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Abstract

Background: Herpes simplex virus infection is a global health concern with disproportionately high burden in low and middle-income countries. There is a paucity of data on the prevalence of HSV infection in Ghana, which necessitated the present study. The aim of the study was to provide up-to-date data on sero-prevalence of HSV-1 and HSV-2 infection among women attending Cervicare clinics in Ghana. Methods: This was a cross-sectional study in which 380 women attending routine Cervicare clinics at Regional Hospitals in Kumasi and Accra, Ghana were enrolled into the study. Serum HSV-1 IgG and HSV-2 IgG were determined by ELISA method. The Chi-square test was used to investigate the association between sero-prevalence of HSV-1 and HSV-2 and socio-demographic and behavioral factors using the Statistical Package for the Social Scientists (SPSS) version 22. Statistical significance was accepted at p < 0.05. Results: The overall HSV-1 and HSV-2 sero-prevalence estimates were 99.2% (95% CI: 98.0-100%) and 78.4% (95% CI: 74.5-81.8%) respectively. The study observed 78.2% cross-positive prevalence of HSV-1 and HSV-2 among the studied participants. There was no association between the presence of HSV-1 and HSV-2 infection and age (χ2 = 2.351, p = 0.799 and χ2 = 1.655, p = 0.895 respectively). Our findings however, revealed association between the prevalence of HSV-2 and the age at coitarche (p = 0.021) as well as with number of sexual partners (p = 0.022). Conclusions: The sero-prevalence estimates of HSV-1 and HSV-2 among the study population of women in Ghana were found to be high. This high prevalence could be attributed to high endemicity and inadequate intervention in this population. There is the need to raise awareness through organized public health screening and education to ensure control.
R E S E A R C H A R T I C L E Open Access
SERO-prevalence of herpes simplex virus
type 1 and type 2 among women
attending routine Cervicare clinics in Ghana
Oksana Debrah
1,4*
, Francis Agyemang-Yeboah
1
, Richard Harry Asmah
3
, Emmanuel Timmy-Donkoh
1,2
,
Mohammed Mustapha Seini
1,4
, Linda Ahenkorah Fondjo
1
, Nilok Sight
5
and Ellis Owusu-Dabo
2,6
Abstract
Background: Herpes simplex virus infection is a global health concern with disproportionately high burden in low
and middle-income countries. There is a paucity of data on the prevalence of HSV infection in Ghana, which
necessitated the present study.
The aim of the study was to provide up-to-date data on sero-prevalence of HSV-1 and HSV-2 infection among women
attending Cervicare clinics in Ghana.
Methods: This was a cross-sectional study in which 380 women attending routine Cervicare clinics at Regional
Hospitals in Kumasi and Accra, Ghana were enrolled into the study. Serum HSV-1 IgG and HSV-2 IgG were determined
by ELISA method. The Chi-square test was used to investigate the association between sero-prevalence of HSV-1 and
HSV-2 and socio-demographic and behavioral factors using the Statistical Package for the Social Scientists (SPSS)
version 22. Statistical significance was accepted at p<0.05.
Results: The overall HSV-1 and HSV-2 sero-prevalence estimates were 99.2% (95% CI: 98.0100%) and 78.4% (95% CI:
74.581.8%) respectively. The study observed 78.2% cross-positive prevalence of HSV-1 and HSV-2 among the studied
participants. There was no association between the presence of HSV-1 and HSV-2 infection and age (χ
2
=2.351,
p=0.799andχ
2
=1.655,p= 0.895 respectively). Our findings however, revealed association between the prevalence
of HSV-2 and the age at coitarche (p=0.021)aswellaswith numberofsexual partners(p=0.022).
Conclusions: The sero-prevalence estimates of HSV-1 and HSV-2 among the study population of women in Ghana
were found to be high. This high prevalence could be attributed to high endemicity and inadequate intervention in
this population. There is the need to raise awareness through organized public health screening and education to
ensure control.
Keywords: Herpes simplex virus, Sero-prevalence, Ghana
Background
Herpes simplex virus (HSV) has been characterized into
two distinct serotypes: HSV -1 and HSV -2 [1]. HSV
type 1 has been associated with orofacial infections and
HSV type 2 with genital infections. Clinical reports
citing an increasing number of genital infections caused
by HSV -1 have been recognized, although HSV -2
dominates as a causative agent [1,2].
Sixty to 95 % of mature humans are either carrying
HSV viruses or are affected by associated infections
which are usually present in the host in latent state [3].
The large majority of persons with genital herpes do not
know they have the disease. Infection and reactivation
are typically asymptomatic,and depend on the hosts
immune system as well as the frequency of entries [3,4].
Both types are highly infectious and can be transmitted
from mother to neonate and increase the mortality rate
[5]. Additionally, infection with HSV-2 increases the risk
of human immunodeficiency virus (HIV) and human
papillomavirus (HPV) acquisition [6,7]. Estimation of
* Correspondence: oksanadeb@yahoo.com
1
Department of Molecular Medicine, Kwame Nkrumah University of Science
and Technology, Kumasi, Ghana
4
Laboratory Department, Ridge Regional Hospital, Accra, Ghana
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Debrah et al. BMC Infectious Diseases (2018) 18:378
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the burden of infection is important in appreciating the
scale of the epidemic. Although HSV infection is not a
curable medical condition, there are effective medica-
tions available to treat symptoms and prevent outbreaks.
Unfortunately there is currently no approved vaccine to
prevent HSV infection either [8].
