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Clinical Trial
. 2016 Feb 15;62(4):456-61.
doi: 10.1093/cid/civ908. Epub 2015 Nov 17.

Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples

Amalia S Magaret  1 , Andrew Mujugira  2 , James P Hughes  3 , Jairam Lingappa  4 , Elizabeth A Bukusi  5 , Guy DeBruyn  6 , Sinead Delany-Moretlwe  7 , Kenneth H Fife  8 , Glenda E Gray  9 , Saidi Kapiga  10 , Etienne Karita  11 , Nelly R Mugo  5 , Helen Rees  7 , Allan Ronald  12 , Bellington Vwalika  13 , Edwin Were  14 , Connie Celum  15 , Anna Wald  16 ; Partners in Prevention HSV/HIV Transmission Study Team
Collaborators, Affiliations
Clinical Trial

Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples

Amalia S Magaret et al. Clin Infect Dis. .

Abstract

Background: The efficacy of condoms for protection against transmission of herpes simplex virus type 2 (HSV-2) has been examined in a variety of populations with different effect measures. Often the efficacy has been assessed as change in hazard of transmission with consistent vs inconsistent use, independent of the number of acts. Condom efficacy has not previously measured on a per-act basis.

Methods: We examined the per-act HSV-2 transmission rates with and without condom use among 911 African HSV-2 and human immunodeficiency virus type 1 (HIV-1) serodiscordant couples followed for an average of 18 months in an HIV prevention study. Infectivity models were used to associate the log10 probability of HSV-2 transmission over monthly risk periods with reported numbers of protected and unprotected sex acts. Condom efficacy was computed as the proportionate reduction in transmission risk for protected relative to unprotected sex acts.

Results: Transmission of HSV-2 occurred in 68 couples, including 17 with susceptible women and 51 with susceptible men. The highest rate of transmission was from men to women: 28.5 transmissions per 1000 unprotected sex acts. We found that condoms were differentially protective against HSV-2 transmission by sex; condom use reduced per-act risk of transmission from men to women by 96% (P < .001) and marginally from women to men by 65% (P = .060).

Conclusions: Condoms are recommended as an effective preventive method for heterosexual transmission of HSV-2.

Keywords: HIV; HSV-2; condom; efficacy; transmission.

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Figures

Figure 1.
Figure 1.
Herpes simplex virus type 2 (HSV-2) per-act infectivity for protected and unprotected sex acts, by sex of susceptible partner. Numbers shown below each column are the numbers of acts of each type reported over risk periods by source participants. Transmission rates using the infectivity model are 1.7 and 0.6 cases per 1000 unprotected and protected sex acts, respectively, for susceptible men, and 28.5 and 1.3 cases per 1000 unprotected and protected sex acts, respectively, for susceptible women. Condom efficacy, or the proportionate reduction in per-act transmission when using a condom, is therefore estimated at 65% for transmission from women to men and 96% for transmission from men to women. Error bars show 95% confidence intervals for per-act transmission rates.
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