Herpes simplex virus type 1 in Europe: systematic review, meta-analyses and meta-regressions

Yousuf, Wajiha; Ibrahim, Huda; Harfouche, Manale; Hijleh, Farah Abu; Abu‐Raddad, Laith J.

doi:10.1136/bmjgh-2020-002388

Cited by 52 publications

(73 citation statements)

References 42 publications

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“…HSV-2 infection (as opposed to HSV-1 infection) proved to be the etiological cause of 76% of genital herpes cases, lower than in Africa at 97% 24 and in LAC at 91%. 39 This finding is consistent with the finding that HSV-1 infection now plays a growing role in genital herpes in Asia, 25 just as in North America 40 , 54 and Europe, [55] , [56] , [57] , [58] , [59] but differs from the pattern found in Africa, 60 LAC, 61 and possibly the Middle East and North Africa, 62 where sexual transmission of HSV-1 infection is still less pervasive. Curiously, HSV-2 seems more significant in genital herpes among men than women ( Table 4 ), a finding that may reflect the relative ease of clinically diagnosing this condition in men compared to women.…”

Section: Discussionsupporting

confidence: 73%

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

AlMukdad

Harfouche

Wettstein

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection worldwide. This systematic review was conducted to characterize HSV-2 epidemiology in Asia, including the World Health Organization regions of Southeast Asia and the Western Pacific.Methods: Cochrane and PRISMA guidelines were followed to systematically review and report findings. Pooled mean seroprevalence and proportions of HSV-2 isolated in genital ulcer disease (GUD) and in genital herpes were calculated using random-effects meta-analyses. Meta-regressions were also conducted. Quality assessment was performed.Findings: HSV-2 measures extracted from 173 publications included 15 seroconversion rates, 11 seroincidence rates, 272 overall seroprevalence measures (678 stratified), 14 proportions of HSV-2 isolation in GUD (15 stratified), and 27 proportions of HSV-2 isolation in genital herpes (36 stratified). Pooled mean seroprevalence was 12.1% (95% confidence interval (CI): 11.0-13.2%) among general populations, 23.6% (95% CI: 20.9-26.3%) among men who have sex with men and transgender people, 46.0% (95% CI: 39.2-52.9%) among HIV-positive individuals and individuals in HIV-discordant couples, and 62.2% (95% CI: 58.9-65.6%) among female sex workers. Among general populations, pooled mean seroprevalence increased gradually from 4.7% (95% CI: 3.3-6.3%) in < 20-year-old individuals to 26.6% (95% CI: 19.2-34.7%) in > 60-year-old individuals. Compared to women and across all populations, men had 0.60-fold (95% CI: 54.0-67.0) lower seroprevalence, that is women had 70% higher seroprevalence. Seroprevalence declined by 0.98-fold (95% CI: 0.97-0.99) per year, that is a 2% decline per year in the last three decades. Pooled mean proportions of HSV-2 isolation in GUD and in genital herpes were 48.2% (95% CI: 34.9-61.6%) and 75.9% (95% CI: 68.3-82.8%), respectively.Interpretation: Over 1 in 10 individuals is infected with HSV-2, but seroprevalence is declining. HSV-2 accounts for half of GUD cases and three-quarters of genital herpes cases. These findings support the need for an HSV-2 vaccine and universal access to sexual and reproductive health services.

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Section: Discussionsupporting

confidence: 73%

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

AlMukdad

Harfouche

Wettstein

et al. 2021

The Lancet Regional Health - Western Pacific

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“…(80, 81) HSV-2 infection (as opposed to HSV-1 infection) was also found to account for nearly all cases of genital herpes (>97%; Table 5). This finding is presumably due to the nature of HSV-1 being widely acquired in childhood in SSA through oral transmission,(33) and distinguishes this region from other global regions where there is an increasing role for HSV-1 in genital herpes,(33–36) with some countries already observing HSV-1 as the cause of a large proportion of cases of genital herpes. (33–36)…”

Section: Discussionmentioning

confidence: 98%

“…The review was informed by the methodology applied recently in a series of systematic reviews for HSV-1 infection. (32–36)…”

Section: Methodsmentioning

confidence: 99%

The epidemiology of herpes simplex virus type 2 in sub-Saharan Africa: systematic review, meta-analyses, and meta-regressions