The World Health Organization (WHO) reports that
HSV prevalence shows variations between regions and
populations [9]. The worldwide prevalence of HSV-1
infection in 2012 was 67.0%, with the highest estimated
prevalence of infection in Africa (87%) and lowest in
America (4050%). The overall prevalence of HSV -2
worldwide was 11.3% [10]. The prevalence of HSV-2 was
consistently higher in females compared to males (14.8
and 8.0% respectively). The highest prevalence was
reported in Sub-Saharan Africa, where prevalence
reached 31.5% followed by America 14.4% [9,10]. In
the meantime, there is a paucity of data on the preva-
lence of HSV infection in Ghana.
The purpose of the study was therefore, to provide
relevant baseline data on sero-prevalence of HSV-1 and
HSV-2 infection and associated risk factors among
women attending routine Cervicare centers in Ghana so
as to inform the development of future studies and guide
public health policy in the context of HSV infections.
Methods
Study design, setting and population
The study was a hospital based cross-sectional descrip-
tive study, covering the period from October 2014 to
March 2015.
In all, three hundred and eighty (380) women attend-
ing routine Cervicare Clinics at the Kumasi South Re-
gional Hospital, Kumasi, Ashanti Region, Ghana and
Ridge Regional Hospital, Accra, Greater Accra Region in
Ghana were enrolled in the study.
The participants were women who had come to Cervi-
care centers for visual inspection with acetic acid or to
perform Papanicolaou (Pap) smear test. The Cervicare
centers were established by Ghana Health Service in
selected regional hospitals and health facilities where
regular public announcements are carried out to invite
the women to participate in screening programs.
Sampling and data collection
Convenient sampling protocols were followed to recruit
the required sample size. The sample size was calculated
by StatCalc application of EpiInfo 3.5.3. The approach
used here to calculate sample size emphasized adequate
precision of reported sample statistics: that is the ability to
estimate sample statistics that do not differ from the true
population parameter by more than a preset limit of confi-
dence. Therefore, assuming a prevalence of HSV of 67%
in the general population of women, and a sufficiently
large population of women attending cervical screening
clinics, a maximum sample size of 340 women ensured
that the study had adequate precision (here we have set
the desired level of precision at ±5%) to provide statistics
close enough to the true population parameters. The
required sample size was pegged at 380 to cater for miss-
ing and incomplete data entries and other unforeseen
circumstances.
To mitigate bias in the sample, researchers conducted
public health awareness campaigns within the catchment
of the hospitals: on radio and at market centers and
encouraged women to present themselves for screening
at no cost. Additionally, a separate day was set aside the
regular clinic days to enroll study participants. At
recruitment, all volunteers gave informed consent by
signature or thumbprint. A questionnaire was adminis-
tered through one-on-one interview for data collection
on socio-demographic and gynecological characteristics,
sexual exposure, medical history and knowledge of HSV
infection. No participants had symptoms of cervical
ulcer from gynecological examination or orofacial ulcer
at the time of recruitment.
Inclusion and exclusion criteria
Participants who were more than 20 years old, non-
pregnant and who had written informed consent and
had gone through a pre-consented interview were in-
cluded in the study. Participants, who were less than
20 years old, had previously undergone a cervical
examination, were pregnant, had refused to sign an in-
formed consent and were unable to undergo a pre-con-
sented interview were not included in the study.
Sample collection
Five milliliters (5 ml) of venous blood was drawn from
all subjects to determine the presence of HSV-1 IgG and
HSV-2 IgG. The samples were allowed to clot before
centrifugation. Serum obtained by centrifugation was
aliquoted into eppendorf tubes for storage at 20° C till
analyzed.
Laboratory analysis
The serum HSV-1 IgG and HSV-2 Ig G were determined
by ELISA method using commercial test kits from
Calbiotech Inc., CA, USA. The manufacturers instruc-
tions were followed for the analyses. Briefly, 10 μlof
serum was diluted with 200 μl of diluent and incubated
at room temperature for 5 min. 100 μl of the sample
diluent (as a reagent blank), calibrator, negative and
positive controls, as well as patientsserum were then
aliquoted into microplate wells in duplicate, and incu-
bated at room temperature for 20 min. Three cycles of
washing were performed using 1X washing buffer and
100 μl of anti-IgG conjugate was added and incubated
Debrah et al. BMC Infectious Diseases (2018) 18:378 Page 2 of 7
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for 20 min. The washing procedure was repeated for an-
other three cycles and 100 μl of substrate solution was
added and incubated in the dark at room temperature for
10 min after which the reaction was stopped with 100 μl
of stopping solution. The absorbance was measured at
450 nm within 15 min using a reference wavelength of
600 nm 650 nm. The Antibody (Ab) Index of each de-
termination was calculated by dividing the mean OD value
of each sample as well as negative and positive controls by
the cut-off value. The cut-off value was calculated as
Calibrator OD× Calibrator Factor. Calibrator factor value
was indicated on the calibrator bottle.
Wells with patient antibody index greater than 1.1
were conventionally considered positive for the various
antibodies tested and those between 0.9 and 1.1 were
considered equivocal. While those wells with antibody
index less than 0.9 were considered negative for the
different antibodies tested. All equivocal samples were
retested with reagents of the same kit lot number.
Statistical analysis
The data collected from the questionnaire responses was
stored using Microsoft Excel 2007 software (Microsoft
Corporation, Redmond Campus, Washington DC, USA).
Quantitative variables were tested for normal distribu-
tion and reported as means ± standard deviation. Quali-
tative variables were presented as count (percentages).
The Chi-square test was used to investigate the associ-
ation between sero -prevalence of HSV type 1 and type
2, and socio-demographical and behavioral factors using
the Statistical Package for the Social Scientists (SPSS)
version 22. Statistical significance was conventionally set
at p< 0.05.
