Epidemiology of herpes simplex virus type 2 infections in a high-risk adolescent population

Seroprevalence of herpes simplex virus type 2 antibodies in an STD clinic in Paris

Our objective was to evaluate the seroprevalence of herpes simplex virus (HSV)-2 and HSV-1 in a population of men and women attending the STD clinic of Hôpital St-Louis (Paris, France).

Four hundred and eighty-seven patients (264 men and 223 women) were tested for HSV-2 and HSV-1 antibodies by specific enzyme immunoassay (EIA) (Smithkline-Beecham Biologicals). Univariate and multivariate analyses were carried out for correlations with clinical, socio-epidemiological and behavioural data. HSV-2 seroprevalence was 55% (44.7% in men, 67.3% in women). HSV-1 seroprevalence was 93% (94.7% in men, 91% in women). The predictive factors of HSV-2 seropositivity being female (OR: 3.37), age (OR: 1.04), country of origin (Central Africa OR: 3.52, North Africa OR: 1.36), history of genital herpes (OR: 10.97), hepatitis B virus (HBV) markers (OR: 1.92) and hepatitis C virus (HCV) markers (OR: 3.96). The only protective factor was HSV-1 seropositivity (OR: 0.25). The predictive factors of HSV-1 seropositivity were only the country of origin (Central Africa OR: 2.95, North Africa OR: 1.83) and the absence of genital herpes (OR: 11.01). Only 23 (8.6%) HSV-2 seropositive patients had a history of genital herpes.

This study underlines the very high HSV-2 seroprevalence of patients with STDs, only a few of whom have a history of genital herpes. Detection and counselling is urgently needed for these patients.

Case-crossover analysis of condom use and herpes simplex virus type 2 acquisition

BACKGROUND

Although growing evidence suggests that condoms offer moderate protection against herpes simplex virus type 2 (HSV-2), inability to control for unknown or unmeasured confounders associated with sexual activity may reduce the accuracy of the estimates. The case-crossover design offers increased control of individual-level confounders, and was thus used with the aim of producing a more accurate estimate of the effect of condom use on HSV-2 acquisition.

METHODS

Data were pooled from 6 prospective studies that measured HSV-2 status at enrollment and over follow-up, and included periodic self-reported condom use and sexual activity. Sexual activity contemporaneous with acquisition was assigned to a case period; earlier sexual activity was assigned to a control period. Conditional logistic regression was used to assess differences in behavior during the case and control periods.

RESULTS

One hundred ninety-one eligible participants acquired HSV-2 during follow-up. This approach detected a 3.6% increase in the odds of HSV-2 acquisition with each unprotected act (odds ratio = 1.036; 95% confidence interval: 1.021-1.052), but no increase in the odds of acquisition associated with protected acts (odds ratio = 1.008; 95% confidence interval: 0.987-1.030).

CONCLUSIONS

This analysis suggests that condoms offer significant protection against HSV-2 transmission.

Interim modelling analysis to validate reported increases in condom use and assess HIV infections averted among female sex workers and clients in southern India following a targeted HIV prevention programme

Objectives

This study assesses whether the observed declines in HIV prevalence since the beginning of the ‘Avahan’ India HIV/AIDS prevention initiative are consistent with self-reported increases in condom use by female sex workers (FSWs) in two districts of southern India, and provides estimates of the fraction of new infections averted among FSWs and clients due to increases in condom use in commercial sex after 2004.

Methods

A deterministic compartmental model of HIV/sexually transmitted infection (STI) transmission incorporating heterogeneous sexual behaviour was developed, parameterised and fitted using data from two districts in Karnataka, India. Three hypotheses of condom use among FSWs were tested: (H₀), that condom use increased in line with reported FSW survey data prior to the Avahan initiative but remained constant afterwards; (H₁) that condom use increased following the Avahan initiative, in accordance with survey data; (H₂) that condom use increased according to estimates derived from condom distribution data. The proportion of fits to HIV/STI prevalence data was examined to determine which hypothesis was most consistent.

Results

For Mysore 0/36/82.7 fits were identified per million parameter sets explored under hypothesis H₀/H₁/H₂, respectively, while for Belgaum 9.7/8.3/0 fits were identified. The HIV epidemics in Belgaum and Mysore are both declining. In Mysore, increases in condom use during commercial sex between 2004 and 2009 may have averted 31.2% to 47.4% of new HIV infections in FSWs, while in Belgaum it may have averted 24.8% to 43.2%, if there was an increase in condom use.

