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Prevalence of Herpes Simplex Virus Type 2 Infection, Human Immunodeficiency Virus/Herpes Simplex Virus Type 2 Coinfection, and Associated Risk Factors in a National, Population-Based Survey in Kenya

Mugo, Nelly MD*†; Dadabhai, Sufia S. MHS; Bunnell, Rebecca ScD§; Williamson, John PhD; Bennett, Eddas MPH; Baya, Isaack MS**; Akinyi, Nelly MS§††; Mohamed, Ibrahim MD‡‡; Kaiser, Reinhard MD§

doi: 10.1097/OLQ.0b013e31822e60b6
Original Study

Background: Herpes simplex virus type 2 (HSV-2) is a known biologic cofactor for human immunodeficiency virus (HIV) transmission and acquisition. The Kenya AIDS Indicator Survey 2007 provided Kenya's first nationally representative estimate of HSV-2 prevalence and risk factors.

Methods: KAIS was a household serosurvey among women and men aged 15 to 64 years. The survey included a behavioral interview and serum testing for HSV-2, HIV, and syphilis infections. Results were weighted for sampling design and nonresponse.

Results: Of 19,840 eligible individuals, 90% completed an interview and 80% consented to testing. In all, 35% were infected with HSV-2, of which 42% were women and 26% were men. Between 15 and 24 years of age, HSV-2 prevalence increased from 7% to 34% in women and 3% to 14% in men. Among couples, 30% were HSV-2 concordant-positive, 21% were discordant, and 49% were concordant-negative. In all, 81% of HIV-infected persons were coinfected with HSV-2. HIV prevalence was 16% among those with HSV-2 and 2% among those without HSV-2. Women with circumcised partners had an HSV-2 prevalence of 39% compared to 77% of women with uncircumcised partners.

Conclusions: One-third of Kenyans were HSV-2 infected. HIV-1 infection, age, female sex, and lack of male circumcision were population-level predictors for HSV-2 infection. Targeted prevention interventions are needed, including an effective vaccine.

A national study of Kenyans aged 15 to 64 years found 42% of women and 26% of men were HSV-2-infected. Human immunodeficiency virus prevalence was 8 times greater among those with HSV-2 than those without.

From the *Department of Gynaecology, Kenyatta National Hospital, Nairobi, Kenya; †Department of Global Health, University of Washington, Seattle, WA; ‡Global Health Sciences, University of California San Francisco, Nairobi, Kenya; §Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya; ¶Center for Global Health, U.S. Centers for Disease Control and Prevention, Kisumu, Kenya; ∥Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA; **National HIV Reference Laboratory, Kenya National Public Health Laboratory Services, Nairobi, Kenya; ††Kenya Medical Research Institute, Nairobi, Kenya; and ‡‡Kenya National AIDS and STI Control Programme, Nairobi, Kenya

We thank Dr. George Rutherford for his careful comments on an earlier version of the manuscript and Dr. Anna Wald for her insights.

Presented at Conference of the International AIDS Society, July 2009, Cape Town, South Africa, Abstract MOPEB016.

The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention and the U.S. Agency for International Development; and by the Joint United Nations Programme on HIV/AIDS.

The authors declare that we fulfill the criteria for authorship and that no author has any financial or non-financial association to an institution that might have an interest in the submitted work.

Correspondence: Sufia S. Dadabhai, MHS, 1201 W. Mount Royal Avenue, 529, Baltimore, MD 21217. E-mail:

Received for publication April 3, 2011, and accepted July 18, 2011.

© Copyright 2011 American Sexually Transmitted Diseases Association