Decreasing seroprevalence of herpes simplex virus type 1 and type 2 in Germany leaves many people susceptible to genital infection: time to raise awareness and enhance control

Gerit Korr,Irina Czogiel,Klaus Jansen,Christina Poethko-Mueller,Viviane Bremer,Michael Thamm

doi:10.1186/s12879-017-2527-1

Gerit Korr, Irina Czogiel + Show 4 more

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https://doi.org/10.1186/s12879-017-2527-1

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Abstract

BackgroundHerpes simplex infections (HSV1/2) are characterized by recurrent symptoms, a risk of neonatal herpes, and the facilitation of HIV transmission. In Germany, HSV1/2 infections are not notifiable and data are scarce. A previous study found higher HSV1/2 seroprevalences in women in East Germany than in women in West Germany. We assessed changes in the HSV1/2 seroprevalences over time and investigated determinants associated with HSV1/2 seropositivity to guide prevention and control.MethodsThe study was based on the German Health Interview and Examination Survey for Adults (DEGS; 2008–2011) and the German National Health Interview and Examination Survey (GNHIES; 1997–1999). We tested serum samples from DEGS participants for HSV1 and HSV2 immunoglobulin G. We used Pearson’s χ2 test to compare the HSV1/HSV2 seroprevalences in terms of sex, age, and region of residence (East/West Germany) and investigated potential determinants by calculating prevalence ratios (PR) with log-binomial regression. All statistical analyses included survey weights.ResultsIn total, 6627 DEGS participants were tested for HSV1, and 5013 were also tested for HSV2. Overall, HSV1 seroprevalence decreased significantly from 1997–1999 (82.1%; 95%CI 80.6–83.6) to 2008–2011 (78.4%; 95%CI 77.8–79.7). In the same period, overall HSV2 seroprevalence decreased significantly from 13.3% (95%CI 11.9–14.9) to 9.6% (95%CI 8.6–10.8), notably in 18–24-year-old men (10.4 to 0%) in East Germany. Women were more likely than men to be seropositive for HSV1 (PR 1.1) or HSV2 (PR 1.6). A lower level of education, smoking, and not speaking German were associated with HSV1 in both sexes. Women of older age, who smoked, or had a history of abortion and men of older age or who had not attended a nursery school during childhood were more often seropositive for HSV2.ConclusionThe reduced seroprevalences of HSV1 and HSV2 leave more people susceptible to genital HSV1/2 infections. Practitioners should be aware of HSV infection as a differential diagnosis for genital ulcers. We recommend educational interventions to raise awareness of the sexual transmission route of HSV1/2, possible consequences, and prevention. Interventions should especially target pregnant women, their partners, and people at risk of HIV.

Highlights

Herpes simplex infections (HSV1/2) are characterized by recurrent symptoms, a risk of neonatal herpes, and the facilitation of Human immunodeficiency virus (HIV) transmission
Laboratory methods Serum samples from the DEGS participants were tested for Herpes simplex virus 1 (HSV1) and Herpes simplex virus 2 (HSV2) with a chemiluminescence immunoassay (CLIA) (LIAISON® HSV1/ 2, DiaSorin, von Hevesy-Strasse 3, 63,128 Dietzenbach)
Neither the study population tested for HSV1 nor the study population tested for HSV2 differed from the total DEGS study population with regard to sex, age, or region of residence

Summary

Introduction

Herpes simplex infections (HSV1/2) are characterized by recurrent symptoms, a risk of neonatal herpes, and the facilitation of HIV transmission. Herpes simplex virus is the main cause of genital ulcers worldwide [1]. Both Herpes simplex virus 1 (HSV1) and Herpes simplex virus 2 (HSV2) infect the epithelial cells of the skin and mucosa through minor breaks, and travel by retrograde transport to the sensory root ganglia, where they persist throughout life [2]. The specific tropism of the virus means that HSV1 predominantly infects the orolabial tissue and is transmitted by contact with infected saliva, which often occurs early in life [6]. HSV2 typically infects the genitalia and is transmitted through sexual contact. In recent decades, an increasing proportion of genital HSV infections have been caused by HSV1 [7,8,9]. Two main developments have been suggested to be responsible for this trend: an increased proportion of adolescents and young adults who are HSV1 negative and more susceptible to the acquisition of HSV1 through the sexual route, and an increased frequency of oral sex [10]

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