Discussion

Increased condom use following the Avahan intervention is likely to have played a role in curbing the HIV epidemic in Mysore. In Belgaum, given the limitations in available data, this method cannot be used alone to decide if there has been an increase in condom use.

The physical health status of young Australian offenders

AIMS

To describe the socio-economic background and physical health status of young offenders in custody in New South Wales (Australia).

DESIGN

Cross-sectional survey of all young offenders held at nine juvenile detention centres across New South Wales (NSW) (eight male and one female) between January and March 2003.

METHODS

Demographic and health information was collected by nurse interviewers and psychologists using a face-to-face interview. Blood and urine samples were collected to screen for blood-borne viruses and sexually transmissible infections.

RESULTS

The final sample comprised 242 young people (223 males and 19 females). Overall, 90% of those assessed rated their general health as 'excellent', 'very good' or 'good'. Sixty-nine (30%) young offenders reported that they had been previously diagnosed with asthma. Two young women reported a past diagnosis of diabetes with the results of the random blood glucose testing indicating that a further six young people required testing for possible diabetes. None of those tested were positive for HIV, 9% tested positive for hepatitis C antibody, and 11% tested positive for hepatitis B core-antibody.

CONCLUSIONS

Our findings indicate that young offenders in New South Wales have backgrounds characterised by extreme disadvantage (poor educational attainment, unemployment, and care placements) and poor physical health. Parental incarceration was common to 43% of the sample. Our findings reinforce the concept that for marginalised groups, contact with the criminal justice system represents an important opportunity to detect illness, initiate treatment, and promote contact with health services.

Psychiatric and medical health care policies in juvenile detention facilities

OBJECTIVES

Many adolescents admitted to detention facilities have serious mental and physical health problems. Little is known about policies for the delivery of mental and physical health care in these settings. Our objective was to describe current health care policies in U.S. detention facilities.

METHOD

Telephone interviews were requested from 83 juvenile detention facility administrators across the United States.

RESULTS

The response rate was 97.6%. Data were collected over 12 months, from 2003-2004. Policies for admission health screening existed in 99% of facilities; 90% included mental health screening. Most sites had policies about psychopharmacotherapy and 92% had crisis services. Continuation of existing psychotropic medication treatment was provided at 96% of facilities. Seventy-three percent of facilities used physicians to manage medications in-house; in 61% of the centers, these physicians were psychiatrists. Medication administration policies most often specified nurses, but 16% of facilities used guards. Provisions for discharge psychotropic medication existed at 84% of sites, but there was wide variation in dispensing policies.

CONCLUSIONS

Detention health care policies for adolescents have significant gaps, particularly for mental health care. Future research should include an epidemiological study of detained youths, evaluating their health needs and the actual care received.

A national overview of reproductive health care services for girls in juvenile justice residential facilities

PURPOSE/RESEARCH QUESTIONS: Adolescent girls involved in the juvenile justice system face a substantially higher risk for a host of reproductive health problems. This study is the first national overview of the extent to which Juvenile Justice Residential Facilities (JJRFs) are meeting their reproductive health needs. The primary focus is whether all girls/young women receive gynecologic services.

METHODS

Data are from the 2004 Juvenile Residential Facility Census, an ongoing national institution-level data collection. Respondents include facility administrators and facility health care providers. Mixed-gender and girls-only facilities are included in these analyses (n = 1,255).

MAIN FINDINGS

Full population testing for pregnancy and sexually transmitted diseases occurs in <18% of all facilities. Although about 25% of all JJRFs report housing > or =1 pregnant teens, an equal number offers no obstetric services. Most JJRFs (about 85%) report that only some girls receive care from a gynecologist, largely "as necessary" and based on self-reports of sexual activity or suspected pregnancy. Provision of gynecologic services to all girls/young women is significantly more likely in all-female, state-owned, large population, and longer stay facilities and less likely in short stay, mixed-gender, crowded, and locally and privately owned facilities.

CONCLUSIONS

Results indicate that most facilities can garner a few necessary services. However, contrary to recommendations of national organizations, the services tend to be provided in an ad hoc manner rather than to the full population of young women. Results of multivariate models predicting facility types most likely to provide full population services should be useful as leaders in the area retarget their recommendations to address this gap in services.

The epidemiology of sexually transmitted infections in adolescents

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.

