Seroprevalence of Herpes Simplex Virus Type 2 and Characteristics Associated With Undiagnosed Infection: New York City, 2004
New York City Department of Health and Mental Hygiene, New York, New York 10013, USA. Sex Transm Dis
(Impact Factor: 2.84).
07/2008; 35(6):599-606. DOI: 10.1097/OLQ.0b013e3181666fb1
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.
Available from: Todd Anthony Coleman
- "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. "
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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.
Available from: Edmir Marrero
- "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]. "
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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.
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