Herpes simplex virus type 2 infection among bar and hotel workers in northern Tanzania: prevalence and risk factors

BACKGROUND: Type-specific serological tests have allowed for a better understanding of the epidemiology of herpes simplex virus type 2 (HSV-2) infection in Africa. GOAL: The goal was to determine risk factors for HSV-2 among bar and hotel workers in Moshi, Tanzania. STUDY DESIGN: A cross-sectional study was conducted involving 515 workers in randomly selected bars and hotels in Moshi. RESULTS: The seroprevalence of HSV-2 was 43.5%. Women were more likely to be HSV-2-seropositive than men (age-adjusted OR = 3.8; 95% CI = 2.5-5.8). In multivariate analyses, age was positively associated with HSV-2 in both women and men. HIV-1-seropositive women had a significantly increased risk of HSV-2 infection (adjusted OR = 2.8; 95% CI = 1.5-5.1). Other predictors of HSV-2 were religion and sexual behavior for women and level of education, frequency of alcohol use, and concurrent partners for men. CONCLUSION: The most common genital infection was that with HSV-2. Control of HSV-2 might be an important strategy for HIV-1 infection prevention in this population.     

Prevalence and risk factors for herpes simplex virus type 2 antibodies among low- and high-risk populations in Indonesia

OBJECTIVES/GOAL: Data on prevalence of herpes simplex virus type 2 (HSV-2) infections are limited in Asia. This study investigated the seroprevalence of, and risk factors for, antibodies to HSV-2 among low- and high-risk, predominantly asymptomatic populations in Indonesia. STUDY DESIGN: We screened women attending maternal and child health, obstetric, gynecology, and sexually transmitted infection (STI) clinics; men attending STI clinics; and female sex workers (FSWs) for type-specific HSV-2 antibodies using the HerpesSelect 2 enzyme-linked immunosorbent assay IgG and Western blot. RESULTS: HSV-2 antibodies were detected in 153 of 176 FSWs (86.9%; 95% confidence interval [CI], 81.0-91.5); increasing age was the only significant independent risk factor (odds ratio [OR], 1.15; 95% CI, 1.06-1.24; P = 0.001). Among non-sex worker females, HSV-2 antibodies were detected in 78 of 418 (18.7%; 95% CI, 15.0-22.7); significant independent associations were any contraceptive use (OR, 2.24, 95% CI = 1.33-3.85, P = 0.003), symptoms or signs of genital ulcer (OR, 2.69; 95% CI, 1.27-5.70; P = 0.01) and younger age of sexual debut (OR, 0.92; 95% CI, 0.86-0.99; P = 0.03). HSV-2 antibodies were detected in 25 of 116 men (21.6%; 95% CI, 14.5-30.1). CONCLUSIONS: HSV-2 seroprevalence reported here is in the upper range of that reported in nearby regions. Health promotion is needed to encourage affected individuals to recognize symptoms of genital herpes and seek care and advice on reducing transmission. The high seroprevalence among FSWs has potentially serious implications for the HIV epidemic in Indonesia.     

Herpes simplex virus type 2 (HSV-2) seroprevalence at the time of HIV-1 diagnosis and seroincidence after HIV-1 diagnosis in an ethnically diverse cohort of HIV-1-infected persons

OBJECTIVE: The objective of this study was to determine herpes simplex virus type 2 (HSV-2) seroprevalence at HIV-1 diagnosis and seroincidence > or =1 year after HIV-1 diagnosis. METHODS: HSV type-specific antibodies were detected by enzyme immunoassay. RESULTS: The cohort comprised 850 adults diagnosed HIV-positive in 1986-2001 and followed for a median of 3 years. HSV-2 seroprevalence was 63% (95% confidence interval [CI], 60-66%) and was associated with female gender, heterosexual risk group, black ethnicity, and older age. HSV-2 seroincidence was 1.8 per 100 person-years (95% CI, 0.8-2.8) and was associated with other sexually transmitted diseases, including human papilloma virus infection (P = 0.005) and gonorrhea (P = 0.05). A diagnosis of genital herpes was made in 21% HSV-2-seropositive persons and was more likely in those who tested HIV-positive before 1997 (adjusted odds ratio, 5.11; 95% CI, 3.28-7.98; P = 0.0001). CONCLUSIONS: Results confirm the epidemiologic association between HIV-1 and HSV-2. HSV-2 seroconversion was a marker of high-risk sexual behavior. The likelihood of developing symptoms of genital herpes declined from 1997 onward.     