Genital herpes in adolescents

Herpes simplex virus (HSV) infections occur commonly among adolescents. Most HSV-2 infections are genital, but genital herpes can be caused by either HSV-1 or HSV-2. Weighted means were calculated based on published seroprevalence data on adolescents from the United States and found HSV-1 rates of 53.1 percent for adolescent males and 49.4 percent for adolescent females. The weighted means for HSV-2 was 15 percent for adolescent females and 12 percent for adolescent males. Most individuals who are infected with HSV-2 are unaware of their infection. Healthcare providers of adolescents should consider genital herpes even when an adolescent presents with nonspecific genital symptoms. In this article, we review current recommendations for diagnosis and management and review the psychological sequelae that can be associated with having genital herpes. Finally, we discuss biomedical interventions that are being developed to help reduce the epidemic of HSV and the challenges that these interventions face with regard to implementation.

Sexual and demographic risk factors for herpes simplex virus type 2 according to schooling level among Mexican youths

BACKGROUND

Herpes simplex virus type 2 (HSV-2), the agent causing one of the most common sexually transmitted infections in sexually active individuals, is currently considered a public health problem. In Mexico, there have been no population-based studies of the prevalence and factors associated with HSV-2 infection among young students.

GOAL

The goal was to measure HSV-2 seroprevalence and identify possible associated factors among students in the state of Morelos, Mexico.

STUDY DESIGN

Through a cross-sectional population-based study involving students at 92 schools in the state of Morelos, Mexico, 898 students aged 11 to 24 years old were identified. All of them reported they had already initiated sexual activity and provided a blood sample to detect the presence of anti-HSV-2 antibodies through the Western blot technique. The association between risk factors and HSV-2 was evaluated through multiple logistic regression analysis with stratification by sex and schooling level.

RESULTS

In the population under study, the prevalence of HSV-2 seropositivity was 5.7% (51/898), and the ratio of females to males was 2:1. The prevalence of consistent condom use overall was 22.6% among the 898 students. For students in Morelos State, Mexico, the HSV-2 seroprevalence was higher among the youngest female students (9.5% among junior high school versus 3.3% among university students; P<0.001). The main factors associated with HSV-2 infection were sex (for females the risk was 2.2 times higher than for males; 95% CI, 1.2-3.9); junior high school status (2.5 times higher risk than university students (95% CI, 1.1-6.0); and having had same-sex sexual intercourse (3.5 times higher risk; 95% CI, 1.4-8.9).

CONCLUSION

In contrast with other reports, the HSV-2 seroprevalence was higher among younger people. This finding can be explained by a cohort effect of more exposition to behavioral risks, particularly an earlier age at first intercourse and very low use of condoms among youngest students. Longitudinal surveys about serological responses to HSV-2 infection in different age groups are warranted.

Genital herpes simplex virus infection in the adolescent: special considerations for management

Genital herpes simplex virus (HSV) infections are increasingly common among adolescents. In developed countries, during the 1990s, adolescent HSV type 2 seroprevalence rates ranged from 4 to 30% depending on the population studied. The clinical diagnosis of genital herpes may be unreliable and laboratory testing is recommended. Aciclovir, valaciclovir, and famciclovir are three antiviral drugs that have proven efficacy in the treatment of genital herpes. These drugs can be used in the treatment of the first episode or for recurrent infections, or can be used long term to suppress recurrent infections. Once or twice daily administration regimens are preferable for adolescents for reasons of adherence, and because it avoids the need to take medication at school. Unproven remedies are used commonly and can be harmful. In addition to antiviral therapy, proper management of the adolescent with genital herpes should also include developmentally appropriate explanations of the diagnosis, treatment and potential complications, recommendations for symptomatic relief, screening for other sexually transmitted infections, and discussion of safer sexual practices. All adolescents should have follow-up visits to complete education and counseling and to assess compliance with antiviral therapy.

Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review

Information on age- and sex-specific prevalence of herpes simplex virus (HSV) types 2 and 1 infections is essential to optimize genital herpes control strategies, which increase in importance because accumulating data indicate that HSV-2 infection may increase acquisition and transmission of human immunodeficiency virus. This review summarizes data from peer-reviewed publications of type-specific HSV seroepidemiologic surveys. HSV-2 prevalence is, in general, highest in Africa and the Americas, lower in western and southern Europe than in northern Europe and North America, and lowest in Asia. HSV-2 and -1 prevalence, overall and by age, varies markedly by country, region within country, and population subgroup. Age-specific HSV-2 prevalence is usually higher in women than men and in populations with higher risk sexual behavior. HSV-2 prevalence has increased in the United States but national data from other countries are unavailable. HSV-1 infection is acquired during childhood and adolescence and is markedly more widespread than HSV-2 infection. Further studies are needed in many geographic areas.

