In the Journals

HSV-2 shedding increases after circumcision of HIV coinfected men

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May 26, 2015

Penile shedding of herpes simplex virus type 2 appeared to be more prevalent among men coinfected with HIV in the weeks after circumcision, according to recently published data.

“Randomized trials have shown that male circumcision (MC) significantly decreases male heterosexual acquisition of HIV, HPV and HSV-2,” the researchers wrote. “[In a previous study,] both the number of HIV shedding events and the quantity of virus shed from the MC wound were significantly elevated in ART-naive HIV-positive men, in the first 3 weeks after MC. “It is unknown if MC also increases the frequency and intensity of HSV-2 shedding after surgery.”

Researchers examined changes in HIV and HSV-2 shedding among Ugandan men offered free MC services from June 2009 to April 2012. Of these, 176 were HIV/HSV-2 coinfected and provided lavage samples before and after the procedure. Participants self-reported information on sociodemographics, ART use and sexual behavior upon enrollment. Baseline rates of HSV-2 penile shedding were compared with those obtained at weekly follow-ups for 6 weeks, and then at 8 weeks and 12 weeks.

Median time to a fully healed MC wound was 4 weeks, with healed wounds being observed among all participants by week 6. Nine percent of participants reported resuming sexual activity by week 4; 68% reported sexual activity by week 6.

Before MC, HSV-2 shedding was detected among 9.7% of participants. Shedding among participants increased to 12.9% of men 1 week after surgery (prevalence risk ratio [PRR] = 1.33; 95% CI, 0.75-2.38) and 14.8% after 2 weeks (PRR = 1.5; 95% CI, 0.86-2.62). Shedding was less prevalent than baseline at 4 weeks (5.7%; PRR = 0.58; 95% CI, 0.26-1.31) and 6 weeks (6.9%; PRR = 0.71; 95% CI, 0.36-1.41). In addition, viral load was greater only at week 1 among men with detectable shedding, but not statistically significant.

“We observed an increase in the number of men shedding HSV-2 immediately after MC and higher HSV-2 viral loads in this study, although the results were not statistically significant,” the researchers wrote. “HIV and HSV-2 coinfected men receiving MC, and their partners, should be counseled on the possible risk of HIV and HSV-2 transmission. MC programs should promote voluntary HIV counseling and testing, sexual abstinence during wound healing and condom use thereafter.” — by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.

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