Herpes virus type 2 infection and genital symptoms in primary care patients

OBJECTIVE: We aimed to identify whether genital symptoms were associated with unrecognized herpes simplex virus type 2 (HSV-2) infection in a primary care population. STUDY DESIGN: Five thousand four hundred fifty-two individuals aged 18 to 59 seeking general care at 36 suburban medical offices in 6 U.S. cities were tested for HSV-2 antibody and asked about 10 types of genital symptoms. In patients with no known history of genital herpes, we assessed whether HSV-2 infection was independently associated with symptoms. RESULTS: HSV-2 infection was associated with increases in reports of "sores, blisters, ulcers, crusts, or small cuts/slits" in men [adjusted odds ratio (OR), 1.79; 95% CI, 1.24-2.58] and with increases in reports of "redness, irritation, or a rash" among women (adjusted OR, 1.50; 95% CI, 1.06-2.11). HSV-2 was not significantly associated with other types of genital symptoms. CONCLUSIONS: Primary-care physicians should consider unrecognized HSV-2 infection as a potential cause of some common genital symptoms.     

Type-specific seroprevalence of herpes simplex virus type 2 and associated risk factors in middle-aged women from 6 countries: the IARC multicentric study

GOAL: To determine type-specific seroprevalence of herpes simplex viruses (HSV-1 and HSV-2) and HSV-2 risk factors. STUDY DESIGN: Six-hundred fifty eight middle-aged control women (hospital-based in 4 of 6 countries) from a multicenter cervical cancer case-control study participated from 1985 to 1997. Type-specific serum IgG antibodies against HSV-1 and HSV-2 were detected with Western Blot. RESULTS: HSV-1 seroprevalence was 89% to 100% everywhere except Thailand (51%). HSV-2 seroprevalence ranged from 9% (Spain) to 57% (Colombia), and was independently associated with having >or=2 lifetime sexual partners overall [Odds ratio (OR), 2.1; 95% confidence interval (CI) 2.5-3.1], and in Morocco (OR, 2.7; 95% CI, 1.2-6.1) and Thailand (OR, 4.4; 95% CI, 1.3-15.4), and with being unmarried in Colombia, Peru, Spain, but not significantly in Mali. Women whose male partner's sexual debut was 相似文献   

High prevalence of antibodies to herpes simplex virus type 2 among middle-aged women in Mexico City, Mexico: a population-based study

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted diseases worldwide. In Mexico there is a lack of population-based HSV-2 surveys. GOALS: To determine population-based HSV-2 seroprevalence and risk factors among women in Mexico City. STUDY DESIGN: A random sample of 730 women was identified among the residents of Mexico City. Women ages 25 to 85 years were selected from 3,694 households. Western blot serology testing was conducted on serum samples to determine HSV-2 type-specific serostatus. A structured questionnaire was administered, and multivariate analyses were performed to identify risk factors for HSV-2 seropositivity, which were stratified into two age categories: younger than 50 years of age and 50 years of age or older. RESULTS: The HSV-2 seroprevalence among female participants was 29.8%, with a significant trend of increasing HSV-2 prevalence for each higher level of age (P < 0.001). Female participants had a median age of 46 years and were predominantly monogamous (82.6%). The overall population-based seroprevalence estimated in Mexico City among women was 35.8%. The independent risk factors for HSV-2 seropositivity included a history of two or more sexual partners (odds ratio [OR], 2.2; 95% CI, 1.4-3.4), two or more sexual partners before first pregnancy (OR, 2.3; 95% CI, 1.4-3.7), cohabitation with partner (OR, 2.5; 95% CI, 1.3-4.7), and current vaginal douching (OR, 1.7; 95% CI, 1.2-2.6). CONCLUSIONS: Population-based HSV-2 seroprevalence is endemically high among middle-age women in Mexico City, and clearly is correlated with higher-risk sexual behavior. This elevated HSV-2 seroprevalence may reflect unrecognized HSV-2 transmission throughout life.     