Results
Socio-demographic and obstetric characteristics of study
participants
The mean age of study participants was 40.83 years (SD ±
11.12) and ranged from 21 to 76 years. Socio-demographic
characteristics of study participants are presented in Table 1.
The age group from 25 to 44 years was the most repre-
sented (63.2%). Majority of the participants were married
(58.7%). The literacy rate among the women was very high
(91.1%), among which those educated up to the tertiary
level were 22.6% (n= 86), up to SHS/Vocational- 18.1% (n
= 69), up to JHS level- 38.7% (n= 147) and up to primary-
11.6% (n= 44). Majority of women were traders (n=145,
38.2%), self-employed (n= 77, 20.3%) followed by govern-
ment employees (n= 51, 13.4%) and private sector
employees (n= 38, 10.0%).
While about fifth of participants, 19.2% were nullipar-
ous, a large proportion of them had their first pregnancy
between the age of 1825 years (n= 195, 51.3%)
(Table 2). The study also sought to determine the level
of awareness of women pertaining to HSV and its mode
of transmission (Additional file 1). However, although a
few (n= 37, 9.7%) women had heard about the term
Table 1 Demographics and herpes simplex virus infection sero-
prevalence
Characteristics No
tested
Prevalence of HSV infection
HSV -1 IgG
N (%*)
HSV -2 IgG
N (%*)
Age group, years
25 12 12 (3.2) 8 (2.1)
2534 118 116 (30.5) 94 (24.7)
3544 122 121 (31.8) 94 (24.7)
4554 80 80 (21.1) 65 (17.1)
5564 39 39 (10.3) 30 (7.9)
65 9 9 (2.4) 7 (1.8)
χ
2
(df), p- value 2.351
(5), 0.799
1.655
(5), 0.895
Education
Never attended 34 34 (8.9) 30 (7.9)
Primary 44 44 (11.6) 36 (9.5)
Junior High School (JHS) 147 146 (38.4) 128 (33.7)
Senior High School (SHS) 45 45 (11.8) 30 (7.9)
Technical/ vocational 24 24 (6.3) 16 (4.2)
Tertiary 86 84 (22.1) 58 (15.3)
χ
2
(df), p- value 3.783
(5), 0.581
20.500
(5), 0.001
Marital status
Never married 61 59 (15.5) 45 (11.8)
Divorced/separated 33 33 (8.7) 29 (7.6)
Married 223 222 (58.4) 174 (45.8)
Cohabiting 31 31 (8.2) 23 (6.1)
Widowed 32 32 (8.4) 27 (7.1)
χ
2
(df), p- value 5.921
(4), 0.205
3.542
(4), 0.472
Occupation
Government employee 51 50 (13.2) 39 (10.3)
Private sector employee 38 37 (9.7) 30 (7.9)
Self -employed 77 76 (20.0) 50 (13.2)
Trader 145 145 (38.2) 128 (33.7)
Subsistence farming 4 4 (1.1) 4 (1.1)
Student 12 12 (3.2) 8 (2.1)
House wife 5 5 (1.3) 3 (0.8)
Unemployed 35 35 (9.2) 26 (6.8)
Retired 13 13 (3.4) 10 (2.6)
χ
2
(df), p- value 4.498
(8), 0.810
20.172
(8), 0.010
*- Column percentages computed in relation to total number of women (380)
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Herpes, none of the women knew about HSV or its
mode of transmission.
Sero-prevalence of study participants
The overall HSV-1 and HSV-2 sero-prevalence were
99.2% (95% CI: 98.0100.0%) and 78.4% (95% CI: 74.5
81.8%) respectively (Tables 3and 4). The majority of sero-
positive participants for HSV-1 and HSV-2 were between
25 and 44 years (n= 237), and the least rates were among
those 65 years and older (n=9)(Table1). Chi-square ana-
lysis did not indicate any association between the occur-
rences of HSV-1 and HSV-2 infection and age groups (χ
2
=2.351, p= 0.799 and χ
2
=1.655, p= 0.895 respectively).
Overall, sero-prevalence of both types of herpes infection
did not differ by marital status of participants (p=0.205
for HSV-1 and p= 0.472 for HSV-2). A strong association
existed between HSV-2 infection and level of education
among participants (p= 0.001) and the age of first
pregnancy (p=0.003), but not in the case of HSV-1 infec-
tion (p= 0.581 and p= 0.086 respectively).
The study observed that cross-positive prevalence of
HSV-1 and HSV-2 of study participants was 78.2% (95%
CI: 73.981.6%). There was no association between
multiple infection and age of participants (χ
2
= 6.702, p
= 0.753), as the same in case of marital status (χ
2
=
13.531, p= 0.095). A study also showed a strong associ-
ation between multiple infection and educational status
(p= 0.006) and the age of first pregnancy (p= 0.001).
Sexual risk factors
The analysis of some behavioral risk factors associated
with HSV-1 and HSV-2 sero-prevalence is presented in
Table 5. There were significant differences between
number of sexual partners and the prevalence of HSV-2
(p= 0.022). A higher proportion of women (57.9%) had
the first sexual relationship before age 20. The study
showed that the prevalence of HSV-2 decreased as the
age at coitarche increased. This association was statisti-
cally significant (p= 0.021). Multiple infection was
associated with age of first sexual debut (p= 0.004), but
not with multiple sexual partners (p= 0.137).
