Herpes simplex virus type 2 (HSV-2) infection is associated with substantial morbidity and increased risk for human immunodeficiency virus acquisition. We describe HSV-2 seroprevalence in adult New Yorkers, and examine the relationship between select characteristics, infection, and diagnosis.
HSV-2 seroprevalence and risk factors were measured using the 2004 New York City Health and Nutrition Examination Survey, a population-based cross-sectional survey of adults. HSV-2 seroprevalence and corresponding 95% confidence intervals were computed for select characteristics. Associations between proposed risk factors and HSV-2 infection and diagnosis were estimated using unadjusted and adjusted odds ratios.
Nearly 28% of adults were infected with HSV-2; 88.4% of HSV-2 positive persons were undiagnosed. Black women had the highest seroprevalence (59.7%) of any sex or race/ethnicity group. Women, non-Hispanic blacks, and Hispanics (vs. non-Hispanic whites), and men who have sex with men were at greater odds of HSV-2 infection. Among HSV-2 infected individuals, non-Hispanic blacks (vs. non-Hispanic whites), uncircumcised men, and those with no routine place of care were less likely to be diagnosed.
HSV-2 is highly prevalent and largely undiagnosed in New York City; seroprevalence varies by subgroup. Targeted HSV-2 screening, counseling and treatment may help reduce transmission of HSV-2 and human immunodeficiency virus.
"Our analysis found overall HSV-2 rates to stabilize with age, consistent with results from recent analyses of 1999-2004 NHANES data, and earlier examinations of NHANES II and NHANES III data. Prevalences were higher among women than men in our analysis, and among Black Americans than other races, similar to findings from other studies[1,7,8,13,14]. However, the increase in HSV-2 with age was not significantly different for Blacks than for other racial groups across the 20-29 year age range, and in fact increased at a slower rate over ages 30-49. "
[Show abstract][Hide abstract] ABSTRACT: U.S. population studies show herpes simplex virus type 2 (HSV-2) seroprevalence levelling by approximately age 30, suggesting few new infections after that age. It is unclear whether this pattern is driven by greater percentages in stable relationships, and to what extent adults who initiate new relationships may be at risk of incident HSV-2 infection.
Survey and laboratory data from the 1999-2008 waves of the U.S. National Health and Nutrition Examination Survey (NHANES) were combined for 12,862 adults age 20-49. Weighted population estimates of self-reported genital herpes, HSV-2 seroprevalence, and past-year sexual history were calculated, stratified by age, sex, race, and relationship status. Multivariable logistic regression was used to assess whether relationship status provided additional information in predicting HSV-2 over age, race and sex, and whether any such associations could be accounted for through differences in lifetime number of sex partners.
Those who were unpartnered had higher HSV-2 prevalence than those who were married/cohabitating. Among unpartnered 45-49 year olds, seroprevalence was 55.3% in women and 25.7% in men. Those who were married/cohabitating were more likely to have had a past-year sex partner, and less likely to have had two or more partners. The effect of age in increasing the odds of HSV-2 was modified by race, with higher HSV-2 prevalence among Black Americans established by age 20-24 years, and the effect of race decreasing from age 30 to 49. Relationship status remained an independent predictor of HSV-2 when controlling for age, race, and sex among those age 30 to 49; married/cohabitating status was protective for HSV-2 in this group (OR = 0.69)
Whereas sexually transmitted infections are often perceived as issues for young adults and specific high-risk groups, the chronic nature of HSV-2 results in accumulation of prevalence with age, especially among those not in married/cohabitating relationships. Increased odds of HSV-2 with age did not correspond with increases in self-reported genital herpes, which remained low. Adults who initiate new relationships should be aware of HSV-2 in order to better recognize its symptoms and prevent transmission.
"HIV seropositivity was significantly higher in men who ever reported sex with other men than in men who did not report same-sex contact. These observations are consistent with surveillance findings and previous seroepidemiologic surveys and support the notion that adoption of HIV and other STIs' risk reduction behaviors should be encouraged for the general population, especially those at high risk, including barrier precautions to reduce the risk for exposure to these viral agents [10,12,14,28,32]. "
[Show abstract][Hide abstract] ABSTRACT: Viral hepatitis and sexually transmitted infections (STIs) are key public health problems that pose an enormous risk for disease transmission in the general population. This study estimated, for the first time, prevalence estimates of serologic markers of HCV, HBV, HAV, HIV and HSV-2 in the adult population of Puerto Rico and assessed variations across sociodemographic and behavioral characteristics.
