Risk of Acquisition of Genital Herpes Simplex Virus Type 2 in Sex Partners of Persons with Genital Herpes: A Prospective Couple Study

Bryson, Yvonne J.; Dillon, Maryanne; Bernstein, David I.; Radolf, Justin D.; Zakowski, Phil; Garratty, Eileen

doi:10.1093/infdis/167.4.942

Cited by 112 publications

(45 citation statements)

References 8 publications

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“…25 The observed female-male diVerences for HSV-2 prevalence and incidence rates have been documented by other studies. [26][27][28] The diVerence is believed to be due to the greater mucosal surface of the female genital tract, which results in higher risk of transmission to women. Males are also thought to have higher rate of disease recurrence which is likely to make them more infectious 29 : the estimated risk of a susceptible female contracting HSV from an infected male is 80% following a single contact.…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence and incidence of genital ulcer infections in a rural Ugandan population

Kamali

Nunn

Mulder

et al. 1999

Sexually Transmitted Infections

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Objectives: To determine age-sex specific seroprevalence and incidence rates of Treponema pallidum, Haemophilus ducreyi, and HSV-2; to assess the association between HIV-1 status and incidence of these STIs; and HSV-2 serostatus with number of lifetime sexual partners. Methods: Antibodies against HIV-1, T pallidum, H ducreyi, and HSV-2 infections were tested using approximately 1000 paired (2 year interval) sera collected from a rural adult (15-54 years) population cohort in south west Uganda. Results: Overall HIV-1 prevalence was 4.9%. Prevalence for T pallidum was 12.9% among males and 12.6% among females. The corresponding rates for H ducreyi were 9.8% and 7.3% respectively. HSV-2 prevalence rates were considerably lower in males (36.0%) than in females (71.5%), p <0.001. Incidence rates for T pallidum per 1000 person years of observation were 8.4 for males and 12.3 for females. The corresponding rates for H ducreyi were 24.6 and 20.0 and for HSV-2 were 73.2 and 122.9 per 1000 person years of observation, respectively. The RR of HSV-2 incidence was 3.69 in HIV seropositive cases versus HIV seronegative after adjusting for age and sex. The corresponding RR for H ducreyi was 3.50 among female HIV positive cases versus negatives with no eVect seen in males. Association between HIV-1 prevalence and prevalence of other STIs was significant (Mantel-Haenszel test) for H ducreyi (p=0.01) and for HSV-2 (p=0.004) but not for T pallidum (p >0.4). HSV-2 prevalence was associated with number of lifetime sexual partners (females, p=0.003; males, p=0.08). Conclusions:The results have provided a reliable estimate of the magnitude of the STI problem and demonstrated an association between HIV-1 status and serology of other STIs in a general rural population in sub-Saharan Africa. The study has also highlighted a correlation between HSV-2 seropositivity and number of reported lifetime sexual partners. (Sex Transm Inf 1999;75:98-102)

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Section: Discussionmentioning

confidence: 99%

Seroprevalence and incidence of genital ulcer infections in a rural Ugandan population

Kamali

Nunn

Mulder

et al. 1999

Sexually Transmitted Infections

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“…[3][4][5][6] This is important because most sexual transmission of HSV occurs during episodes of subclinical reactivation among persons with unrecognized infection. 4,[7][8][9][10] Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease. 5 In the absence of symptoms, HSV-2 can be detected in the genital tract, by viral culture, on 3% of days for the first year after initial infection, then on 1% of days for the next 2 years.…”