A population based study of herpes simplex virus 2 seroprevalence in rural Costa Rica

OBJECTIVES: To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay. METHODS: Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity. RESULTS: Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p(Trend<0.0001)), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p(Trend<0.0001)). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1). CONCLUSIONS: HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.     

Association between bacterial vaginosis and Herpes simplex virus type-2 infection: implications for HIV acquisition studies

OBJECTIVES: Bacterial vaginosis (BV) and Herpes simplex virus type-2 (HSV-2) have been linked to an increased risk of HIV-1 acquisition. Recent research suggests an association between BV and HSV-2 acquisition, but the converse has not been studied. Here, we investigate whether an association exists between BV and HSV-2 infection METHODS: We examined the determinants of BV occurrence in a cohort of female sex workers in Burkina Faso. Participants were followed every 3 months for diagnosis of genital infections and report of sexual behaviours. Factors associated with BV occurrence were assessed using generalised estimating equation models. RESULTS: We enrolled 273 women (mean age, 28 years) and conducted 812 follow-up visits (mean 2.93 visit per woman). Baseline seroprevalence of HIV-1, HSV-2 and recent syphilis were 31.5%, 70.1% and 0.4%, respectively, while baseline prevalence of BV, Trichomonas vaginalis (TV) and Candida albicans were 20.5%, 3.3% and 2.5%, respectively. In multivariable analysis, HSV-2 (relative risk (RR) = 1.73, 95% CI 1.12 to 2.65), HIV-1 (RR = 1.76, 95% CI 1.30 to 2.40), TV (RR = 1.5, 95% CI 1.0 to 2.3), and having > or = 3 sexual partners in the preceding week (RR = 2.2, 95% CI 1.1 to 4.6) were independently associated with BV, while hormonal contraception showed a protective effect (RR = 0.11, 95% CI 0.02 to 0.70). CONCLUSIONS: HSV-2 infection was associated with BV occurrence in this population. As HSV-2 is strongly linked to HIV-1 acquisition, studies assessing the cofactor effect of BV on HIV acquisition should control for the presence of HSV-2. Further studies are required to investigate the relative effect of asymptomatic HSV-2 shedding and/or genital ulcerations on BV occurrence.     

Should screening of genital infections be part of antenatal care in areas of high HIV prevalence? A prospective cohort study from Kigali,Rwanda, 1992-1993. The Pregnancy and HIV (EGE) Group.

OBJECTIVE--To study the prevalence and incidence of genital infections and their association with HIV-1 infection among pregnant women in Kigali, Rwanda. SUBJECTS AND METHODS--HIV+ and HIV- pregnant women were followed prospectively during the last three months of pregnancy. At enrolment, syphilis test (RPR) on blood sample, Chlamydiae trachomatis ELISA test on cervical smear, laboratory gonococcal culture, trichomonas and candida direct examination, CD4 lymphocyte count were performed. At each monthly follow-up clinic visit until delivery, genital infections were screened in the presence of clinical signs and symptoms. RESULTS--The HIV seroprevalence rate was 34.4% (N = 1233), 384 HIV+ women and 381 HIV- women of same parity and age were enrolled. Prevalence of genital infections at enrolment was generally higher in HIV+ women than in HIV- women: syphilis, 6.3% versus 3.7% (p = 0.13); Neisseria gonorrhoea, 7.0% versus 2.4% (p = 0.005); Trichomonas vaginalis, 20.2% versus 10.9% (p = 0.0007); Chlamydia trachomatis, 3.4% versus 5.5% (p = 0.21); Candida vaginalis, 22.3% versus 20.1% (p = 0.49). Until delivery, the relative risk of acquiring genital infections was also higher in HIV+ women than in HIV- women: 1.0 for syphilis (95% CI: 0.5-2.2), 3.7 for Neisseria gonorrhoea (1.0-13.3), 2.6 for Trichomonas vaginalis (1.5-4.6) and 1.6 for Candida vaginalis (1.1-2.4). CONCLUSION--In the context of high HIV-1 seroprevalence among pregnant women, prenatal care should include at least once screening for genital infections by clinical examination with speculum and a syphilis testing in Africa.     