A seroepidemiologic survey was employed using a stratified cluster probability sample of households in Puerto Rico. Participants completed a face-to-face interview, a self-administered questionnaire using an ACASI system, and provided blood specimens for antibody testing. Prevalence estimates of viral hepatitis, HIV and HSV-2 were estimated using a logistic regression model weighting for the probability of participation in each household block and the inverse of the probability of selection according to geographic strata, households' blocks, and sex distribution.
A total of 1,654 adults participated in the study. Seroprevalence estimates for HCV (2.3%, 95% CI: 1.3%-4.2%), HBV (3.1%, 95% CI: 2.0%-4.7%), and HSV-2 (22.3%, 95% CI: 18.5%-26.7%) in Puerto Rico are roughly in agreement with estimates obtained in the US population; however, HAV (41.3%, 95% CI: 36.9%-45.8%) and HIV (1.1%, 95% CI: 0.5%-2.3%) seroprevalence estimates in Puerto Rico were higher. The proportion of individuals that were unaware of their serostatus was as follows: 80% for HCV, 98.3% for HBV, 96.4% for HAV, 36.4% for HIV, and 97.8% for HSV-2. Post-stratification estimates of seroprevalence varied significantly by demographic and risk related characteristics.
This data underscore the disproportionate impact of some viral infections across selected population subgroups in Puerto Rico. A concerted island-wide effort is needed to strengthen viral hepatitis and STIs prevention and control strategies, support surveillance to monitor chronic infections, and ensure appropriate counseling, testing, and medical management of infected persons. Integration of HCV, HBV, and HSV-2 counseling into HIV existing prevention services and outreach through social networks might represent a valuable approach to reach high-risk individuals.
[Show abstract][Hide abstract] ABSTRACT: There are no known racial differences in genital herpes disease pathogenesis or response to therapy. Despite high herpes simplex virus (HSV) seroprevalence in Black persons, clinical trials investigating the treatment of recurrent genital herpes (RGH) have typically enrolled a small proportion of Black patients.
This multicenter, double-blind, placebo-controlled study evaluated the efficacy and safety of patient-initiated, 1-day famciclovir 1000 mg twice-daily in immunocompetent Black adults (USA and South Africa) with RGH. Eligible patients were randomized (2:1) to famciclovir or placebo. The primary endpoint was time to healing of non-aborted genital herpes lesions (i.e., lesions that progressed beyond papule stage). Secondary endpoints included proportion of patients with aborted genital herpes lesions, time to resolution of associated symptoms, and safety.
www.ClinicalTrials.gov ; trial identifier NCT00477334.
A total of 299 patients with RGH (66% female, median age = 37 years) received either 1-day famciclovir 1000 mg twice-daily (n = 201) or placebo (n = 98). In the modified intent-to-treat population, the estimated median time to healing of non-aborted genital herpes lesions was 5.38 days for famciclovir and 4.79 days for placebo (median of treatment differences = 0.26 days; 95% CI [-0.40, 0.98]; p = 0.416). Consistent findings were reported in the completer and per-protocol populations. No significant differences were reported for all secondary analyses. Adverse events (AEs) were consistent with the established safety profile of famciclovir: 18 (6%) patients had drug-related AEs (16 [8%] famciclovir; 2 [2%] placebo), none of which were serious or led to discontinuation or dose adjustment/interruption. There are some limitations of this research: many study sites either lacked prior experience in conducting clinical studies in patients with HSV infection or enrolled small numbers of patients, which may have compromised efficacy outcomes. Also, HIV antibody testing was not mandated at enrollment.
This study showed similar efficacy and tolerability of 1-day treatment with famciclovir 1000 mg twice-daily compared to placebo in immunocompetent Black adults with RGH. Famciclovir has proven efficacy and safety in the overall RGH population. Further understanding of the efficacy of antiherpes therapy in Black patients with recurrent genital herpes may be warranted.
Current Medical Research and Opinion 03/2010; 26(3):653-61. DOI:10.1185/03007990903554471 · 2.65 Impact Factor
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