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Time Trends in First-Episode Genital Herpes Simplex Virus Infections in an Urban Sexually Transmitted Disease Clinic

Dabestani, Nazila MPH, MBA*; Katz, David A. PhD, MPH*,†; Dombrowski, Julia MD, MPH†,‡; Magaret, Amalia PhD§,¶; Wald, Anna MD, MPH‡,§,¶,∥; Johnston, Christine MD, MPH‡,¶

doi: 10.1097/OLQ.0000000000001076
Original Studies
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Background Genital herpes simplex virus type 1 (HSV-1) has emerged as the leading cause of first-episode genital herpes among specific populations in the United States, such as adolescents, young adult women, and men who have sex with men (MSM). We examined trends in the etiology of first-episode genital herpes diagnoses over time in a sexually transmitted disease (STD) clinic population.

Methods Using an electronic database, we identified persons diagnosed as having first-episode genital herpes at Public Health – Seattle & King County STD Clinic from 1993 to 2014 and compared risk factors for genital HSV-1 versus herpes simplex virus type 2 (HSV-2) infection.

Results Of 52,030 patients with genital ulcers, 3065 (6.15%) had first-episode genital herpes infection: 1022 (33.3%) with HSV-1 and 2043 (67.7%) with HSV-2. Overall, 1154 (37.7%) were women, the median age was 28 years (interquartile range, 24–36 years), 1875 (61.2%) patients were white, and 353 (11.5%) were MSM. The number of patients diagnosed as having first-episode genital HSV-2 declined on average by 5.5 persons per year, from 208 in 1993 to 35 in 2014 (change of −5.6 per year; 95% confidence interval [CI], −6.9 to −4.1), whereas HSV-1 diagnoses remained stable at approximately 50 per year (change of 0.2; 95% CI, −0.4 to 0.9). In a multivariate model, persons diagnosed as having first-episode genital HSV-1 rather than genital HSV-2 infection were more likely to be younger (age <30 years [relative risk {RR}, 1.38; 95% CI, 1.22–1.55]), white (RR, 3.16; 95% CI, 2.57–3.88), and MSM (RR, 1.50; 95% CI, 1.31–1.71).

Conclusions We observed a significant decrease in the frequency of first-episode genital HSV-2 and a stable number of first-episode genital HSV-1 infections in a STD clinic over the last 2 decades.

We observed a significant decrease in first-episode genital herpes simplex virus type 2 diagnoses and a stable number of first-episode genital herpes simplex virus type 1 infections over the last 2 decades in an urban sexually transmitted disease clinic.

From the *Department of Global Health, University of Washington

HIV/STD Program, Public Health – Seattle & King County

Departments of Medicine

§Laboratory Medicine, University of Washington

Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center

Department of Epidemiology, University of Washington, Seattle, WA

Acknowledgments: The authors would like to thank the Public Health – Seattle & King County STD Clinic for providing the data for this study.

Conflict of Interest and Sources of Funding: A.W. and C.J. have received grants from the National Institutes of Health and funding for clinical trials from Vical and Genocea. A.W. participates as a Data & Safety Monitoring Board member for Merck and is a consultant for Aicuris. C.J. has received funding for clinical trials from Sanofi-Pasteur. This work was supported by the National Institutes of Health (Grant AI-030731).

Correspondence: Christine Johnston; 325 9th Ave, Box 359928, Seattle, WA 98104. E-mail: cjohnsto@uw.edu.

Received for publication July 1, 2019, and accepted September 11, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).

Online date: October 31, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association