Genital ulcer disease in women in Durban, South Africa.

OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in women. DESIGN--Microbial and clinical assessment of genital ulcers in women. SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu women with genital ulceration who had not received antibiotics in the previous two weeks. RESULTS--Syphilis was diagnosed in 40%, genital herpes in 18%, donovanosis (granuloma inguinale) in 16%, chancroid in 14%, lymphogranuloma venereum in 7% and scabies in 2%. No recognised cause was detected in 18%. Secondary syphilis was diagnosed in 21%, primary syphilis in 16% and mixed primary and secondary syphilis in 3%. Multiple infections were detected in 13 women, of whom 12 had syphilis. Bleeding was observed from the ulcers of 59 during swab collection. Three women had HIV-1 antibodies. Neisseria gonorrhoeae was isolated from the ulcers and endocervix of two women and from the endocervix alone in nine. Generalised scabies was diagnosed in 14. CONCLUSIONS--All the major causes of GUD are prevalent in Zulu women in Durban: secondary syphilis was the commonest diagnosis. Donovanosis, which often presents late with large ulcers, and genital herpes are now significant problems. Mixed infections with coexisting syphilis are common. All women in this population with GUD should be treated for syphilis and receive oral antibiotics effective for chancroid and donovanosis.     

Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2

GOALS: We assessed baseline prevalence of human immunodeficiency virus type 1 (HIV-1) and other STDs, as well as behavioral and biologic risk factors for HIV-1 in a population of female bar/hotel workers in Moshi, Tanzania. STUDY DESIGN: Between 2002 and 2003, we enrolled 1042 female bar/hotel workers in an ongoing prospective cohort study. We analyzed data collected at baseline to assess the associations between alcohol, sexual behavior, STDs, and HIV-1 infection. RESULTS: The prevalence of HIV-1 infection was 19.0% (95% confidence interval [CI] = 16.6%-21.4%). Consistent condom use was low (11.1%). HIV-1 was associated with genital ulcers on examination (adjusted odds ratio [AOR] = 2.08, 95% CI = 1.16-3.74), herpes simplex virus type 2 (HSV-2) (AOR = 3.80, 95% CI = 2.42-5.97), and problem drinking (AOR = 1.92, 95% CI = 1.06-3.47). Other independent predictors of HIV-1 were increasing age, number of sex partners, cohabitating, formerly married, location of employment, and having a husband with another wife. CONCLUSIONS: These findings suggest that programs designed to control HSV-2, reduce the number of sexual partners and alcohol use, and promote condom use could be effective in reducing transmission of HIV-1 in this population.     

Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians

BACKGROUND AND OBJECTIVES: Sexual transmission of bacterial and viral sexually transmitted disease has been reported between women. No data are available on seroprevalence of herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2) among lesbians. GOAL: The goal was to define prevalence of infection with HSV-1 and HSV-2 among lesbians, and associated risk factors. STUDY DESIGN: Women who reported sex with another woman in the preceding year were eligible. Medical and sexual histories were obtained. Serum was tested for HSV-1 and HSV-2 antibodies using Western Blot assay. RESULTS: Among 392 subjects, antibodies to HSV-1 were detected in 46% and to HSV-2 in 8%. Increasing age predicted higher seroprevalence to both HSV types, and HSV-2 seropositivity was associated with a history of male partner with genital herpes. Of 78 women reporting no prior sex with men, 3% were HSV-2-seropositive. Most HSV-2-seropositive subjects (71%) reported no history of genital herpes. HSV-1 seroprevalence increased significantly with an increasing number of female sex partners. CONCLUSIONS: HSV-2 infection occurs in nearly 1 in 10 lesbians and is not predicted by report of sex with men or sexual identity. Most lesbians infected with HSV-2 are not aware of their infection. Sexual transmission of HSV-1 may occur more frequently among lesbians than among heterosexual women.     