Discussion
There is a paucity of data on sero-prevalence of HSV
infection type 1 and type 2 in Ghana. To our knowledge
this is the first study on sero-prevalence of HSV-1 and
Table 2 Obstetric characteristics and herpes simplex virus
infection sero-prevalence
Characteristics No.
tested
Prevalence of HSV infection
HSV 1 IgG N (%*) HSV 2 IgG N (%*)
Age at first pregnancy, years
17 36 35 (9.2) 29 (7.6)
1821 98 98 (25.8) 86 (22.6)
2225 97 96 (25.3) 81 (21.3)
> 25 72 72 (18.9) 53 (13.9)
Never pregnant 45 43 (11.3) 27 (7.1)
Do not remember 32 32 (8.4) 22 (5.8)
χ
2
(df), p- value 9.641 (5), 0.086 17.840 (5), 0.003
Gravidae
0 45 43 (11.3) 27 (7.1)
12 90 90 (23.7) 72 (18.9)
34 133 132 (34.7) 109 (28.7)
5 112 112 (29.5) 90 (23.7)
χ
2
(df), p- value 9.285 (3), 0.026 10.386 (3), 0.016
*Column percentages computed in relation to total number of women (380)
Table 3 Sero-prevalence of HSV-1 IgG and HSV-2 IgG among
the study participants
Result HSV-1 IgG HSV-2 IgG
N (%) N (%)
Positive 377 (99.2) 298 (78.4)
Borderline 1 (0.3) 54 (14.2)
Negative 2 (0.5) 28 (7.4)
Table 4 HSV-1 IgG and HSV-2 IgG positivity stratified by ELISA
OD index
Result HSV-1 IgG HSV-2 IgG
N (%) N (%)
Low positive 228 (60.0) 203 (53.4)
High positive 149 (39.2) 95 (25%)
Low positiv e: 1.1 < OD 2.0; High positive: OD > 2.0
Table 5 Study population behavioral factors and herpes
simplex virus infection sero-prevalence
Characteristics No.
tested
Prevalence of HSV infection
HSV 1 IgG N (%*) HSV 2 IgG N (%*)
Age of coitarche, years
15 28 28 (7.4) 23 (6.1)
1620 192 192 (50.5) 157 (41.3)
2125 53 51 (13.4) 38 (10.0)
26 24 24 (6.3) 13 (3.4)
Do not remember 83 82 (21.6) 67 (17.6)
χ
2
(df), p- value 8.150 (4), 0.086 11.521 (4), 0.021
Number of life time sex partners
1 155 154 (40.5) 110 (28.9)
2 91 90 (23.7) 73 (19.2)
39 127 126 (33.2) 109 (28.7)
10+ 7 7 (1.8) 6 (1.6)
χ
2
(df), p- value 0.208 (3), 0.976 9.598 (3), 0.022
*Column percentages computed in relation to total number of women (380)
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HSV-2 infection among the women presenting to
Cervicare centers in Ghana. The study showed a high
prevalence of HSV-1 and HSV-2 among the population
of women (99.2 and 78.4% respectively).
Our findings are consistent with those of studies
among various populations in several African countries
[9]. A study conducted among women in urban Uganda
and among pregnant women in Benin city of Nigeria
also showed very high prevalence of HSV-1 infection: 98
and 96.6% respectively [11,12] whereas prevalence of
HSV-1 infection among pregnant women in Vanuatu
was reported as 100% [13]. In 2012, the WHO 2012
reported a global prevalence of HSV-1 of 68%, with the
highest prevalence in Africa (87%) [9].
In the case of HSV-2 infection our findings are corrob-
orated by other studies conducted in Ghana [14,15].
Those studies focused on smaller numbers of partici-
pants. One of the studies showed a sero-prevalence of
HSV-2 infection among women attending sexually trans-
mitted disease (STD) clinics in Accra and Kumasi
(Ghana) of 71% (n= 278) [14]. The other study
conducted in Ghana among 91 pregnant women also
reported a high prevalence of HSV-2 (68%) which is
similar to the current findings [15].
Similar high sero-prevalence rates have been reported
in other African countries. Among pregnant women in
Cote DIvoire 96.5% [16], women attending STD clinics
in Bangui (Central Africa Republic) and Nigeria: 95 and
86.4% respectively [14,17]. The high prevalence of
HSV-2 infection on our study could be due to the high
transmission of the virus. The lack of awareness of this
viral infection among the population and environmental
factors could also be contributory factors.
However, the prevalence of HSV-2 was higher com-
pared to estimates from some African studies as well.
The prevalence of infection among women was 58% in
Uganda [11], 68% in Zimbabwe [18], 55% in Zambia [19]
and 28% in Gambia [20]. A study conducted in Sudan
among pregnant women reported a prevalence rate of
34.6% for HSV-2 infection [21] and 20.7% in Tanzania
[22]. Two independent studies from Nigeria reported
lower sero-prevalence of HSV-2 infection among preg-
nant women, 44.3% [12] and 47.3% [23] than we found.
HSV-2 prevalence is thought to increase with age as
infection is lifelong [10]. However, our study did not re-
veal a significant correlation between age and HSV-2
infection. This finding was also observed in a study
conducted among Sudanese pregnant women [21]. The
sexual behavioral factors associated with HSV-2 were
young age at sexual debut and multiple sexual partners.
Other research supports our findings that earlier age of
sexual intercourse is associated with prevalence of
HSV-2 infection. Our findings correlated with those
reported in Nigeria, India and Zimbabwe [2325].
Some studies had also indicated that HSV-2 infection
is associated with multiple sex partners [24]. In our
study this behavioral factor was also significantly associ-
ated with HSV-2 prevalence (p= 0.022).
However, the presence of HSV-1 infection was not
related to sexual behavior in this study. This could be
because women in our study were infected early in life
and already had antibodies against HSV-1 by the time
they became sexually active. This is corroborated by a
report from WHO, where in Africa and South-East Asia
most HSV-1 infection occurred during first 5 years of
life, with no new infections in adulthood [9].
The high estimate of HSV infection highlights the
need for development of vaccines and other new HSV
prevention strategies [10].
