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Risk Factors for Incident Herpes Simplex Type 2 Virus Infection Among Women Attending a Sexually Transmitted Disease Clinic

GALLO, MARIA F. PhD*; WARNER, LEE PhD*; MACALUSO, MAURIZIO MD, DrPH*; STONE, KATHERINE M. MD*; BRILL, ILENE MPH; FLEENOR, MICHAEL E. MD, MPH; HOOK, EDWARD W. III MD†‡§∥; AUSTIN, HARLAND D. DSc; LEE, FRANCIS K. PhD#; NAHMIAS, ANDRé J. MD, MPH#

Sexually Transmitted Diseases: July 2008 - Volume 35 - Issue 7 - p 679-685
doi: 10.1097/OLQ.0b013e31816fcaf8
Article

Objectives: To estimate the incidence of herpes simplex type 2 virus (HSV-2) infection, to identify risk factors for its acquisition, and to assess the protective effect of condoms.

Study Design: Prospective study of 293 HSV-2 seronegative women, aged 18 to 35 years, attending a sexually transmitted disease clinic in Alabama from 1992 to 1995.

Results: Incidence of HSV-2 infection was 20.5 per 100 woman-years [95% confidence interval (CI), 13.1–30.5]. Young women (18–20 years) had a significantly higher risk of incident HSV-2 infection [adjusted hazard ratio (HR), 2.8; 95% CI, 1.3–6.4] than older women. Women diagnosed with prevalent or incident bacterial vaginosis had a higher incidence of HSV-2 infection than those who were not so diagnosed (adjusted HR, 2.4; 95% CI, 1.1–5.6). No significant protective effect was observed for consistent (100%) condom use without breakage and slippage against HSV-2 acquisition (adjusted HR, 0.8; 95% CI, 0.2–2.3).

Conclusion: Acquisition of HSV-2 infection among study participants was higher than previous estimates for adult female sexually transmitted disease clinic attendees, and no protective effect for condoms was demonstrated. The high incidence of HSV-2 infection with its potential for adverse health consequences emphasizes the need for better prevention strategies.

Incidence of herpes simplex type 2 virus infection among women attending an sexually transmitted disease clinic was 20.5 per 100 woman-years and was higher among younger women and those with bacterial vaginosis. No significant protection from condom use was observed.

From the *Division of Reproductive Health, National Center for Chronic Disease Prevention, Atlanta, Georgia; †Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; ‡Jefferson County Department of Health; Departments of §Medicine and ∥Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; ¶Department of Epidemiology, Rollins School of Public Health; and #Division of Infectious Diseases, Epidemiology, and Immunology, Department of Pediatrics, Emory University, Atlanta, Georgia

This project was carried out under contract with the National Institute of Child Health and Human Development (Contract N01-HD-1-3135).

The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence: Maria F. Gallo, PhD, Division of Reproductive Health, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA 30341-3724. E-mail: mgallo@cdc.gov.

Received for publication October 27, 2007, and accepted January 24, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association