Increasing prevalence of genital herpes in developing countries: implications for heterosexual HIV transmission and STI control programmes

Abstract

Background:The recognition that sexually transmitted infections (STI) facilitate HIV transmission among heterosexuals has led to a rejuvenated focus on improving STI control as a component of HIV prevention programmes in developing countries. While eVorts so far have focused mainly on all STI, there is increasing evidence that genital ulcers facilitate a considerable proportion of HIV transmission among heterosexuals and that this eVect has been underestimated. This paper focuses on the epidemiology of genital herpes in developing countries past and present. Objectives: To review the scientific literature about the epidemiology of genital herpes in developing countries and discuss the implications of the findings for STI control and HIV prevention programmes. Search methodology: A Medline search for June 1966 to August 1999 using the keywords, genital herpes, STD and developing countries, and genital ulcers in MeSH and free text. Abstract books from recent international AIDS conferences and other international STD conferences were reviewed. The annual reports of the medical oYcers of heath for Harare 1982 and Durban 1989 were reviewed to detect trends in genital herpes diagnoses. Findings: Genital herpes, formerly regarded as a minor STI in most developing countries, has now emerged as a leading cause of genital ulceration in many countries where syphilis and chancroid were more prevalent previously. This increased recognition of genital herpes reflects both a change in the pattern of STI epidemiology through a decline in syphilis and chancroid as a response to HIV control programmes and improved techniques for diagnosing herpetic infection. Countries with significant heterosexual HIV epidemics also appear to have rapidly increasing numbers of genital herpes cases. Conclusions:The emergence of this herpes epidemic must be addressed through innovative strategies that will be viable, sustainable, acceptable, and eVective in developing countries. In countries where genital herpes is a significant problem, local adaptation of WHO treatment algorithms should be made. STI service providers should be trained about issues around the transmission of herpes and how best to advise clients about dealing with, and recognising, recurrences. The eVectiveness of antiviral treatment for genital herpes should be investigated in core groups at high risk of HIV. (Sex Transm Inf 1999;75:377-384)

Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes

“…[17][18][19] Data presented here indicate that a large proportion abstain from sex during symptomatic periods. However, condoms were used irregularly.…”

Identification of Novel Immunodominant CD4+Th1-Type T-Cell Peptide Epitopes from Herpes Simplex Virus Glycoprotein D That Confer Protective Immunity

“…HSV infection is a major cause of a spectrum of morbidity and clinical diseases in humans (59,60,64,81). During the last decade, HSV vaccine development has primarily focused on various forms of recombinantly expressed glycoproteins (40, 75).…”

“…Importantly, immunization of H-2 d mice with the four newly identified CD4 ؉ Th1 peptide epitopes but not with four CD4 ؉ Th2 peptide epitopes induced a robust protective immunity against lethal ocular HSV-1 challenge. These peptide epitopes may prove to be important components of an effective immunoprophylactic strategy against herpes.Genital, dermal, and ocular herpes simplex virus (HSV) infections cause prevalent, lifelong recurrent infections, with a spectrum of clinical manifestations, including cold sores, genital lesions, corneal blindness, and encephalitis (41,58,60,64,81). Despite the availability of many interventional strategies, there has been a constant increase of HSV prevalence during the last 3 decades (27,41,47).…”

Immunodominant “Asymptomatic” Herpes Simplex Virus 1 and 2 Protein Antigens Identified by Probing Whole-ORFome Microarrays with Serum Antibodies from Seropositive Asymptomatic versus Symptomatic Individuals

“…For example, infection of the brain and eyes can lead to irreversible brain damage and blindness (37). Over 400,000 adults in the United States have a history of recurrent ocular disease capable of causing a loss of vision (62,63,65,67,68,83). Virtually all herpetic orolabial disease is caused by HSV-1 (42).…”