In general, there was very low awareness of the clinical
symptoms and mode of transmission of the HSV infec-
tion among the women enrolled in the study. Some even
believed that, lesions around the mouth were symptoms
of malaria. Even though herpes infection could look
harmless (since the infected person may be asymptom-
atic and clueless) it is a lifelong infection which could
lead to a silentspread in the population, with possible
debilitating consequences. This implies that public
health concern should be seriously directed to this issue
in Ghana. There is a necessity for educational programs
and improved strategies in patient care, especially in
at-risk populations.
Limitations
The study design used in this work may limit the
generalizability of these findings to the broader popula-
tion because of variability in risk factor profiles among
the general population of women and women with
health seeking behavior. Because of this, it is possible
that prevalence estimates reported here may be slightly
higher than in the general population. Any attempt to
generalize these studies beyond this population must be
made with caution. Nevertheless, we conducted public
health awareness campaigns within the catchment of the
hospitals: on radio and at market centers and encour-
aged women to freely present themselves for screening
at no cost. Additionally, it is hoped that fixing a separate
day aside the regular clinic days to enroll study partici-
pants could arrest and mitigate any bias. Also, because
these results are based on cross-sectional data, any
causal inference is speculative.
Conclusion
The prevalence of HSV-1 and HSV-2 among the women
attending the Cervicare centers in Accra and Kumasi,
the two major cities in Ghana was high. The major fac-
tor found to be associated with sero-prevalence of
HSV-2 was age at coitarche and number of life time
Debrah et al. BMC Infectious Diseases (2018) 18:378 Page 5 of 7
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sexual partners. This could be due to the high endem-
icity and inadequate intervention in this population, the
lack of awareness of some viral infections among the
population and environmental factors. There is the need
to raise awareness through organized public health
screening and education to ensure control.
Additional file
Additional file 1: Questionnaire. (DOCX 19 kb)
Abbreviations
HIV: Human Immunodeficiency Virus; HPV: Human Papillomavirus;
HSV: Herpes Simplex Virus; JHS: Junior High School; Pap: Papanicolaou;
SHS: Secondary High School; SPSS: Statistical Package for the Social Scientists;
WHO: World Health Organization
Acknowledgements
We wish to acknowledge all the staff of Cervicare centers from both facilities
(Accra and Kumasi) in Ghana and all the study participants.
Ethical approval and consent to participate
The study was approved by the Committee on Human Research Publication and
Ethics (CHRPE), Kwame Nkrumah University of Science and Technology, School of
Medical Sciences (KNUST-SMS) and Komfo Anokye Teaching Hospital (KATH)
(CHRPE/AP/115/14), Kumasi, Ghana and Ghana Health Service Ethical Review
Committee, Research and Development Division (GHS-ERC:07/03/14). Voluntary
written informed consent was sought from the participants. The study was
conducted in an environment with no form of coercion and volunteers were
adequately informed of the purpose, nature and procedures of the study.
Availability of data and materials
The datasets used and/or analyzed during the current study are available
from the corresponding author on reasonable request.
Authorscontributions
OD formulated the concept, carried out the implementation of the research,
involved in the recruitment of the participants and data collection, performed
laboratory analysis, analyzed and interpreted the data, wrote the manuscript
with input from all authors. FAY formulated the concept, directed the
implementation of research, supervised findings of this work, and was a major
contributor in writing the manuscript and final approval of the version to be
published. RHA help to supervise the project and contributed to the final
version of the manuscript. ETD involved in the recruitment of the participants
and data collection, contributed to the analyses of the results and to
the final version of the manuscript. MMS assisted with laboratory analysis
and contributed to the final version of the manuscript. LAF contributed to the
final copy of the manuscript. NS assisted with laboratory analysis and contributed
to the final version of the manuscript. EOD supervised the project and
contributed to the final version of the manuscript. All authors read and
approved the final manuscript.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
PublishersNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Department of Molecular Medicine, Kwame Nkrumah University of Science
and Technology, Kumasi, Ghana.
2
Kumasi Center for Collaborative Research
in Tropical Medicine, Kwame Nkrumah University of Science and Technology,
Kumasi, Ghana.
3
College of Health Sciences, University of Ghana, Legon,
Accra, Ghana.
4
Laboratory Department, Ridge Regional Hospital, Accra,
Ghana.
5
Laboratory Department, C&J Medicare Hospital and Diagnostic
Center, Accra, Ghana.
6
Department of Global Health, School of Public
Health,KNUST, Kumasi, Ghana.
Received: 19 September 2017 Accepted: 31 July 2018
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... In their review article, , reported a high incidence of genital HSV-1 cases in America and European, and negligible incidence in Africa and South East Asia [9]. Although the prevalence of HSV infection in Ghana is also thought to be high [5,9,10], case reporting is not mandatory in Ghana. Consequently, statistics on the occurrence of infections are not available in Ghana, as well as in most African countries. ...
... Consequently, statistics on the occurrence of infections are not available in Ghana, as well as in most African countries. The few available data on the prevalence of infection were generally achieved in isolated studies conducted in public health clinics on sexually transmitted diseases; and mostly based on serology [10,11,12]. ...
... Two of such centers is situated at the Greater Accra Regional Hospital in Accra, the capital of Ghana and Kumasi South Hospital in Kumasi in the middle-belt of Ghana. Between October 2013 and March 2014, we undertook a cross-sectional study on the distribution of genital human papillomaviruses and seroprevalence of herpes infection among Ghanaian women presenting to this facility [10,15]. In all, three hundred and eighty (380) women attending routine Cervicare Centers at two Regional Hospitals (Greater Accra Regional Hospital, Accra and Kumasi South Regional Hospital, Kumasi) were enrolled in the parent study. ...
