Abstract
Background: Herpes simplex virus type 2 (HSV-2) infection is a globally prevalent, life-long, sexually transmitted infection. This study characterized HSV-2 seroprevalence in Europe for various at-risk populations and proportions of HSV-2 detection in genital ulcer disease (GUD) and in genital herpes. Data on neonatal herpes and HSV-2’s contribution to HIV transmission were also reviewed.
Methods: Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings. The search was conducted in PubMed and Embase databases up to February 20, 2022. Any publication reporting data on the outcome measures was included. Meta-analyses and meta-regressions were conducted.
Findings: 211 relevant reports were identified, including 12 overall incidence measures, 294 overall (813 stratified by factors such as age and sex) seroprevalence measures, 13 overall (15 stratified by sex) proportions of HSV-2 detection in clinically diagnosed GUD, and 70 overall (183 stratified by factors such as age and sex) proportions of HSV-2 detection in laboratory confirmed genital herpes. Pooled mean seroprevalence was 12·4% (95% CI: 11·5-13·3%) among general populations, 27·8% (95% CI: 17·5-39·4%) among men who have sex with men, 46·0% (95% CI: 40·1-51·8%) among people living with HIV and people in HIV discordant couples, and 63·2% (95% CI: 55·5-70·6%) among female sex workers. Most measures showed heterogeneity in HSV-2 seroprevalence. The pooled mean seroprevalence among general populations increased with age and was 0·65-fold (95% CI: 0·58-0·74) lower in men than women. Seroprevalence decreased by 1% per calendar year. Pooled mean proportions of HSV-2 detection in GUD and in genital herpes were 22·0% (95% CI: 15·3-29·6%) and 66·0% (95% CI: 62·9-69·1%), respectively. HSV-2 detection in genital herpes cases was 1·21-fold (95% CI: 1·10-1·32) higher 3 in men compared to women and decreased by 1% per calendar year. Incidence of neonatal herpes indicated an increasing trend.
Interpretation: Although seroprevalence is declining, a significant proportion of Europe’s population is infected with HSV-2. HSV-2 accounts for approximately one-fifth of GUD cases and two-thirds of genital herpes cases. Findings support the need to invest in HSV-2 vaccine development, and sexual and reproductive health services.
Methods: Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings. The search was conducted in PubMed and Embase databases up to February 20, 2022. Any publication reporting data on the outcome measures was included. Meta-analyses and meta-regressions were conducted.
Findings: 211 relevant reports were identified, including 12 overall incidence measures, 294 overall (813 stratified by factors such as age and sex) seroprevalence measures, 13 overall (15 stratified by sex) proportions of HSV-2 detection in clinically diagnosed GUD, and 70 overall (183 stratified by factors such as age and sex) proportions of HSV-2 detection in laboratory confirmed genital herpes. Pooled mean seroprevalence was 12·4% (95% CI: 11·5-13·3%) among general populations, 27·8% (95% CI: 17·5-39·4%) among men who have sex with men, 46·0% (95% CI: 40·1-51·8%) among people living with HIV and people in HIV discordant couples, and 63·2% (95% CI: 55·5-70·6%) among female sex workers. Most measures showed heterogeneity in HSV-2 seroprevalence. The pooled mean seroprevalence among general populations increased with age and was 0·65-fold (95% CI: 0·58-0·74) lower in men than women. Seroprevalence decreased by 1% per calendar year. Pooled mean proportions of HSV-2 detection in GUD and in genital herpes were 22·0% (95% CI: 15·3-29·6%) and 66·0% (95% CI: 62·9-69·1%), respectively. HSV-2 detection in genital herpes cases was 1·21-fold (95% CI: 1·10-1·32) higher 3 in men compared to women and decreased by 1% per calendar year. Incidence of neonatal herpes indicated an increasing trend.
Interpretation: Although seroprevalence is declining, a significant proportion of Europe’s population is infected with HSV-2. HSV-2 accounts for approximately one-fifth of GUD cases and two-thirds of genital herpes cases. Findings support the need to invest in HSV-2 vaccine development, and sexual and reproductive health services.
| Original language | English |
|---|---|
| Article number | 100558 |
| Journal | The Lancet Regional Health - Europe |
| Early online date | 12 Dec 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 12 Dec 2022 |
Bibliographical note
Funding Information:Funding: This work was supported by the Qatar National Research Fund [ NPRP 9-040-3-008 ] and by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar.
Funding Information:
The authors gratefully acknowledge Professor Emeritus Rhoda Ashley Morrow of the University of Washington, for her support in assessing the quality of study diagnostic methods. The authors are also grateful to Ms. Adona Canlas for administrative support. The authors are grateful for pilot funding by the Biomedical Research Program and infrastructure support provided by the Biostatistics, Epidemiology, and the Biomathematics Research Core at Weill Cornell Medicine-Qatar . K.J.L. is a member of the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol. This publication was also made possible by NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the article. The findings achieved herein are solely the responsibility of the authors.
Funding Information:
Qatar National Research Fund [NPRP 9-040-3-008] and pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar supported this study.The authors gratefully acknowledge Professor Emeritus Rhoda Ashley Morrow of the University of Washington, for her support in assessing the quality of study diagnostic methods. The authors are also grateful to Ms. Adona Canlas for administrative support. The authors are grateful for pilot funding by the Biomedical Research Program and infrastructure support provided by the Biostatistics, Epidemiology, and the Biomathematics Research Core at Weill Cornell Medicine-Qatar. K.J.L. is a member of the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol. This publication was also made possible by NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the article. The findings achieved herein are solely the responsibility of the authors. Funding: This work was supported by the Qatar National Research Fund [NPRP 9-040-3-008] and by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar.
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