Epidemiology of herpes simplex virus type 2 in the Middle East and North Africa: Systematic review, meta‐analyses, and meta‐regressions

Abstract

Herpes simplex virus type 2 (HSV-2) infection is a prevalent, sexually transmitted infection with poorly characterized prevalence in the Middle East and North Africa (MENA) region.This study characterized HSV-2 epidemiology in MENA. HSV-2 reports were systematically reviewed as guided by the Cochrane Collaboration Handbook and findings were reported following PRISMA guidelines. Random-effects meta-analyses and metaregressions were performed to estimate pooled mean outcome measures and to assess predictors of HSV-2 antibody prevalence (seroprevalence), trends in seroprevalence, and between-study heterogeneity. In total, sixty-one overall (133 stratified) HSV-2 seroprevalence measures and two overall (four stratified) proportion measures of HSV-2 detection in laboratory-confirmed genital herpes were extracted from 37 relevant publications. Pooled mean seroprevalence was 5.1% (95% confidence interval [CI]: 3.6%-6.8%) among general populations, 13.3% (95% CI: 8.6%-18.7%) among intermediate-risk populations, 20.6% (95% CI: 5.3%-42.3%) among female sex workers, and 18.3% (95% CI: 3.9%-39.4%) among male sex workers. Compared to Fertile Crescent countries, seroprevalence was 3.39-fold (95% CI: 1.86-6.20) and 3.90-fold (95% CI:1.78-8.57) higher in Maghreb and Horn of Africa countries, respectively. Compared to studies published before 2010, seroprevalence was 1.73-fold (95% CI: 1.00-2.99) higher in studies published after 2015. Pooled mean proportion of HSV-2 detection in genital herpes was 73.8% (95% CI: 42.2%-95.9%). In conclusion, MENA has a lower HSV-2 seroprevalence than other world regions. Yet, 1 in 20 adults is chronically infected, despite conservative prevailing sexual norms. Seroprevalence may also be increasing, unlike other world regions. Findings support the need for expansion of surveillance and monitoring of HSV-2 infection in MENA.

Epidemiology of herpes simplex virus type 2 in China: Systematic review, meta-analyses, and meta-regressions

“…The HSV-2 seroprevalence among the general population is 7.9% (6.9-8.8%), similar to the overall prevalence of HSV-2 in Asia, 21 lower than in Europe, Sub-Saharan Africa, and Australia but higher than the Middle East and North Africa. 8,10,12,13,30 With other regions whose prevalence was flat 8 or increasing 10,11 , we observed the HSV-2 prevalence in China reduced by about 2% every five years, which could be attributed to better STI clinic access and improved STI education among the general population nationwide. 31,32 Stratified by sex, we observed comparable HSV-2 prevalence between men and women.…”

“…7 Recent meta-reviews have reported a wide range of prevalence estimates from different geographical regions, including 37.3% in sub-Saharan Africa, 8 20.6% in Latin America, 9 15.4% in Canada, Australia, and New Zealand, 10 12.4% in Europe, 11 12.1% in Asia, 12 and 5.1% in the Middle East and North Africa among the general population. 13 Seroprevalences of HSV-2 among key populations such as male sex workers(MSW), men who have sex with men (MSM), and female sex workers (FSW) are substantially higher across regions, ranging from 20.6% to 74.8% for FSW and from 18.3% to 54.6% for MSM and MSW. [8][9][10][11][12][13] Despite the existing literature, a comprehensive overview of HSV-2 epidemiology and trends among different populations in China is limited, calling for a systematic review and meta-analysis.…”

“…13 Seroprevalences of HSV-2 among key populations such as male sex workers(MSW), men who have sex with men (MSM), and female sex workers (FSW) are substantially higher across regions, ranging from 20.6% to 74.8% for FSW and from 18.3% to 54.6% for MSM and MSW. [8][9][10][11][12][13] Despite the existing literature, a comprehensive overview of HSV-2 epidemiology and trends among different populations in China is limited, calling for a systematic review and meta-analysis. A meta-analysis in Asia reported a pooled HSV-2 seroprevalence of 9.3% among the general population.…”

Estimated global and regional incidence and prevalence of herpes simplex virus infections and genital ulcer disease in 2020: Mathematical modeling analyses

“…Summary of the standardized methodology used in updating the previously conducted systematic reviews for Asia [1, 2], Europe [3, 4], Latin America and the Caribbean [5, 6], Middle East and North Africa [7, 8], sub-Saharan Africa [9, 10], and for Canada, Australia, New Zealand, and Pacific Island nations [11–13].…”

Enhanced Anti-Herpetic Activity of Valacyclovir Loaded in Sulfobutyl-ether-β-cyclodextrin-decorated Chitosan Nanodroplets

“…Genital herpes is a common sexually transmitted infection characterized by painful genital blisters or ulcers, with an estimated 491 million (13%) people aged 15-49 years affected worldwide [1][2][3][4]. It is mainly caused by herpes simplex virus type 2 (HSV-2) and more rarely by HSV type 1 (HSV-1).…”