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Global and regional estimates of genital ulcer disease due to herpes simplex virus

Research output: Contribution to journalArticle

Original languageEnglish
JournalBMJ Global Health
DateAccepted/In press - 10 Nov 2019


Herpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2) but may also be due to genital HSV-1, which has less frequent recurrent episodes than HSV-2. The global burden of GUD has never been quantified. Here we present first global and regional estimates of GUD due to HSV-1 and HSV-2 among 15-49 year old females and males.

We developed a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection, informed by a literature search for data on model parameters. We considered both diagnosed and undiagnosed symptomatic infection. This model was then applied to existing infection estimates and population sizes for 2016. A sensitivity analysis was carried out varying the assumptions made.

We estimated that 187 million people aged 15-49 years had at least one episode of HSV-related GUD globally in 2016: 5.0% of the world’s population. Of these, 178 million (95% of those with HSV-related GUD) had HSV-2 compared to 9 million (5%) for HSV-1. GUD burden was highest in Africa, and approximately double in women compared to men. Altogether there were an estimated 8 billion
person-days spent with HSV-related GUD globally in 2016, with 99% of days due to HSV-2. Taking into account parameter uncertainty, the percentage with at least one episode of HSV-related GUD ranged from 3.2%-7.9% (120-296 million). However, the estimates were sensitive to the model assumptions.

Our study represents a first attempt to quantify the global burden of HSV-related GUD which is large. New interventions such as HSV vaccines, antivirals or microbicides, have the potential to improve the quality of life of millions of people worldwide.

    Research areas

  • Genital ulcer disease, herpes simplex virus type 2, herpes simplex virus type 1, disease burden, epidemiology, sexually-transmitted infection, world, humans



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