Correlates of human herpesvirus-8 seropositivity among U.S. military members recently infected with human immunodeficiency virus

BACKGROUND: Human herpesvirus 8 (HHV-8), the cause of Kaposi's sarcoma, is common among HIV-infected persons. The exact route of transmission of HHV-8 in various populations is still debated. GOAL: The goal was to define the correlates of HHV-8 infection among men recently infected with human immunodeficiency virus. STUDY DESIGN: Three hundred forty-two HIV-infected U.S. military men were evaluated using a questionnaire regarding potential risk factors and laboratory data, including HHV-8, herpes simplex virus 2 (HSV-2), syphilis, hepatitis B, and hepatitis C serologies. RESULTS: The seroprevalence of HHV-8 was 32%. HHV-8 was significantly associated with hepatitis B seropositivity (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.5-4.1), and black ethnicity was negatively associated with HHV-8 (OR, 0.6; 95% CI, 0.3-0.9) in the multivariate analysis. HHV-8 was not associated with drug use or hepatitis C seropositivity. Among men who have sex with men (MSM), HHV-8 infection correlated with hepatitis B seropositivity (OR, 2.2; 95% CI, 1.1-4.3) and HSV-2 (OR, 2.6; 95% CI, 1.4-4.9). Among heterosexuals, the correlates of HHV-8 were different; blacks as compared with whites (OR, 0.3; 95% CI, 0.1-0.8) and married versus single status (OR, 0.4; 95% CI, 0.2-0.9) were associated with a lower rate of HHV-8 infection. Among heterosexuals, hepatitis B, HSV-2, and sexual behaviors were not associated with HHV-8. CONCLUSION: This study suggests that the seroprevalence of HHV-8 is increased in both MSM and heterosexual men with HIV infection, and that the route(s) of HHV-8 acquisition might be different between MSM and heterosexuals.     

HIV-1 and other sexually transmitted infections in a cohort of female sex workers in Chiang Rai, Thailand

OBJECTIVES: To determine demographic and behavioural factors and sexually transmitted infections (STIs) associated with prevalent HIV-1 infection among brothel based and other female sex workers (FSWs) in Chiang Rai, northern Thailand. METHODS: Data were collected from questionnaires, physical examinations, and laboratory evaluations on Thai FSWs enrolled in a prospective cohort study in Chiang Rai, Thailand, from 1991 to the end of 1994. RESULTS: HIV-1 seroprevalence was 32% among 500 women: 47% for 280 brothel workers and 13% for 220 other FSWs (p < 0.001); 96% of infections were due to HIV-1 subtype E. At enrolment, other STIs were common: chlamydia, 20%; gonorrhoea, 15%; active syphilis (serological diagnosis), 9%; genital ulcer, 12%; seroreactivity to Haemophilus ducreyi, 21%, and herpes simplex virus type 2 (HSV-2), 76%. On multiple logistic regression analysis, HIV-1 was associated with brothel work, birth in upper northern Thailand, initiation of commercial sex at < 15 years of age, syphilis, HSV-2 seropositivity, and genital ulcer. CONCLUSIONS: Young Thai FSWs working in brothels in northern Thailand in the early phase of the HIV epidemic have been at very high risk for HIV-1 infection and several other STIs. Programmes are needed to prevent girls and young women from entering the sex industry and to reduce the risk of infection with HIV-1 and other STIs.     

Correlates of syphilis seroreactivity among pregnant women: the HIVNET 024 Trial in Malawi, Tanzania, and Zambia

