Seroprevalence of herpes simplex virus types 1 and 2 in HIV-Infected and uninfected homosexual men in a primary care setting

doi:10.1016/S1386-6532(01)00203-7

Journal of Clinical Virology

Volume 22, Issue 3, October 2001, Pages 305-313

https://doi.org/10.1016/S1386-6532(01)00203-7 Get rights and content

Abstract

Background: Genital herpes is usually caused by herpes simplex virus type 2 (HSV-2), with infections often being unrecognised by patients and/or clinicians. HSV-2 infections may be a risk factor for the transmission of human immunodeficiency virus (HIV) infection. Reliable tests for type-specific HSV antibodies are now readily available. Objectives: To determine the seroprevalence of HSV-1 and -2 in HIV-seronegative gay men in a primary care setting in Melbourne, Australia, and to compare it with the rate in HIV-infected gay men. To assess the utility in a clinical setting of a type-specific HSV enzyme linked immunosorbent assay (ELISA) as compared with western blot. Study design: We recruited a total of 300 HIV-seronegative homosexual men attending for HIV antibody testing, and HIV-infected men attending for CD4 lymphocyte count and viral load estimation. The subjects completed a questionnaire, and sera were sent for total IgG HSV testing and testing by Gull type-specific HSV ELISA assay. Selected serum samples were retested by western blotting and the results analysed. Results: In total, 168 HIV-antibody negative men and 132 HIV-antibody positive men were recruited. Of all subjects, 73.3% had HSV-1 antibodies. This proportion did not differ between HIV-seronegative and seropositive men (P=0.48). About twenty percent of HIV-seronegative men and 61% of HIV-seropositive men had antibodies to HSV-2 (P<0.0001); 75.6% of HIV-seronegative men with antibodies to HSV-2 gave no history of genital herpes, as did 66.7% of HIV-seropositive men. Overall, in using the type-specific ELISA (Gull) assay, false negative, false positive or equivocal results were obtained in 33/300 (11%) of samples tested compared with western blot. Conclusions: High rates of HSV-2 infection were found in homosexual males, with the rate for HIV-seropositive men being over twice that for HIV uninfected men. Most subjects were not aware of their infection with HSV-2. HIV-infected individuals were also older and had higher numbers of sexual partners, but we were unable to unambiguously establish that these variables contributed to the difference in HSV-2 seroprevalence rates. The Gull type-specific assay for HSV antibodies has significant problems with sensitivity and specificity at a discrepancy rate of 11%. Caution is advised in using this type-specific commercial assay for clinical purposes.

Section snippets

Background

Genital herpes is one of the most widespread sexually transmitted infections (STIs). It is caused frequently by infection with herpes simplex virus type 2 (HSV-2), although infections with HSV type 1 would appear to be an increasingly commonly recognised cause of genital herpes infections (Wald et al., 1994, Christie et al., 1997). Symptoms of HSV genital infections may range from mild to severe, and often are asymptomatic, going unrecognised by patient and/or physician.

The prevalence of HSV-2

Study design

The study population subjects were recruited from January 1999 to May 2000 from two inner city primary care practices with high-caseloads of gay men and HIV-positive individuals. The target was 300 subjects, with half being HIV-seronegative and half seropositive. Subjects were recruited when requesting an HIV antibody test (HIV-seronegative gay men), or when they requested routine CD4 lymphocyte and HIV viral load estimation (HIV-seropositive gay men). Written informed consent was obtained.

Results

The target population of 300 was reached, with 138 subjects (46.0%) being HIV-infected and 162 (54.0%) being HIV-uninfected subjects.

The mean age of the 300 subjects was 36.9 (range=19.4–71.8). Of the HIV-seronegative subjects, the mean age was 36.45 and for HIV-seropositive individuals it was 38.96 (P=0.0125). This information and sexual history is displayed in Table 1. Data involving age and other factors concerning sexual behaviour are compared between HIV-seronegative and HIV-seropositive

Discussion

This study confirms previous data showing high rates of HSV-2 infection among homosexual men, with the HSV-2 seroprevalence rates for HIV-infected men being more than double that of the HIV-uninfected men. The HIV-infected subjects were slightly older than those who were uninfected and also had a higher number of sexual partners. Although the multivariate analysis did not detect relationships between these variables, there was a sizeable amount of missing data (12%) specific to the sexual

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Seroprevalence of herpes simplex virus types 1 and 2 in HIV-Infected and uninfected homosexual men in a primary care setting

Abstract

Section snippets

Background

Study design

Results

Discussion

J. Virol. Methods

Hum. Pathol.

Herpes simplex viruses

Ability of a rapid serology test to detect seroconversion to herpes simplex virus type 2 glycoprotein G soon after infection

J. Clin. Microbiol.

Fluctuations of HIV load in semen of HIV positive patients with newly acquired sexually transmitted diseases

Br. Med. J.

Increased genital shedding of herpes simplex virus type 2 in HIV-seropositive women

Ann. Intern. Med.

Herpes simplex viruses

Herpes simplex virus type 2 infection of heterosexual men attending a sexual health centre

Med. J. Aust.

Herpes simplex virus type 2 in prisoners, New South Wales, Australia

Int. J. Sex. Transm. Dis. AIDS

Prevalence of antibodies to herpes simplex virus type 2 among homosexual men either positive or negative for human immunodeficiency viruses in Slovakia

Acta Virol.

Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection

Sex. Transm. Dis.

Herpes simplex type 1 and genital herpes in Northern Ireland

Int. J. Sex. Transm. Dis. AIDS

Antibody to herpes simplex virus type 2 as serological marker of sexual lifestyle in populations

Br. Med. J.

Herpes simplex virus type 2 antibody in patients attending antenatal or STD clinics

Med. J. Aust.

The causal role for genital ulcer disease as a risk factor for transmission of human immunodeficiency virus: an application of the Bradford Hill Criteria

Sex. Transm. Dis.