Antibody to Herpes Simplex Virus Type 2 as a Marker of Sexual Risk Behavior in Rural Tanzania

London School of Hygiene, Central Public Health Laboratory, London, United Kingdom.
The Journal of Infectious Diseases (Impact Factor: 6). 02/1999; 179(1):16-24. DOI: 10.1086/314555
Source: PubMed


A serosurvey was conducted in a random sample of 259 women and 231 men in 12 rural communities in Mwanza Region, Tanzania,
using a type-specific ELISA for Herpes simplex virus type 2 (HSV-2) infection. Seroprevalence rose steeply with age to ∼75% in women ≥25 years old and 60% in men ≥30. After
adjusting for age and residence, HSV-2 prevalence was higher in women who were married, in a polygamous marriage, Treponema pallidum hemagglutination assay (TPHA)-positive, had more lifetime sex partners, or who had not traveled. Prevalence was higher in
men who were married, had lived elsewhere, had more lifetime partners, had used condoms, or were TPHA-positive. HSV-2 infection
was significantly associated with recent history of genital ulcer. The association between HSV-2 infection and lifetime sex
partners was strongest in those < 25 years old in both sexes. This association supports the use of HSV-2 serology as a marker
of risk behavior in this population, particularly among young people.

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    • "The limitations of self-reported sexual behavior data (Catania et al., 1990; Cleland et al., 2004; Helleringer et al., 2011; Morris, 2004; Obasi et al., 1999; Pisani et al., 2003), could be a key reason for the challenges encountered in these analyses. Our analysis provided a contextual support of a remarkable reduction in sexual risk behavior, but through an indirect approach rather than direct empirical data. "
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    ABSTRACT: HIV prevalence is decreasing in much of sub-Saharan Africa (SSA), but the drivers of the decline are subject to much dispute. Using mathematical modeling as a tool for hypothesis generation, we demonstrate how the hypothesis that the drop in prevalence reflects declines in sexual risk behavior is self-consistent. We characterize these potential declines in terms of their scale, duration, and timing, and theorize on how small changes in sexual behavior at the individual-level could have driven large declines in HIV prevalence.
    Full-text · Article · Sep 2014 · Epidemics
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    • "Unfortunately, currently available markers in vaginal fluids (Y-chromosome, semenogelin, prostate-specific antigen) do not reliably detect previous sex that occurred over 14 days prior to sample collection [47]. A serological marker of sexual exposure, such as herpes simplex virus type-2 (HSV-2) antibody [48] was not measured because of budget constraints, concerns that drawing a blood sample may have increased refusal rate, and because HSV-2 is not a gold standard for the detection of sexual debut [49]. Finally, self-administered vaginal swabs were collected rather than physician-collected endocervical specimens. "
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    ABSTRACT: Background. Human papillomavirus (HPV) vaccines are recommended for girls prior to sexual debut because they are most effective if administered before girls acquire HPV. Little research has been done on HPV prevalence in girls who report not having passed sexual debut in high HPV-prevalence countries. Methods. Using attendance registers of randomly selected primary schools in the Mwanza region of Tanzania, we enrolled girls aged 15–16 years who reported not having passed sexual debut. A face-to-face interview on sexual behavior and intravaginal practices, and a nurse-assisted self-administered vaginal swab were performed. Swabs were tested for 13 high-risk and 24 low-risk HPV genotypes. Results. HPV was detected in 40/474 (8.4%; 95% confidence interval [CI], 5.9–11.0) girls. Ten different high-risk and 21 different low-risk genotypes were detected. High-risk genotypes were detected in 5.3% (95% CI, 3.5–7.8). In multivariable analysis, only intravaginal cleansing (practiced by 20.9%) was associated with HPV detection (adjusted odds ratio = 2.19, 95% CI, 1.09–4.39). Conclusion. This cohort of adolescent Tanzanian girls had a high HPV prevalence prior to self-reported sexual debut, and this was associated with intravaginal cleansing. This most likely reflects underreporting of sexual activity, and it is possible that intravaginal cleansing is a marker for unreported sexual debut or nonpenetrative sexual behaviors.
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    • "• Sexual risk behaviour will be measured in the Population Cohort at each survey and used to assess whether there is behavioural disinhibition related to the intervention. This analysis will be supported by data collected in the Population Cohort on Herpes simplex virus, type 2 incidence, which has been shown to be a biomarker for sexual risk behaviour especially among young people [61-63]. "
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