OBJECTIVES: The objectives of this cross-sectional study were to determine correlates of syphilis seroprevalence among HIV-infected and -uninfected antenatal attendees in an African multisite clinical trial, and to improve strategies for maternal syphilis prevention. RESULTS: A total of 2,270 (86%) women were HIV-infected and 366 (14%) were HIV-uninfected. One hundred seventy-five (6.6%) were syphilis-seropositive (7.3% among HIV-infected and 2.6% HIV-uninfected women). Statistically significant correlates included geographic site (odds ratio [OR] = 4.5, Blantyre; OR = 3.2, Lilongwe; OR = 9.0, Lusaka vs. Dar es Salaam referent); HIV infection (OR = 3.3); age 20 to 24 years (OR = 2.5); being divorced, widowed, or separated (OR = 2.9); genital ulcer treatment in the last year (OR = 2.9); history of stillbirth (OR = 2.8, one stillbirth; OR = 4.3, 2-5 stillbirths); and history of preterm delivery (OR = 2.7, one preterm delivery). CONCLUSION: Many women without identified risk factors were syphilis-seropositive. Younger HIV-infected women were at highest risk. Universal integrated antenatal HIV and syphilis screening and treatment is essential in sub-Saharan African settings.     

Herpes simplex virus type 2 and other genital ulcerative infections as a risk factor for HIV-1 acquisition.

We studied the role of genital ulcerative infections for acquisition of human immunodeficiency virus type 1 (HIV-1) infection in a cohort of 989 homosexual men in Amsterdam between October 1984 and December 1988. Among 53 HIV-1 seroconverters serological and anamnestic data were gathered regarding herpes simplex virus type 2 (HSV-2) and syphilis in the 6 months before seroconversion. For statistical analysis a control who remained seronegative during the same interval was selected at random for each HIV-1 seroconverter. A significant difference between the prevalence of HSV-2 antibodies among HIV-1 seroconverters and controls was found (72% vs 38%). HSV-2 seroconversions among men initially seronegative for HSV-2 were found among three of 18 HIV-1 seroconverters and among three of 36 controls. (O.R. = 2.2, 95% C.I. 0.4-12.1). Self-reported cases of anogenital herpes were found more frequently among HIV-1 seroconverters (8) than among controls (4). One case of syphilis was diagnosed among HIV-1 seroconverters, and one among controls. Summing up these cases we assessed the total number of genital ulcerative infections: 12 among HIV-1 seroconverters and eight among controls (23 vs 15%, O.R. 1.7, C.I. 0.6-4.62). These data suggest little evidence for genital ulcerative infections being an important independent risk factor for HIV-1 acquisition among homosexual men in Amsterdam during the time period studied.     

Seroprevalence of herpes simplex virus-2 in suburban primary care offices in the United States

OBJECTIVE: The objective of this study was to estimate herpes simplex virus-2 (HSV-2) seroprevalence from a weighted sample of adults attending relatively affluent, suburban primary care physician (PCP) offices. GOAL: Many PCPs in relatively affluent areas do not believe national estimates of HSV-2 seroprevalence are representative of their patient populations. This study aimed to measure HSV-2 seroprevalence in these patient populations. STUDY DESIGN: We conducted a cross-sectional study with approximately 5400 individuals aged 18 to 59 years. Individuals were recruited at 36 PCP offices in 6 U.S. cities and tested for HSV-2 using Focus enzyme-linked immunosorbent assay. A computer-assisted questionnaire was used to assess risk behaviors associated with genital herpes. RESULTS: Among 5452 individuals who provided an analyzable blood sample, the overall weighted HSV-2 seroprevalence was 25.5% (95% confidence interval, 20.2-30.8%). Only 11.9% of HSV-2-seropositive patients reported a history of genital herpes. CONCLUSIONS: Results illustrate the need for greater suburban PCP and patient awareness of the high HSV-2 seroprevalence in this setting.     

