Screening for subclinical genital herpes in pregnant females - A neglected practice

The present study was aimed to screen the Herpes simplex virus (HSV) infection in cervical smears of clinically suspicious to asymptomatic pregnant women of local population.

This descriptive cross-sectional study was conducted at the Department of Histopathology, University of Health Sciences Lahore, Pakistan from August 2021 to September 2022. A total of N=120 cervical smears were taken from the pregnant females of gestation age 18-38 weeks, visiting the outpatient department (OPD) of Gynecology & Obstetrics, Jinnah Hospital Lahore. Endocervical smears were taken; cell block and cytospin preparations were prepared. The cytological changes were categorized according to the updated Bethesda Classification System 2014 and the samples were screened for the presence of HSV 1 & 2 through immunocytochemistry (ICC), immunohistochemistry (IHC) and Immunofluorescence (IF). SPSS version 25.0 was used to analyze the data and p-Value of ≤ 0.05 was considered as statistically significant.

Out of N=120 pregnant females, 12.5% were positive for HSV on ICC while 2.5% cases showed positive nuclear staining for HSV on cell block by IHC. On IF staining, around 7.5% samples were positive for HSV by cytospin method whereas 15% cases showed positivity for HSV on cell block method. Typical herpetic genital lesions were observed in 13% of HSV positive females (p=0.043). Pap staining of cervical smears revealed negative for intraepithelial lesion or malignancy (NILM) in 90% of the samples while 10% of the cases were suggestive of atypical squamous cells of undetermined significance (ASCUS). Moreover, 13% cases showed candida albicans on culture test. None of the subjects showed positive Trichomonas vaginalis on wet smears.

Early and effective diagnosis of sub-clinical cervico-vaginal HSV infection in pregnant females by adopting minimally invasive cytological techniques and immunofluorescent staining may lead to reduced morbidity and mortality.