A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition

Abstract

Background The degree of effectiveness of condoms in preventing the transmission of herpes simplex virus 2 (HSV-2), is uncertain. We performed a large pooled analysis to address this question. Methods We identified prospective studies with individual-level condom use data and laboratory-defined HSV-2 acquisition. Six studies were identified through a review of publications through 2007: three candidate HSV-2 vaccine studies, an HSV-2 drug study, an observational STD incidence study and a behavioral STD intervention study. Study investigators provided us individual-level data to perform a pooled analysis. Effect of condom use was modeled using a continuous percent of sex acts during which a condom was used and, alternatively, using absolute number of unprotected sex acts. Results A total of 5384 people who were HSV-2 negative at baseline contributed 2,040,894 follow-up days. 415 persons acquired laboratory-documented HSV-2 during follow-up. Consistent (100%) condom users had a 30% lower risk of HSV-2 acquisition compared to those who never used condoms (hazard ratio: 0.70; 95 percent confidence interval: 0.40, 0.94; p = 0.01). Risk for HSV-2 acquisition increased steadily and significantly with each unprotected sex act (hazard ratio: 1.16; 95 percent confidence interval: 1.08, 1.25); p < 0.001). Condom effectiveness did not vary by gender. Conclusions This is the largest analysis using prospective data to assess the effect of condoms in preventing HSV-2 acquisition. Although the magnitude of protection was not as large as has been observed with other STIs, we found that condoms offer moderate protection against HSV-2 acquisition in men and women.

Virologic and Immunologic Evidence of Multifocal Genital Herpes Simplex Virus 2 Infection

“…Our participants shed on a median of 12 sites throughout this short study, suggesting that it may be important to inform patients that shedding, and therefore the possibility of transmission, is not confined to the site of genital herpes recurrences. This widespread genital shedding even in the absence of symptoms may explain the partial efficacy of condoms in preventing HSV acquisition (31), as viral shedding frequently occurs in areas not protected by condoms. That CD8 ϩ T cells were significantly more numerous in asymptomatic biopsy specimens than in control biopsy specimens suggests that asymptomatic HSV shedding is associated with a targeted immunologic response in tissue and offers additional evidence that observed shedding patterns are not an artifact of contamination.…”

Contraception for Adolescents

“…43,190 Consistent evidence supports condoms as reducing the risk of disease transmitted to and from the penile urethra, including gonorrhea, Chlamydia, trichomoniasis, hepatitis B, and HIV. [191][192][193][194][195] Emerging evidence also supports condoms as reducing the risk of acquiring diseases transmitted through skin or mucosal contact, including genital herpes simplex virus, 196,197 human papillomavirus, 198,199 and syphilis. 200 Because condoms protect against STIs, all sexually active adolescents should be encouraged to use condoms, regardless of whether an additional contraceptive method is used.…”

Contraception for Adolescents

“…1 Advantages include male involvement in the responsibility for contraception, easy accessibility by minors without a prescription, and low cost. Latex condoms also reduce STI transmission, with consistent evidence for the reduction of gonorrhea, chlamydia, trichomoniasis, [119][120][121][122][123] and hepatitis B and HIV transmission 124 and emerging evidence for the reduction of herpes simplex virus, 125,126 human papillomavirus, 127,128 and syphilis transmission. 129 However, condom use requires commitment at every sex act, tends to drop off over time, and is influenced by individual, relationship, and broader social factors.…”