Famciclovir reduces viral mucosal shedding in HSV-seropositive persons

OBJECTIVE: Many cases of herpes simplex virus (HSV) infection occur through asymptomatic shedding from persons without evidence of clinical disease. This study explores whether famciclovir reduces HSV shedding in HSV-2 seropositive persons with or without a history of symptomatic genital herpes. STUDY DESIGN: One hundred twenty-seven HSV-2 seropositive participants were randomly assigned to 42 days of famciclovir, followed by 14 days of washout and 42 days of placebo, or vice versa. All subjects swabbed the genital/perianal area; those with HSV-1 infection also swabbed the oral area daily for HSV DNA PCR. RESULTS: Famciclovir reduced genital and oral HSV shedding from 11.4% of days during the placebo period to 4.7% of days during famciclovir therapy. The reduction was greater in participants with a history of genital herpes (74%) than in those without such a history (30%). In multivariate analyses, famciclovir protected against total (clinical and subclinical) genital shedding among persons with a clinical history of genital herpes (RR, 0.23; 95% CI, 0.15-0.35; P < 0.001). Among HSV-2 seropositive participants without a history of genital herpes, 60% had HSV detected in the genital area at least once during the study. Famciclovir therapy did not result in a statistically significant reduction in total HSV shedding in participants without a history of genital herpes. CONCLUSION: Famciclovir therapy decreases genital HSV shedding in HSV-seropositive persons, especially those with a history of genital herpes. Overall, antiviral drugs may have varying effects on symptomatic and asymptomatic viral shedding, depending on the clinical history of the disease.     

Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis

OBJECTIVES: Male circumcision is associated with reduced risk of HIV infection. This may be partly because of a protective effect of circumcision on other sexually transmitted infections (STI), especially those causing genital ulcers, but evidence for such protection is unclear. Our objective was to conduct a systematic review and meta-analyses of the associations between male circumcision and infection with herpes simplex virus type 2 (HSV-2), Treponema pallidum, or Haemophilus ducreyi. METHODS: Electronic databases (1950-2004) were searched using keywords and text terms for herpes simplex, syphilis, chancroid, ulcerative sexually transmitted diseases, or their causative agents, in conjunction with terms to identify epidemiological studies. References of key articles were hand searched, and data were extracted using standardised forms. Random effects models were used to summarise relative risk (RR) where appropriate. RESULTS: 26 articles met the inclusion criteria. Most syphilis studies reported a substantially reduced risk among circumcised men (summary RR = 0.67, 95% confidence interval (CI) 0.54 to 0.83), although there was significant between study heterogeneity (p = 0.01). The reduced risk of HSV-2 infection was of borderline statistical significance (summary RR = 0.88, 95% CI 0.77 to 1.01). Circumcised men were at lower risk of chancroid in six of seven studies (individual study RRs: 0.12 to 1.11). CONCLUSIONS: This first systematic review of male circumcision and ulcerative STI strongly indicates that circumcised men are at lower risk of chancroid and syphilis. There is less association with HSV-2. Potential male circumcision interventions to reduce HIV in high risk populations may provide additional benefit by protecting against other STI.     

Herpes simplex virus type 2 seroepidemiology in Spain: prevalence and seroconversion rate among sexually transmitted disease clinic attendees

BACKGROUND: Only limited data on the seroprevalence of herpes simplex virus type 2 (HSV-2) are available from European countries. Until recently, serologic tests for HSV-2 serotyping have been hampered by cross-reactivity to type-common antigens. The present study aims at providing data on the prevalence of HSV-2 infection in a group of STD clinic attendees using a reliable type-specific immunoassay. GOAL: To evaluate the seroprevalence of HSV-2 and the accumulated incidence of clinical genital herpes infection in a sample of Spanish sexually transmitted disease (STD) clinic attendees. STUDY DESIGN: The study consisted of two parts. First, a cross-sectional study of HSV-2 seroprevalence was conducted in patients with STDs. Second, a prospective cohort study was undertaken to evaluate the accumulated incidence of infection by HSV-2 and of clinical episodes of genital herpes in HSV-2-negative patients included in the first study during a follow-up period of 6 to 18 months. RESULTS: Of the 374 patients (129 men, 245 women) studied, 25% were seropositive for HSV-2 (12% of men, 30% of women). Antibodies to HSV-2 were related to female gender (odds ratio, 2.7; P < 0.001) and to the number of sexual partners (odds ratio, 4.1; P < 0.001). Fifty-two percent of patients (145 of 281 patients) who were initially seronegative returned to the clinic for a second serologic testing, of whom 1% (2 of 145 patients) had seroconverted. None of the patients developed genital herpes during the follow-up period. CONCLUSION: The relatively high seroprevalence (25%) and the low rate (4%) of HSV-2 previously reported in the general population in Spain suggest that the virus circulation may be restricted to certain risk groups. Therefore, future healthcare measures may target specific groups, such as patients with STDs.