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Herpes simplex virus infections account for a large burden of disease worldwide. HSV-1 is traditionally considered to cause orofacial infections, whereas HSV-2 is known for genital infections. A number of studies have suggested an increase of genital herpes infections caused by HSV-1. As reporting of diseases caused by herpes simplex virus is not mandatory in Ghana, reliable statistics on the epidemiology of infections are not available. We took advantage of the Cervicare program in Ghana to screen for the presence of HSV variants 1 and 2 among a convenient subset of asymptomatic women presenting for cervical screening in Accra, Ghana (n = 94). Genetic markers for both HSV 1 and 2 were detected in cervical swabs. There was a preponderance of HSV-1 (12.8%) genital infections in our study sample: compared to HSV-2 (4.8%). HSV-1 and 2 co-infection was detected in 4.3% of study population. Among positive cases for HSV-1 DNA, 92% had con rmed seropositive HSV-1 status and 8% were borderline result. All positive HSV-2 DNA were con rmed seropositive HSV-2 status. We have successfully demonstrated the presence of herpes simplex virus type 1 and type 2 gene variants in genital swabs. Owing to the lack of epidemiological data on genital HSV-1 infection in Ghana, the role of sexual transmission for HSV-1 is unclear: the ndings of our pilot study have important public health implications. A bigger surveillance study is recommended in Ghana to identify the etiology of genital herpes and estimate the true burden of asymptomatic herpes infection in the population.
... Prevalence in both groups increases with age and is higher in women than in men [11][12][13]. HSV-1 is disproportionately more prevalent in Sub-Saharan Africa, where the infection rate is greater than 90% and increases with age [14][15][16]. ...
... J. Biomed. Nanotechnol.17,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] 2021 ...
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Human Immunodeficiency Virus (HIV) is a global pandemic that has contributed to the burden of disease, and the synergistic interaction between Herpes Simplex Virus (HSV) and HIV has assisted further in the spread of the HIV disease. Moreover, several chemotherapeutic treatment options from antiviral monotherapy to highly active antiretroviral therapy (HAART) have been adopted to manage the infection; however, HIV has developed new mechanisms against these active pharmaceutical agents (APAs), limiting the effect of the drugs. In this article, we reviewed different nanoparticles and their antiviral potency against HSV and HIV infection as well as the effect of drug encapsulated nanoparticles using different drug delivery systems as they palliate to some flaws or deficiencies that the stand-alone drugs present. Drug encapsulated nanoparticles show better treatment outcomes of HSV and HIV infection. The nanoparticles can transverse the anatomic privilege sites to exert their therapeutic effect, and a prolonged and higher dose of the encapsulated therapeutic agent can ease the dosage frequency, thus palliating low drug compliance which the stand-alone drugs fail to perform. Therefore, it is clear that nanoparticles prevent antiviral drug resistance by maintaining sustained drug release over an extended period, improving the therapeutic effect of the entrapped drug
... In the United States, between 2015 and 2016, the prevalence of HSV-1 and HSV-2 among people between 14 and 49 years of age was 47.8% and 11.9%, respectively [4]. During the period from October 2014 to March 2015 in Ghana, the prevalence rates of HSV-1 and HSV-2 among females were 99.2% and 78.4%, respectively [5]. These results indicate that the global spread of HSV-1 and HSV-2 is high and attention-worthy [6]. ...
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Objective: Herpes simplex virus (HSV) infections have been reported in 60% to 95% of the adult population worldwide, making them one of the most common infectious conditions globally. HSV-1 and HSV-2 cause severe disease in immunocompromised patients. Therefore, the aim of this study was to provide information that could be used to reduce the incidence of genital herpes caused by HSV-1 and HSV-2. Methods: From September 2018 to December 2020, 59,381 specimens were collected from outpatients across primary and secondary hospitals in Korea who requested U2Bio (Korea) to conduct molecular biological testing of their samples for sexually transmitted infections. In this study, the positivity rates of HSV-1 and HSV-2 were analyzed according to age, sex, and specimen type. Results: In the age-specific analysis of HSV-1, the highest positivity rate (0.58%) was observed in patients under 19 years of age, whereas the lowest positivity rate (0.08%) was observed in patients aged over 70 years. In the age-specific analysis of HSV-2, the highest positivity rate (2.53%) was likewise observed in patients under 19 years of age. Conclusion: Our study identified differences in the infection rates of HSV-1 and HSV-2 depending on patients' sex and age. These differences will be useful for improving disease prevention and control measures for HSV-1 and HSV-2.
... and cell targets, potentially leading to higher efficacy and lower toxicity because of drug synergy [6]. Therefore, in the clinical treatment of complex diseases, such as parasitic nematode infections or herpes simplex virus (HSV), a variety of drugs have been used in combination for treatment improvement [7]. The infection of parasitic nematodes (or roundworms) poses a serious safety hazard to humans and livestock [8], and the anthelmintics (or antinematode drugs) are highly susceptible to drug resistance. ...
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Background Combinatorial drug therapy for complex diseases, such as HSV infection and cancers, has a more significant efficacy than single-drug treatment. However, one key challenge is how to effectively and efficiently determine the optimal concentrations of combinatorial drugs because the number of drug combinations increases exponentially with the types of drugs. Results In this study, a searching method based on Markov chain is presented to optimize the combinatorial drug concentrations. In this method, the searching process of the optimal drug concentrations is converted into a Markov chain process with state variables representing all possible combinations of discretized drug concentrations. The transition probability matrix is updated by comparing the drug responses of the adjacent states in the network of the Markov chain and the drug concentration optimization is turned to seek the state with maximum value in the stationary distribution vector. Its performance is compared with five stochastic optimization algorithms as benchmark methods by simulation and biological experiments. Both simulation results and experimental data demonstrate that the Markov chain-based approach is more reliable and efficient in seeking global optimum than the benchmark algorithms. Furthermore, the Markov chain-based approach allows parallel implementation of all drug testing experiments, and largely reduces the times in the biological experiments. Conclusion This article provides a versatile method for combinatorial drug screening, which is of great significance for clinical drug combination therapy.
