Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2011, Article ID 874820, 10 pages doi:10.1155/2011/874820 Clinical Study HSV Serologic Testing for Pregnant Women: Willingness to Be Tested and Factors Affecting Testing David A. Baker,1 Andrea Pressley,1 Lillian Meek,1 Reinaldo Figueroa,1 Barbara Yates,2 and Lynn Dix2 1 Division of Infectious Diseases, Department of Obstetrics, Gynecology, and Reproductive Medicine, School of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-8091, USA 2 GlaxoSmithKline, Research Triangle Park, Durham, NC, USA Correspondence should be addressed to David A. Baker, dbaker@notes.cc.sunysb.edu Received 12 November 2010; Accepted 22 January 2011 Academic Editor: J. Paavonen Copyright © 2011 David A. Baker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. This prospective study was undertaken to evaluate pregnant women’s willingness to undergo HSV type-speciﬁc serologic testing and factors aﬀecting willingness in an obstetrics/gynecology ambulatory unit. Methods. At prenatal Visit 1, pregnant women (n = 303) with no history of HSV-2 were tested for HSV-1/HSV-2 before and after they received counseling on genital and neonatal herpes. Results. In both the Unwilling Subgroup and the group that changed from being willing to being unwilling, the most common reasons for choosing not to be tested were not being at risk for genital herpes, being tested is too personal, and concern about what will be done with the results. Of the 134 participants in the Willing/Tested Subgroup, 27 (20%) were HSV-2 seropositive and 81 (60%) were HSV-1 seropositive. Conclusions. These results support the feasibility of HSV serologic testing and counseling in pregnant women. 1. Introduction An estimated 45 million people in the United States, includ- ing approximately 1 in 5 pregnant women (22%), have genital herpes caused by herpes simplex virus-2 (HSV-2) [1–3]. HSV-1 infection, also highly prevalent in the United States, aﬀects approximately two thirds of pregnant women (63%) [3]. HSV infection in pregnancy is of particular concern because of one of its most devastating sequelae— neonatal herpes, which is associated with signiﬁcant neu- rodevelopmental impairment or death in at least one third of infected babies [4]. Caused by intrapartum exposure of the fetus to HSV-2 or, less frequently, HSV-1, neonatal herpes has been estimated to aﬀect approximately 1500 infants annually in the United States although recent ﬁndings suggest a higher incidence [5–7]. Means of reducing risk of HSV transmission to the neonate are directed at women with established, symp- tomatic infection: using antiviral prophylaxis during the last 4 weeks of pregnancy delivering via cesarean section instead of vaginally and limiting the use of invasive procedures in women shedding HSV during labor [4, 8]. Because these strategies do not address prevention of maternal HSV acquisition during pregnancy or subclinical HSV infections (∼90% of HSV infections), they prevent only an estimated 20% to 30% of cases of neonatal herpes [9]. The majority of HSV infections in pregnancy are undiagnosed and are therefore not addressed by current preventative strategies [10]. For example, in a recent study of infants born to 252,474 mothers from January 1997 to June 2002 in a large US managed-care database, a prior diagnosis of HSV infection had been made in only 12% of mothers who gave birth to infants with neonatal HSV [6]. Because awareness of maternal HSV status is integral to eﬀorts to prevent viral transmission to the neonate, improvement in diagnosis of genital herpes among pregnant women is warranted. Type-speciﬁc serological tests, which can detect HSV regardless of whether lesions are present, constitute the most eﬀective means of diagnosing HSV. Many experts recommend routine HSV serologic testing during