher frequency of HSV-2 shedding compared to the luteal phase. Lesion frequency is similar during the 2 menstrual phases. Hormonal contraception use was not observed to affect genital HSV-2 DNA detection or lesions.

Publication types

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

MeSH terms

  • Adult
  • DNA, Viral / analysis
  • Female
  • Genitalia, Female / pathology*
  • Genitalia, Female / virology
  • Herpes Genitalis / physiopathology*
  • Herpes Genitalis / virology
  • Herpesvirus 2, Human / genetics
  • Herpesvirus 2, Human / physiology
  • Hormonal Contraception*
  • Humans
  • Menstrual Cycle*
  • Middle Aged
  • Statistics, Nonparametric
  • Virus Shedding*
  • Young Adult


  • DNA, Viral