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Background: Herpes simplex virus (HSV) is a widely distributed human pathogen that is known for its ulcerative lesions at the infection site. HSV can cause persistent infection in the host that is often followed by a period of latency within the neurons. Considering the high rate of HIV infection in South Africa, it is important to assess the seroprevalence of HSV with a focus to determine the epidemiological association between HSV-DNA and HIV-1 in the population. Methods: A total of 44 sera samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of the 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The PCR results, with the use of type specific primers, showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using the chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: There is a significant positive association between HSV-2 and HIV-1 in the study population. Our study shows that some of the HSV-2 isolates are not related to the clinical isolate SD90e from South Africa, suggesting diversity in HSV-2 viral transmission.
Article
Background: Herpes simplex virus (HSV) is a widely distributed human pathogen that is known for its ulcerative lesions at the infection site. HSV can cause persistent infection in the host that is often followed by a period of latency within the neurons. Considering the high rate of HIV infection in South Africa, it is important to assess the seroprevalence of HSV with a focus to determine the epidemiological association between HSV-DNA and HIV-1 in the population. Methods: A total of 44 sera samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of the 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The PCR results, with the use of type specific primers, showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using the chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: There is a significant relationship between HSV-2 and HIV-1 in the study population. Our study shows that some of the HSV-2 isolates are not related to the clinical isolate SD90e from South Africa, suggesting diversity in HSV-2 viral transmission.
Article
Background: Herpes simplex virus (HSV) is a widely distributed human pathogen that is known for its ulcerative lesions at the infection site. HSV can cause persistent infection in the host that is often followed by a period of latency within the neurons. Considering the high rate of HIV infection in South Africa, it is important to assess the seroprevalence of HSV with a focus to determine the epidemiological association between HSV-DNA and HIV-1 in the population. Methods: A total of 44 sera samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of the 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The PCR results, with the use of type specific primers, showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using the chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: The prevalence of HSV in the population is high with an increased HSV-2 infection in women. Our study shows that some of the HSV-2 isolates are not related to the clinical isolate SD90e from South Africa, suggesting diversity in HSV-2 viral transmission.
Article
Full-text available
Herpes simplex virus type 2 is the common cause of genital ulcer disease worldwide. Genital herpes infection is a major concern in pregnancy due to the risk of neonatal transmission. Materials and methods: A descriptive cross-sectional survey was conducted from August 2016 to March 2017 in some hospitals and health centers to assess the seroprevalence and risk factors of herpes simplex virus type 2 infection among pregnant women attending antenatal care in Dhamar city, Yemen. After taking written consent, socio-demographic, behavioral and obstetric history along with blood samples were collected from 200 pregnant women using a pre-structured questionnaire. Sera were analyzed for HSV-2 specific IgG using Electro-Chemiluminescence Immunoassay (ECLIA) method. Results: The overall seroprevalence of HSV-2 infection was 6 % (12/200) among pregnant women in Dhamar city. Levels of education and some obstetrical history such as numbers previous abortion (P=0.03), stillbirth (P=0.001). Although the study showed, there are significant differences in some symptoms, such as itching (P=0.02) and inflammation during urination (P=0.03). Conclusion: Overall, the seroprevalence of HSV-2 infection among pregnant women in Dhamar city is low. There is a critical need to adopt screening of HSV-2 into the antenatal profile tests. There is also need for more health education of this virus infection, methods of transmission, associated risk factors, and effective prevention and control strategies
Preprint
Full-text available
Background: Combinatory drug therapy for complex diseases, such as HSV infection and cancers, has a more significant efficacy than single-drug treatment. However, one key challenge is how to effectively and efficiently determine the optimal concentrations of combinatory drugs because the number of drug combinations increases exponentially with the types of drugs. Results: In this study, a searching method based on Markov chain is presented to optimize the combinatory drug concentrations. Its performance is compared with four stochastic optimization algorithms as benchmark methods by simulation and biological experiements. Both simulation results and experimental data demonstrate that the Markov Chain-based approach is more reliable and efficient than the benchmark algorithms. Conclusion: This article provides a versatile method for combinatory drug screening, which is of great significance for clinical drug combination therapy.
Article
Full-text available
Background: Herpes simplex viruses (HSVs) are highly pervasive and show a strong synergistic interaction with human immunodeficiency virus (HIV). High prevalence of HSV type 1 (HSV-1) has been reported in Africa with a prevalence rate of 20-80% in women and 10-50% in men. Studies on the prevalence of HSV in South Africa are few considering the rate of HIV infection in the country. Our focus was to determine the molecular prevalence of HSV-DNA in HIV-1 sera. Methods: In total, 44 convenience samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The results of PCR with type specific primers showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: High prevalence of HSV-2 recorded in HIV-1 sera corroborate with similar studies conducted within different cohorts in the continent. SPSS Pearson’s chi-squared test established that there is a significant relationship between HSV-2 and HIV-1 transmission.