Increased prevalence of herpes simplex virus type 2 among adolescent women with alcohol use disorders

PURPOSE

To determine the relationship between alcohol use disorders (AUDs) and herpes simplex virus type 2 (HSV-2), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections among a sample of sexually active adolescents.

METHODS

Subjects were 240 sexually active male and female adolescents aged 14 to 21 years (mean 17.5 years) recruited from clinical and community settings in western Pennsylvania between 1991 and 1995; 55% had a lifetime history of AUDs (63 females, 69 males) and 45% did not have a lifetime history of AUDs (57 females, 51 males). Participants provided information about demographic factors and sexual behaviors as well as a serum sample that was assayed for antibodies to HSV-2, HBV, and HIV infections. Multivariate logistic regression was used to determine the independent relationship of AUDs to HSV-2 infections among females.

RESULTS

The seroprevalence of HSV-2 infections was 15% among females and 0% among males; the overall prevalence of HBV (1.2%) and HIV (0.4%) infections was very low. Among adolescent females, the seroprevalence of HSV-2 infections was significantly higher among those with an AUD (19%), compared with those without an AUD (10.5%) (adjusted odds ratio 8.1, 95% confidence interval 1.5-44.8, p =.017).

CONCLUSIONS

Adolescent women with an AUD appear to be at substantially increased risk of HSV-2 infection. These results highlight the need to address sexually transmitted diseases among adolescents with alcohol problems.

Demographic rather than behavioral risk factors predict herpes simplex virus type 2 infection in sexually active adolescents

BACKGROUND

Despite the high prevalence of herpes simplex virus type 2 (HSV-2) infection in adults and data indicating that many HSV-2 infections are acquired in late adolescence, the demographic and sexual behavior correlates of HSV-2 infection in high risk adolescents have not been extensively studied.

METHODS

Using a cross-sectional design we evaluated serologic evidence of HSV-2 infection in 381 adolescents age 14 to 19 years at an urban sexually transmitted disease clinic and a community clinic. Study enrollment was offered to all patients participating in a project offering free hepatitis B vaccine. Participants were interviewed and blood was drawn for HSV Western blot.

RESULTS

Twelve percent [95% confidence interval (CI), 8.6 to 15.1] of 379 adolescents in this study had antibodies to HSV-2. Only 22% of HSV-2-seropositive youth reported a history of herpes. Seropositivity for HSV-2 was significantly associated with African-American race (odds ratio, 2.3; 95% CI 1.1 to 4.8) and female gender (odds ratio, 6.0; 95% CI 2.3 to 15.9); 25% of the African-American girls were HSV-2-seropositive. Self-reported condom use, number of sexual partners in the prior 2 months and history of a sexually transmitted disease did not predict HSV-2 antibody status.

CONCLUSIONS

HSV-2 infection among adolescents was prevalent, particularly among African-American girls, and correlated with demographic rather than behavioral variables. As in adults most HSV-2 infections were unrecognized. These data suggest that type-specific serologic testing for HSV-2 infection should be considered in sexually active adolescents. Prevention efforts should target children before initiation of sexual activity.

College students' attitudes regarding vaccination to prevent genital herpes

BACKGROUND AND OBJECTIVES

Vaccines represent an important strategy for the control of infectious diseases but are only effective if accepted by the public. Unique attitudinal issues may affect usage of vaccines to control sexually transmitted diseases (STDs). The object of this study was to examine among college students factors that may influence acceptance of a vaccine against genital herpes.

GOALS

To examine attitudes regarding acceptance of vaccination for genital herpes by college students using aspects of health behavior theories.

STUDY DESIGN

Subjects were recruited from an undergraduate psychology class to complete a questionnaire regarding attitudes and beliefs about receiving a potential genital herpes vaccine.

RESULTS

Of the 518 subjects, 100 would not get the vaccine, 207 would, and 211 were unsure. In the final models, factors that influenced acceptance were low cost and an opinion that the vaccine should be recommended for everyone. Those who were unsure were more likely to be influenced by an opinion that the vaccine would be unsuccessful. While not remaining in the final models, those who believed they were at low risk of acquiring genital herpes were unlikely to accept a genital herpes vaccine.

CONCLUSIONS

Our results indicate that most college students would not reject vaccination, a priori, against genital herpes. Vaccine acceptance may be maximized if vaccine cost is low, the public is educated regarding risk of acquiring genital herpes, and public health policy encourages universal vaccination.