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Prevalence and Risk Factors for Herpes Simplex Virus Type 2 Antibodies Among Low- and High-Risk Populations in Indonesia

Davies, Stephen C. MM(ven), FAChSHM*; Taylor, Janette A. MPhil; Sedyaningsih-Mamahit, Endang R. MD, DrPH; Gunawan, Suriadi MD; Cunningham, Anthony L. MD, FRACP, FRCPA; Mindel, Adrian FRCP, MD§

Sexually Transmitted Diseases: March 2007 - Volume 34 - Issue 3 - p 132-138
doi: 10.1097/01.olq.0000230427.01727.80

Objectives/Goal: Data on prevalence of herpes simplex virus type 2 (HSV-2) infections are limited in Asia. This study investigated the seroprevalence of, and risk factors for, antibodies to HSV-2 among low- and high-risk, predominantly asymptomatic populations in Indonesia.

Study Design: We screened women attending maternal and child health, obstetric, gynecology, and sexually transmitted infection (STI) clinics; men attending STI clinics; and female sex workers (FSWs) for type-specific HSV-2 antibodies using the HerpesSelect 2 enzyme-linked immunosorbent assay IgG and Western blot.

Results: HSV-2 antibodies were detected in 153 of 176 FSWs (86.9%; 95% confidence interval [CI], 81.0–91.5); increasing age was the only significant independent risk factor (odds ratio [OR], 1.15; 95% CI, 1.06–1.24; P = 0.001). Among nonsex worker females, HSV-2 antibodies were detected in 78 of 418 (18.7%; 95% CI, 15.0–22.7); significant independent associations were any contraceptive use (OR, 2.24, 95% CI = 1.33–3.85, P = 0.003), symptoms or signs of genital ulcer (OR, 2.69; 95% CI, 1.27–5.70; P = 0.01) and younger age of sexual debut (OR, 0.92; 95% CI, 0.86–0.99; P = 0.03). HSV-2 antibodies were detected in 25 of 116 men (21.6%; 95% CI, 14.5–30.1).

Conclusions: HSV-2 seroprevalence reported here is in the upper range of that reported in nearby regions. Health promotion is needed to encourage affected individuals to recognize symptoms of genital herpes and seek care and advice on reducing transmission. The high seroprevalence among FSWs has potentially serious implications for the HIV epidemic in Indonesia.

This study investigated the seroprevalence to herpes simplex virus type 2 in Indonesia. Seroprevalence among female sex workers was 87% and significantly associated with older age. Seroprevalence among other females was 19% and significantly associated with any contraceptive use, symptoms or signs of genital ulcer, and younger age of sexual debut. Prevalence among men was 22%.

From the *Sexual Health Service, Royal North Shore Hospital, St. Leonards, Australia; the †Centre for Virus Research, Westmead Millennium Institute and University of Sydney, Westmead Hospital, Westmead, Australia; the ‡National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia; and the §Sexually Transmitted Infections Research Centre and University of Sydney, Marian Villa, Westmead Hospital, Westmead, Australia

The authors thank health authorities in Indonesia for granting permission to undertake this study, particularly the National Institutes of Health Research and Development in Jakarta. The authors are grateful to the clinical staff of the hospitals and clinics who participated in the recruitment, examination, specimen collection, and documentation for all their patients. Similarly, we thank all the staff of the laboratories who processed specimens and performed tests. The authors thank administrative support staff of the Indonesia HIV/AIDS and STD Prevention and Care Project. The authors also thank Dr Upadisari for managing the transfer of specimens from Indonesia to Sydney, Australia. The authors thank Caron Marks and Dr Karen Byth for help with statistical analysis. The authors are grateful to the women who participated as patients.

This study was supported by an unrestricted educational grant from GlaxoSmithKline.

Correspondence: Stephen Davies, MM(Ven), FAChSHM, Sexual Health Service, Royal North Shore Hospital, St. Leonards NSW 2065, Australia. E-mail:

Received for publication November 13, 2005, and accepted May 4, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association