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      Prevalence and Factors Associated with Herpes Simplex Virus Type 2 Infection in Patients Attending a Baltimore City Emergency Department

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          Abstract

          Objectives

          Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted disease, but there is limited data on its epidemiology among urban populations. The urban Emergency Department (ED) is a potential venue for surveillance as it predominantly serves an inner city minority population. We evaluate the seroprevalence and factors associated with HSV-2 infection among patients attending the Johns Hopkins Hospital Adult Emergency Department (JHH ED).

          Methods

          An identity unlinked-serosurvey was conducted between 6/2007 and 9/2007 in the JHH ED; sera were tested by the Focus HerpeSelect ELISA. Prevalence risk ratios (PRR) were used to determine factors associated with HSV-2 infection.

          Results

          Of 3,408 serum samples, 1,853 (54.4%) were seropositive for HSV-2. Females (adjPRR  = 1.47, 95% CI 1.38–1.56), non-Hispanic blacks (adjPRR  = 2.03, 95% CI 1.82–2.27), single (adjPRR  = 1.15, 95% CI 1.07–1.25), divorced (adjPRR  = 1.28, 95% CI 1.15–1.41), and unemployed patients (adjPRR  = 1.13, 95% CI 1.05–1.21) had significantly higher rates of HSV-2 infection. Though certain zip codes had significantly higher seroprevalence of HSV-2, this effect was completely attenuated when controlling for age and gender.

          Conclusions

          Seroprevalence of HSV-2 in the JHH ED was higher than U.S. national estimates; however, factors associated with HSV-2 infection were similar. The high seroprevalence of HSV-2 in this urban ED highlights the need for targeted testing and treatment. Cross-sectional serosurveys in the urban ED may help to examine the epidemiology of HSV-2.

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          Most cited references21

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          Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States.

          Fujie Xu, Maya Sternberg, Benny J Kottiri … (2006)
          Herpes simplex virus type 1 (HSV-1) and type 2 are common infections worldwide. Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes and is almost always sexually transmitted. In contrast, HSV-1 is usually transmitted during childhood via nonsexual contacts. Preexisting HSV-1 antibodies can alleviate clinical manifestations of subsequently acquired HSV-2. Furthermore, HSV-1 has become an important cause of genital herpes in some developed countries. To examine trends in HSV-1 and HSV-2 seroprevalence in the United States in 1999-2004 compared with 1988-1994. Cross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys [NHANES]), were used to compare national seroprevalence estimates from 1999-2004 with those from 1988-1994, and changes in HSV-1 and HSV-2 seroprevalence since 1976-1980 were reviewed. Persons aged 14 to 49 years were included in these analyses. Seroprevalence of HSV-1 and HSV-2 antibodies based on results from type-specific immunodot assays; diagnosis of genital herpes. The overall age-adjusted HSV-2 seroprevalence was 17.0% (95% confidence interval [CI], 15.8%-18.3%) in 1999-2004 and 21.0% (95% CI, 19.1%-23.1%) in 1988-1994, a relative decrease of 19.0% between the 2 surveys (95% CI, -28.6% to -9.5%; P<.001). Decreases in HSV-2 seroprevalence were especially concentrated in persons aged 14 to 19 years between 1988 and 2004. In adolescents aged 17 to 19 years and young adults, the decreases in HSV-2 seroprevalence were significant even after adjusting for changes in sexual behaviors. Among those infected with HSV-2, the percentage who reported having been diagnosed with genital herpes was statistically different (14.3% in 1999-2004 and 9.9% in 1988-1994; P = .02). Seroprevalence of HSV-1 decreased from 62.0% (95% CI, 59.6%-64.6%) in 1988-1994 to 57.7% (95% CI, 55.9%-59.5%) in 1999-2004, a relative decrease of 6.9% between the 2 surveys (95% CI, -11.6% to -2.3%; P = .006). Among persons infected with HSV-1 but not with HSV-2, a higher percentage reported having been diagnosed with genital herpes in 1999-2004 compared with 1988-1994 (1.8% vs 0.4%, respectively; P<.001). These data show declines in HSV-2 seroprevalence, suggesting that the trajectory of increasing HSV-2 seroprevalence in the United States has been reversed. Seroprevalence of HSV-1 decreased but the incidence of genital herpes caused by HSV-1 may be increasing.
          Article 0 comments Cited 203 times – based on 0 reviews     Review now
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            Seroprevalence of herpes simplex virus types 1 and 2--United States, 1999-2010.