Section: Epidemiology Of Genital Herpesmentioning

confidence: 99%

Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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Neonatal herpes can occur when the neonate is exposed to herpes simplex virus in the maternal genital tract during labour. Attack rates are highest when the mother has a newly acquired infection and, therefore, does not have antibodies to protect the neonate. Even with early therapy, there is significant morbidity and mortality associated with neonatal herpes, suggesting that preventing neonatal herpes simplex virus exposure or early recognition of exposure is important. The incidence of neonatal herpes has not declined despite national guidelines for prevention. This suggests that the prevention guidelines need to be re-addressed.Keywords Herpes, neonate, prevention.Please cite this paper as: Gardella C, Brown Z. Prevention of neonatal herpes. BJOG 2011;118:187-192. Epidemiology of genital herpesBased on serological data from a large National Health and Nutrition Examination Survey (NHANES), 22% of pregnant women in the USA are infected with herpes simplex virus 2 (HSV-2), 63% are HSV-1 seropositive, 13% have both HSV-1 and HSV-2, and 28% are seronegative. 1 In the general population, for the first time since the 1976 inception of NHANES, the seroprevalence of HSV-2 has decreased; overall, the age-adjusted HSV-2 seroprevalence was 17% in 1999-2004, compared with 21% in 1988-94, a relative decrease of 19% between the two study periods. Among those infected with HSV-2, the percentage who reported being diagnosed was 14.3% in 1999-2004 and 9.9% in 1988-94, suggesting that more providers are aware of genital herpes, and able to make appropriate diagnoses. 2 However, the vast majority of people infected with HSV-2 remain undiagnosed and, therefore, untreated and able to spread the infection. Between 75% and 90% of HSV-2-infected people are not aware of having the infection. [3][4][5][6] This is important because most sexual transmission of HSV occurs during episodes of subclinical reactivation among persons with unrecognized infection. 4,7-10 Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease. 5 In the absence of symptoms, HSV-2 can be detected in the genital tract, by viral culture, on 3% of days for the first year after initial infection, then on 1% of days for the next 2 years. HSV-2 DNA can be detected by polymerase chain reaction testing 15-20% of days. 11,12 Recent data suggest that HSV reactivation may occur much more frequently than previously understood, and may be characterised by frequent short bursts of viral shedding that do not correlate with symptoms. 13 As HSV-2 seroprevalence decreased, HSV-1 seroprevalence in the USA increased to 62% in 1988-94 from 57.7% in 1999-2004. 2 Among persons infected with HSV-1 but not HSV-2, a higher percentage reported a diagnosis of genital herpes in 1999-2004 compared with 1988-94 (1.8% versus 0.4%). 2 HSV-1 has emerged as a major cause of genital herpes among college-age populations, in which up to 80% of new cases of genital HSV were caused by HSV-1. [14][1...

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“…8 Several recent developments have changed many of the traditional concepts about this infection. [9][10][11][12][13] Accurate type specific serological tests have been available for the last few years. While the presence of HSV-2 antibodies essentially confirms the previous genital herpes infection, the presence of HSV-1 antibodies indicates previous infection with HSV-1 without identifying the site of infection, which may be oral or genital.…”

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confidence: 99%

Genital herpes: general practitioners' knowledge and opinions

Narouz

2002

Sexually Transmitted Infections

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Objectives: To evaluate GPs' knowledge about genital herpes, especially recent information and to assess their attitudes towards serotesting. Methods: GPs working in Coventry and the surrounding area were asked to complete an anonymous questionnaire. Results: 70% of GPs (183 out of 261) responded to the questionnaire. Overall, 56% of the questions were answered correctly. 73% of participants knew that source partners in most transmission events are unaware of their infection and 77% were aware that patients shed the virus and transmit it even in the absence of clinical signs. As many as 43% did not know that the majority of infected individuals are unaware of their infection and 44% only knew that most transmission occurs during periods of asymptomatic shedding. Only 53% were aware that the proportion of genital herpes caused by HSV-1 is not decreasing. The majority (78%) supported the availability of its serotesting. Conclusions: This study demonstrates the lack of knowledge, among studied GPs, in some areas about genital herpes, especially recent information and indicates the need for more education about the condition. Most GPs in the study support the availability of genital herpes serotesting, although more studies need to be done before the wide availability of this testing. G enital herpes infection is the most common cause of genital ulceration, not only in the developed world, but also in many developing countries. 1 2 Its impact on the psychosocial and psychosexual life of many patients and its importance in HIV transmission are well recognised. 3 4 Neonatal herpes, although rare in the United Kingdom, is a devastating illness. 5 Diagnosis of genital herpes is increasing. In developed countries, it is estimated that as many as 20% of the general population may be herpes simplex virus type 2 (HSV-2) seropositive. Seroprevalence rates as high as 60-90% have been reported in several developing countries. 6 7 Serprevalence rates among genitourinary clinic attenders in London were found to be 25% in females and 17% in males, while in the control group of blood donors, the corresponding rates were 12% in females and 3% in males. 8 Several recent developments have changed many of the traditional concepts about this infection. 9-13 Accurate type specific serological tests have been available for the last few years. While the presence of HSV-2 antibodies essentially confirms the previous genital herpes infection, the presence of HSV-1 antibodies indicates previous infection with HSV-1 without identifying the site of infection, which may be oral or genital.Patients' attitudes have been assessed in previous studies. 14 However, no information is available about the knowledge or opinions of clinicians. General practitioners (GPs) are often the first clinicians to see these patients. This study assessed GPs' knowledge of genital herpes, especially recent information about shedding, transmission, and clinical presentation. We also assessed their opinions regarding serotesting of genital herpes. METHODSGPs working in...

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Risk of Acquisition of Genital Herpes Simplex Virus Type 2 in Sex Partners of Persons with Genital Herpes: A Prospective Couple Study

Cited by 112 publications

References 8 publications

Seroprevalence and incidence of genital ulcer infections in a rural Ugandan population

Seroprevalence and incidence of genital ulcer infections in a rural Ugandan population

Prevention of neonatal herpes

Genital herpes: general practitioners' knowledge and opinions

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