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. 2021 May 7:35:100876.
doi: 10.1016/j.eclinm.2021.100876. eCollection 2021 May.

Epidemiology of herpes simplex virus type 2 in sub-Saharan Africa: Systematic review, meta-analyses, and meta-regressions

Manale Harfouche  1   2 , Farah M Abu-Hijleh  3 , Charlotte James  4 , Katharine J Looker  4 , Laith J Abu-Raddad  1   2   5
Affiliations

Epidemiology of herpes simplex virus type 2 in sub-Saharan Africa: Systematic review, meta-analyses, and meta-regressions

Manale Harfouche et al. EClinicalMedicine. .

Abstract

Background: Herpes simplex virus type 2 (HSV-2) infection is a prevalent, sexually transmitted infection with a sizable disease burden that is highest in sub-Saharan Africa. This study aimed to characterize HSV-2 epidemiology in this region.

Methods: Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings up to August 23, 2020. Meta-analyses and meta-regressions were conducted.

Findings: From 218 relevant publications, 451 overall outcome measures and 869 stratified measures were extracted. Pooled incidence rates ranged between 2.4-19.4 per 100 person-years across populations. Pooled seroprevalence was lowest at 37.3% (95% confidence interval (CI): 34.9-39.7%) in general populations and high in female sex workers and HIV-positive individuals at 62.5% (95% CI: 54.8-70.0%) and 71.3% (95% CI: 66.5-75.9%), respectively. In general populations, pooled seroprevalence increased steadily with age. Compared to women, men had a lower seroprevalence with an adjusted risk ratio (ARR) of 0.61 (95% CI: 0.56-0.67). Seroprevalence has decreased in recent decades with an ARR of 0.98 (95% CI: 0.97-0.99) per year. Seroprevalence was highest in Eastern and Southern Africa. Pooled HSV-2 proportion in genital ulcer disease was 50.7% (95% CI: 44.7-56.8%) and in genital herpes it was 97.3% (95% CI: 84.4-100%).

Interpretation: Seroprevalence is declining by 2% per year, but a third of the population is infected. Age and geography play profound roles in HSV-2 epidemiology. Temporal declines and geographic distribution of HSV-2 seroprevalence mirror that of HIV prevalence, suggesting sexual risk behavior has been declining for three decades. HSV-2 is the etiological cause of half of genital ulcer disease and nearly all genital herpes cases with limited role for HSV-1.

Funding: This work was supported by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar and by the Qatar National Research Fund [NPRP 9-040-3-008].

Keywords: Genital herpes; Genital ulcer disease; Region; Seroprevalence; Synthesis.

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Conflict of interest statement

MH, FAH, CJ, and LJA declare no competing interests. KL is currently funded by the World Health Organization and by GlaxoSmithKline (GSK) for a gonorrhea vaccine modeling project.

Figures

Fig 1
Fig. 1
Flowchart of article selection for the systematic review of HSV-2 infection in sub-Saharan Africa, per PRISMA guidelines Abbreviations: HSV-2 = Herpes simplex virus type 2.
Fig 2
Fig. 2
Forest plots presenting the outcomes of pooled mean proportions of HSV-2 virus isolation in clinically diagnosed genital ulcer disease (GUD) and in clinically diagnosed genital herpes in sub-Saharan Africa. Abbreviations: HSV-2 = Herpes simplex virus type 2.
Fig 2
Fig. 2
Forest plots presenting the outcomes of pooled mean proportions of HSV-2 virus isolation in clinically diagnosed genital ulcer disease (GUD) and in clinically diagnosed genital herpes in sub-Saharan Africa. Abbreviations: HSV-2 = Herpes simplex virus type 2.
See this image and copyright information in PMC

References

    1. James C., Harfouche M., Welton N.J. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bull World Health Organ. 2020;98(5):315–329. - PMC - PubMed
    1. Ahmed H.J., Mbwana J., Gunnarsson E. Etiology of genital ulcer disease and association with human immunodeficiency virus infection in two tanzanian cities. Sex Transm Dis. 2003;30(2):114–119. - PubMed
    1. Gupta R., Warren T., Wald A. Genital herpes. Lancet. 2007;370(9605):2127–2137. - PubMed
    1. Halioua B., Malkin J.E. Epidemiology of genital herpes - recent advances. Eur J Dermatol. 1999;9(3):177–184. - PubMed
    1. Mertz K.J., Trees D., Levine W.C. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis. 1998;178(6):1795–1798. - PubMed

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