            L Markowitz, Elizabeth H Bradley, Lorraine Gibson … (2014)
            Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common infections with serious sequelae. HSV-1 is an increasingly important cause of genital herpes in industrialized countries. Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES), we examined HSV-1 and HSV-2 seroprevalence among 14- to 49-year-olds in the United States. We estimated seroprevalence in 1999-2004 and 2005-2010, stratified by sociodemographic characteristics and sexual behaviors. We also reviewed HSV-1 and HSV-2 seroprevalence from 1976-1980 to 2005-2010. In 2005-2010, the seroprevalence of HSV-1 was 53.9%, and the seroprevalence of HSV-2 was 15.7%. From 1999-2004 to 2005-2010, HSV-1 seroprevalence declined by nearly 7% (P 29% from 1976-1980 to 2005-2010 (P < .01). An increasing number of adolescents lack HSV-1 antibodies at sexual debut. In the absence of declines in HSV-2 infections, the prevalence of genital herpes may increase.
            Article 0 comments Cited 135 times – based on 0 reviews     Review now
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              Herpes simplex virus type 2 in the United States, 1976 to 1994.

              S Aral, Mitchell A. Nahmias, Jae K. Lee … (1997)
              Herpes simplex virus type 2 (HSV-2) infection is usually transmitted sexually and can cause recurrent, painful genital ulcers. In neonates the infection is potentially lethal. We investigated the seroprevalence and correlates of HSV-2 infection in the United States and identified changes in HSV-2 seroprevalence since the late 1970s. Serum samples and questionnaire data were collected during the National Health and Nutrition Examination Surveys (NHANES) II (1976 to 1980) and III (1988 to 1994). HSV-2 antibody was assessed with an immunodot assay specific for glycoprotein gG-2 of HSV-2. From 1988 to 1994, the seroprevalence of HSV-2 in persons 12 years of age or older in the United States was 21.9 percent (95 percent confidence interval, 20.2 to 23.6 percent), corresponding to 45 million infected people in the noninstitutionalized civilian population. The seroprevalence was higher among women (25.6 percent) than men (17.8 percent) and higher among blacks (45.9 percent) than whites (17.6 percent). Less than 10 percent of all those who were seropositive reported a history of genital herpes infection. In a multivariate model, the independent predictors of HSV-2 seropositivity were female sex, black race or Mexican-American ethnic background, older age, less education, poverty, cocaine use, and a greater lifetime number of sexual partners. As compared with the period from 1976 to 1980, the age-adjusted seroprevalence of HSV-2 rose 30 percent (95 percent confidence interval, 15.8 to 45.8 percent). The seroprevalence quintupled among white teenagers and doubled among whites in their twenties. Among blacks and older whites, the increases were smaller. Since the late 1970s, the prevalence of HSV-2 infection has increased by 30 percent, and HSV-2 is now detectable in roughly one of five persons 12 years of age or older nationwide. Improvements in the prevention of HSV-2 infection are needed, particularly since genital ulcers may facilitate the transmission of the human immunodeficiency virus.
              Article 0 comments Cited 124 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Nancy M. Sawtell: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 18 July 2014
                Volume: 9
                Issue: 7
                Electronic Location Identifier: e102422
                Affiliations
                [1 ]Division of Intramural Research, NIAID, NIH, Baltimore, Maryland, United States of America
                [2 ]Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
                Cincinnati Childrens Hospital Medical Center, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: GDK TCQ OL. Performed the experiments: EUP MAF. Analyzed the data: EUP MAF Y-HH OL. Contributed reagents/materials/analysis tools: EUP MAF Y-HH RER AEOB CKK JS CAG GDK TCQ OL. Contributed to the writing of the manuscript: EUP MAF Y-HH RER AEOB CKK JS CAG GDK TCQ OL.

                [¤a]

                Current address: Sinai Medical Center, New York, New York, United States of America

                [¤b]

                Current address: Department of Emergency Medicine, Lehigh Valley Health Network, Bethlehem, Pennsylvania, United States of America

                [¤c]

                Current address: Chase Brexton, Baltimore, Maryland, United States of America

                Article
                Publisher ID: PONE-D-14-17620
                DOI: 10.1371/journal.pone.0102422
                PMC ID: 4103852
                PubMed ID: 25036862
                SO-VID: f51f373f-38fd-4033-8154-b3b73fa43437
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 23 April 2014
                Date accepted : 18 June 2014
                Page count
                Pages: 5
                Funding
                The work was supported in part by the Division of Intramural Research and Dr. Hsieh is supported in part by an NIH Award, 5K01AI100681 from NIAID. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Medical Microbiology
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Herpesviruses
                Subject: Herpes Simplex Virus-2
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Disease Surveillance
                Subject: Infectious Disease Surveillance
                Subject: Pathology and Laboratory Medicine
                Subject: Pathogens
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Herpesviruses
                Subject: Herpes Simplex Virus-2
                Custom metadata
                Data Availability The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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