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

Abstract

Objective: 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.

Method: 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.

Results: 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.

Conclusion: 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.