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. 2023 Mar 4;10(3):ofad099.
doi: 10.1093/ofid/ofad099. eCollection 2023 Mar.

Genital Herpes Simplex Virus Type 2 Suppression With Valacyclovir Is Not Associated With Changes in Nugent Score or Absolute Abundance of Key Vaginal Bacteria

Tara M Babu  1 , Sujatha Srinivasan  2 , Amalia Magaret  3 , Sean Proll  2 , Helen Stankiewicz Karita  1   2 , Jacqueline M Wallis  2 , Stacy Selke  1 , Dana Varon  1 , Thepthara Pholsena  1 , David Fredricks  1   2 , Jeanne Marrazzo  4 , Anna Wald  1   2   5   6 , Christine Johnston  1   2   5
Affiliations

Genital Herpes Simplex Virus Type 2 Suppression With Valacyclovir Is Not Associated With Changes in Nugent Score or Absolute Abundance of Key Vaginal Bacteria

Tara M Babu et al. Open Forum Infect Dis. .

Abstract

Background: In women, genital herpes simplex virus type 2 (HSV-2) infection is associated with increased risk for recurrent bacterial vaginosis (BV), but causal relationships are unclear.

Methods: Women with a self-reported history of BV and HSV-2 seropositivity self-collected vaginal and anogenital swabs for 2 nonconsecutive 28-day periods, in the absence or presence of valacyclovir suppressive therapy (500 mg daily). HSV polymerase chain reaction was performed on anogenital swabs; vaginal swabs were used for assessment of BV by Nugent score and quantification of vaginal microbiota. Days with BV, defined by Nugent score ≥7, were compared during the observational period and valacyclovir treatment.

Results: Forty-one women collected swabs for a median of 28 days (range, 20-32 days) each study period. The HSV-2 shedding rate decreased from 109 of 1126 days (9.7%) presuppression to 6 of 1125 days (0.05%) during valacyclovir (rate ratio [RR], 0.06 [95% confidence interval {CI}, .02-.13]). BV occurred on 343 of 1103 days (31.1%) during observation and 302 of 1091 days (27.7%) during valacyclovir (RR, 0.90 [95% CI, .68-1.20]). The median per-person Nugent score was 3.8 during observation and 4.0 during valacyclovir. Average log10 concentrations of vaginal bacterial species did not change significantly during valacyclovir treatment.

Conclusions: Short-term HSV-2 suppression with valacyclovir did not significantly affect the Nugent score or the vaginal microbiome despite potent suppression of HSV-2 shedding.

Keywords: bacterial vaginosis; herpes simplex virus; microbiome; vaginitis.

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Conflict of interest statement

Potential conflicts of interest. S. S. has received a speaking honorarium from Lupin Inc. A. W. reports receiving funding from the NIH, including as a coinvestigator in the Novavax and Gritstone coronavirus disease 2019 (COVID-19) vaccine trials. She also reports receiving financial support through her institution from Sanofi and GSK for research unrelated to COVID-19. C. J. is a consultant for and has received grants from Gilead; has served as a consultant for GSK and AbbVie; and receives royalties from UpToDate. D. F. reports royalties from BD. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
A, Herpes simplex virus type 2 (HSV-2) detection rate by quantitative polymerase chain reaction by study day during the observational period and valacyclovir suppression. The number of days with swabs collected is noted above each bar. B, Bacterial vaginosis positivity (Nugent score >7) rate during the observational period and valacyclovir suppression phase.
Figure 2.
Figure 2.
Frequency of bacterial vaginosis (by Nugent scores) by number of participants and days during the observational period and valacyclovir suppression phase, with Nugent scores grouped as optimal (0–3), intermediate (4–6), or high (7–10).
Figure 3.
Figure 3.
A, Proportion of days with bacterial vaginosis (BV) per participant during baseline and treatment phase with valacyclovir. Data for each participant are indicated by a single row, with proportion of days with BV during the observational period (orange or left of 0%) and during valacyclovir suppression (blue or right of 0%). Participants 33–41 did not have any days with BV during either the observational or valacyclovir suppression periods. B, Median Nugent score over all days for participants during the baseline and treatment phase with valacyclovir. Data for each participant are indicated by a single row, with median Nugent score during the observational period (orange or left of 0) and during valacyclovir suppression (blue or right of 0).
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