Harfouche

Abu-Hijleh

James

et al. 2021

Preprint

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BackgroundHerpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection with a sizable disease burden that is highest in sub-Saharan Africa. This study aimed to characterize HSV-2 epidemiology in this region.MethodsCochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings. Meta-analyses and meta-regressions were conducted.FindingsFrom 218 relevant publications, 451 overall outcome measures and 869 stratified measures were extracted. Pooled incidence rates ranged between 2.4-19.4 per 100 person-years across populations. Pooled seroprevalence was lowest at 37.3% (95% confidence interval (CI): 34.9-39.7%) in general populations and high in female sex workers and HIV positive individuals at 62.5% (95% CI: 54.8-70.0%) and 71.3% (95% CI: 66.5-75.9%), respectively. In general populations, pooled seroprevalence increased steadily with age. Compared to women, men had a lower seroprevalence with an adjusted risk ratio (ARR) of 0.61 (95% CI: 0.56-0.67).Seroprevalence decreased in recent decades with an ARR of 0.98 (95% CI: 0.97-0.99) per year. Seroprevalence was highest in Eastern and Southern Africa. Pooled HSV-2 proportion in genital ulcer disease was 50.7% (95% CI: 44.7-56.8%) and in genital herpes it was 97.3% (95% CI: 84.4-100%).InterpretationSeroprevalence is declining by 2% per year, but a third of the population is infected. Age and geography play profound roles in HSV-2 epidemiology. Temporal declines and geographic distribution of HSV-2 seroprevalence mirror that of HIV prevalence, suggesting sexual risk behavior has been declining for three decades. HSV-2 is the etiological cause of half of GUD and nearly all genital herpes cases.FundingThis work was supported by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar and by the Qatar National Research Fund [NPRP 9-040-3-008].

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“…30 While this finding is consistent with what is observed in sub-Saharan Africa and possibly the Middle East and North Africa, [77][78][79] it contrasts with what is observed in North America, Europe, and Asia, where the role of HSV-1 in genital herpes has been increasing, and in some settings and populations even reaching the point of being the leading cause of this disease outcome. [80][81][82][83][84][85][86][87][88] This study has limitations. HSV-2 epidemiological data were mainly available for the large countries of Latin America and the Caribbean region that constitute most of its population, but there were no data available for 27 out of the 47 (mostly small) countries constituting this part of the world.…”

Section: Reviewmentioning

confidence: 97%

Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions

2021

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ObjectiveTo characterise epidemiology of herpes simplex virus type 2 (HSV-2) in Latin America and the Caribbean.MethodsHSV-2 reports were systematically reviewed and synthesised, and findings were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses and metaregressions were conducted.Finding102 relevant reports were identified including 13 overall incidence measures, 163 overall (and 402 stratified) seroprevalence measures, and 7 and 10 proportions of virus detection in genital ulcer disease and in genital herpes, respectively. Pooled mean seroprevalence was 20.6% (95% CI 18.7% to 22.5%) in general populations, 33.3% (95% CI 26.0% to 41.0%) in intermediate-risk populations, 74.8% (95% CI 70.6% to 78.8%) in female sex workers, and 54.6% (95% CI 47.4% to 61.7%) in male sex workers, men who have sex with men and transgender people. In general populations, seroprevalence increased from 9.6% (95% CI 7.1% to 12.4%) in those aged <20 years to 17.9% (95% CI 13.6% to 22.5%) in those aged 20–30, 27.6% (95% CI 21.4% to 34.2%) in those aged 30–40 and 38.4% (95% CI 32.8% to 44.2%) in those aged >40. Compared with women, men had lower seroprevalence with an adjusted risk ratio (ARR) of 0.68 (95% CI 0.60 to 0.76). Seroprevalence declined by 2% per year over the last three decades (ARR of 0.98, 95% CI 0.97 to 0.99). Pooled mean proportions of HSV-2 detection in GUD and genital herpes were 41.4% (95% CI 18.9% to 67.0%) and 91.1% (95% CI 82.7% to 97.2%), respectively.ConclusionsOne in five adults is HSV-2 infected, a higher level than other world regions, but seroprevalence is declining. Despite this decline, HSV-2 persists as the aetiological cause of nearly half of GUD cases and almost all of genital herpes cases.

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Herpes simplex virus type 1 in Europe: systematic review, meta-analyses and meta-regressions

Cited by 52 publications

References 42 publications

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

Epidemiology of herpes simplex virus type 2 in Asia: A systematic review, meta-analysis, and meta-regression

The epidemiology of herpes simplex virus type 2 in sub-Saharan Africa: systematic review, meta-analyses, and meta-regressions

Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions

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