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. 2020 Mar 8;5(3):e001875.
doi: 10.1136/bmjgh-2019-001875. eCollection 2020.

The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study

Katharine Jane Looker  1 , Christine Johnston  2   3   4 , Nicky J Welton  1 , Charlotte James  1 , Peter Vickerman  1 , Katherine M E Turner  5 , Marie-Claude Boily  6 , Sami L Gottlieb  7
Affiliations

The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study

Katharine Jane Looker et al. BMJ Glob Health. .

Abstract

Introduction: Herpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2), but may also be due to genital HSV type 1 (HSV-1), which has less frequent recurrent episodes than HSV-2. The global burden of GUD has never been quantified. Here we present the first global and regional estimates of GUD due to HSV-1 and HSV-2 among women and men aged 15-49 years old.

Methods: We developed a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection, informed by a literature search for data on model parameters. We considered both diagnosed and undiagnosed symptomatic infection. This model was then applied to existing infection estimates and population sizes for 2016. A sensitivity analysis was carried out varying the assumptions made.

Results: We estimated that 187 million people aged 15-49 years had at least one episode of HSV-related GUD globally in 2016: 5.0% of the world's population. Of these, 178 million (95% of those with HSV-related GUD) had HSV-2 compared with 9 million (5%) with HSV-1. GUD burden was highest in Africa, and approximately double in women compared with men. Altogether there were an estimated 8 billion person-days spent with HSV-related GUD globally in 2016, with 99% of days due to HSV-2. Taking into account parameter uncertainty, the percentage with at least one episode of HSV-related GUD ranged from 3.2% to 7.9% (120-296 million). However, the estimates were sensitive to the model assumptions.

Conclusion: Our study represents a first attempt to quantify the global burden of HSV-related GUD, which is large. New interventions such as HSV vaccines, antivirals or microbicides have the potential to improve the quality of life of millions of people worldwide.

Keywords: epidemiology; infections, diseases, disorders, injuries.

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Conflict of interest statement

Competing interests: KJL reports grants from WHO during the conduct of the study and outside the submitted work. CJo reports grants from Sanofi Pasteur, the US National Institutes of Health, and the US Centers for Disease Control and Prevention, consultancy fees from Novavax, and royalties from UpToDate, outside the submitted work. In addition, CJo has a patent 'Epitopes cross-reactive between HSV-1, HSV-2 and VZV' issued. NW reports grants from the National Institute for Health Research during the conduct of the study and grants from Pfizer outside the submitted work. M-CB reports grants and other from WHO outside the submitted work. SLG reports grants from the National Institute of Allergy and Infectious Diseases during the conduct of the study.

Figures

Figure 1
Figure 1
Flow chart showing the different possible GUD states relevant to the GUD estimates. Please refer to table 1 for definitions of terms, and online supplementary table A1 for information on how these states map to the natural history parameters used in the GUD burden estimates. Note that this is a simplified representation for the purposes of the estimation process. GUD, genital ulcer disease; HSV, herpes simplex virus.
Figure 2
Figure 2
Estimated number of people (in millions) aged 15–49 years with any GUD due to HSV in 2016, among women (A) and men (B). Percentage of people with any GUD due to HSV in 2016 shown by the colour gradient. GUD, genital ulcer disease; HSV, herpes simplex virus.
See this image and copyright information in PMC

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