Cervical shedding of herpes simplex virus and cytomegalovirus throughout the menstrual cycle in women infected with human immunodeficiency virus type1

OBJECTIVE: Our purpose was to evaluate the frequency and patterns of the sh edding of herpes simplex virus and cytomegalovirus in the female genital tr act throughout the menstrual cycle. STUDY DESIGN: Seventeen women, all seropositive for herpes simplex virus ty pes 1 and 2, cytomegalovirus, and human immunodeficiency virus type 1, unde rwent daily evaluation of cervical viral shedding for the duration or 1 men strual cycle (21-31 visits per woman). Serum estradiol and progesterone lev els were monitored 3 times weekly. RESULTS: Overall, herpes simplex virus deoxyribonucleic acid was detected i n 43 (10%) of 450 cervical swabs, and cytomegalovirus deoxyribonucleic acid was detected in 232 (52%) of 450 cervical swabs. For individual women ther e was considerable variability in the percentage of days on which virus was detected, ranging from 0% to 33% for herpes simplex Virus and from 20% to 97% for cytomegalovirus. Shedding of herpes simplex virus did not vary sign ificantly with menstrual cycle; however, shedding of cytomegalovirus was si gnificantly more frequent in the luteal phase (odds ratio, 1.9, 95% confide nce interval, 1.1-3.4). A CD4(+) lymphocyte count <200/<mu>L was associated with increased frequency of the detection of herpes simplex virus (odds ra tio, 5.7; 95% confidence interval, 1.1-29.4). CONCLUSIONS: Asymptomatic cervical shedding of both herpes simplex virus an d cytomegalovirus occurs very frequently in women infected with human immun odeficiency virus type 1. The risk of transmitting these viruses to sexual partners and neonates may be higher than previously recognized.