Article
Full-text available
Background: Rubella virus, Cytomegalovirus (CMV) and Herpes simplex virus-2(HSV-2) are important viruses associated with adverse outcomes in neonates. Theiroccurrence and frequencies are, however, least studied in many African countriesincluding Ghana. Methods: A cross-sectional study was designed to investigate the prevalence andrisk factors associated with rubella virus, CMV and HSV-2 exposures among pregnantwomen attending the ante-natal unit of the Komfo Anokye Teaching Hospital. Thestudy was carried out between January 2013 and March 2013. IgM and IgGantibodies were tested to assess the current and past history of virus exposure. Results: Ninety one subjects were screened for both CMV and HSV-2 infections, and89 for rubella virus infection. CMV infection had the highest IgG and IgM seropositivityof 95.6% (95% CI: 89.1% - 98.8%) and 38.5% (95% CI: 28.4% - 49.2%) respectively. This was followed by rubella virus infection with IgG positivity of 92.3% (95% CI:87.4% - 98.2%), IgM of 6.6% (95% CI: 2.5% - 13.8%), and HSV-2 IgG positivity of68.1% (95% CI: 57.5% - 77.5%). Fifty four (60.7%) subjects were co-infected with allthe three viruses while 32 (36%) were co-infected by a combinations of two viruses.There was no association between virus exposure and various socio-demographicindicators and risk factors. Conclusions: This study has provided pilot data on herpes and rubella virusesinfections among pregnant women in Ghana. A larger prevalence study isrecommended to inform policy makers and health stakeholders.
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Full-text available
Background: Herpes simplex virus type 1 (HSV-1) commonly causes orolabial ulcers, while HSV-2 commonly causes genital ulcers. However, HSV-1 is an increasing cause of genital infection. Previously, the World Health Organization estimated the global burden of HSV-2 for 2003 and for 2012. The global burden of HSV-1 has not been estimated. Methods: We fitted a constant-incidence model to pooled HSV-1 prevalence data from literature searches for 6 World Health Organization regions and used 2012 population data to derive global numbers of 0-49-year-olds with prevalent and incident HSV-1 infection. To estimate genital HSV-1, we applied values for the proportion of incident infections that are genital. Findings: We estimated that 3709 million people (range: 3440-3878 million) aged 0-49 years had prevalent HSV-1 infection in 2012 (67%), with highest prevalence in Africa, South-East Asia and Western Pacific. Assuming 50% of incident infections among 15-49-year-olds are genital, an estimated 140 million (range: 67-212 million) people had prevalent genital HSV-1 infection, most of which occurred in the Americas, Europe and Western Pacific. Conclusions: The global burden of HSV-1 infection is huge. Genital HSV-1 burden can be substantial but varies widely by region. Future control efforts, including development of HSV vaccines, should consider the epidemiology of HSV-1 in addition to HSV-2, and especially the relative contribution of HSV-1 to genital infection.
Article
Full-text available
Herpes simplex virus type 2 (HSV-2) infection causes significant disease globally. Adolescent and adult infection may present as painful genital ulcers. Neonatal infection has high morbidity and mortality. Additionally, HSV-2 likely contributes substantially to the spread of HIV infection. The global burden of HSV-2 infection was last estimated for 2003. Here we present new global estimates for 2012 of the burden of prevalent (existing) and incident (new) HSV-2 infection among females and males aged 15-49 years, using updated methodology to adjust for test performance and estimate by World Health Organization (WHO) region. We conducted a literature review of HSV-2 prevalence studies world-wide since 2000. We then fitted a model with constant HSV-2 incidence by age to pooled HSV-2 prevalence values by age and sex. Prevalence values were adjusted for test sensitivity and specificity. The model estimated prevalence and incidence by sex for each WHO region to obtain global burden estimates. Uncertainty bounds were computed by refitting the model to reflect the variation in the underlying prevalence data. In 2012, we estimate that there were 417 million people aged 15-49 years (range: 274-678 million) living with HSV-2 infection world-wide (11.3% global prevalence), of whom 267 million were women. We also estimate that in 2012, 19.2 million (range: 13.0-28.6 million) individuals aged 15-49 years were newly-infected (0.5% of all individuals globally). The highest burden was in Africa. However, despite lower prevalence, South-East Asia and Western Pacific regions also contributed large numbers to the global totals because of large population sizes. The global burden of HSV-2 infection is large, leaving over 400 million people at increased risk of genital ulcer disease, HIV acquisition, and transmission of HSV-2 to partners or neonates. These estimates highlight the critical need for development of vaccines, microbicides, and other new HSV prevention strategies.
Article
Full-text available
Introduction: The burden of HSV-2 infection, the cause of most cases of genital herpes in Nigeria, varies from region to region; and so are the associated factors. This infection is known to be responsible for several negative pregnancy outcomes. There is currently no documented data on sexual behavioral factors associated with the occurrence of HSV-2 infection or seroprevalence among pregnant women in Nigeria. This study aimed at identifying the sexual behavioral correlates of HSV-2 seroprevalence among pregnant women in Benin City, Nigeria. Methodology: The cross-sectional study design was adopted and the study took place between November 2011 and June 2012. Four hundred and ten consenting ante-natal clinic patients in two major tertiary hospitals in Benin City were consecutively and prospectively included. Data sources were represented by questionnaires, the patient's case records and laboratory investigations. Each patient's serum was analyzed for HSV-2 antibody detection. Data analysis was performed using SPSS version 16. Results: Four hundred and ten patients were enrolled with average age 30.6 years. Seroprevalence of HSV-2 antibody was 47.3%. Sexual behavioral factors that were significantly associated with HSV-2 seroprevalence included early exposure to sexual intercourse, number of sex partners, involvement in polygamous marriages, involvement of husband in extra-marital affairs and hormonal contraceptive use. Conclusion: The prevalence of HSV-2 among pregnant women in Benin City is high. Public health campaigns aimed at: delaying onset of sexual activity; encouraging monogamous relationships; and emphasizing that hormonal contraceptives do not protect from STI's, are recommended.
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