Sero-epidemiological and -sociological patterns of herpes simplex virus infection in the world

Abstract

A newly developed Herpes simplex virus (HSV) type 1 and type 2 enzyme immunoassay has been applied to over 40,000 sera from different populations in the US and 17 other countries on all 5 continents. The HSV-1 antibody patterns found permit the current and past socioeconomic status, as well as the extent of oral-genital sexual contact, to be deduced for various populations. The HSV-2 antibody results provide an objective measure of various aspects of sexual behavior: extent of polypartnerism in the subjects tested (or their contacts), early age of sexual experience and acquisition rates of genital herpes. It has thus been possible to extend sero-epidemiology to sero-sociology which can provide objective markers for sexual behavior and effects of intervention or educational approaches. Besides such markers having potential applicability for monitoring other STDs, such as HIV infection, recent studies also support a possible role for HSV infections to increase the transmissibility, not only of HIV-1, but also of HTLV-1.

PIP: This is a review of the implications of epidemiology of herpes simplex virus types 1 and 2 accrued over 19 years of use of an enzyme immunoassay on over 40,000 sera from 18 countries from 1964 to 1983. HSV-1, which typically causes intraoral ulcers and fever blisters, is usually acquired in childhood and adolescence, and more often by socioeconomically less advantaged populations. Genital HSV-1 when it occurs is usually a primary genital herpes, is more often acquired by sexual activity, and usually causes severe disease in neonates. Prior HSV-1 confers moderate protection against getting HSV-2, and reduces its severity. There were 2 national settings with a typical infection patterns, Brazzaville, Congo and Wuhan, China. Here a high percentage of HSV-2 antibodies alone suggested that primary, probably neonatal, HSV-2 protected from subsequent HSV-1 infection. The prevalence of HSV-2 antibodies in 18 countries was correlated with number of sexual partners, from zero in nuns and 0.3% in U.S. children, to 50% in pregnant Blacks from Haiti. Prevalence in African countries ranged from 6-97%. Studies showed that most HSV-2 infections were subclinical. 22-28% of pregnant women shed HSV-2 particles vaginally from micro-ulcers only detectable by colposcopy. An association between HSV-2 and HIV infections has been documented in several studies. HSV-2 infections increased in some populations in the 1960-1970s, notably in Western countries undergoing a sexual revolution. Many White Americans experienced severe HSV-2 symptoms possibly because of lack of protection from prior HSV-1.