Abstract
BackgroundHerpes simplex virus type 2 (HSV-2) infection causes significant disease globally. Adolescent and adult infection may present as painful genital ulcers. Neonatal infection has high morbidity and mortality. Additionally, HSV-2 likely contributes substantially to the spread of HIV infection. The global burden of HSV-2 infection was last estimated for 2003. Here we present new global estimates for 2012 of the burden of prevalent (existing) and incident (new) HSV-2 infection among females and males aged 15–49 years, using updated methodology to adjust for test performance and estimate by World Health Organization (WHO) region.Methods and FindingsWe conducted a literature review of HSV-2 prevalence studies world-wide since 2000. We then fitted a model with constant HSV-2 incidence by age to pooled HSV-2 prevalence values by age and sex. Prevalence values were adjusted for test sensitivity and specificity. The model estimated prevalence and incidence by sex for each WHO region to obtain global burden estimates. Uncertainty bounds were computed by refitting the model to reflect the variation in the underlying prevalence data. In 2012, we estimate that there were 417 million people aged 15–49 years (range: 274–678 million) living with HSV-2 infection world-wide (11.3% global prevalence), of whom 267 million were women. We also estimate that in 2012, 19.2 million (range: 13.0–28.6 million) individuals aged 15–49 years were newly-infected (0.5% of all individuals globally). The highest burden was in Africa. However, despite lower prevalence, South-East Asia and Western Pacific regions also contributed large numbers to the global totals because of large population sizes.ConclusionsThe global burden of HSV-2 infection is large, leaving over 400 million people at increased risk of genital ulcer disease, HIV acquisition, and transmission of HSV-2 to partners or neonates. These estimates highlight the critical need for development of vaccines, microbicides, and other new HSV prevention strategies.
Highlights
Herpes simplex virus type 2 (HSV-2) infection is mainly sexually transmitted, causing genital herpes
We present new global estimates for 2012 of the burden of prevalent and incident HSV-2 infection among females and males aged 15–49 years, using updated methodology to adjust for test performance and estimate by World Health Organization (WHO) region
Suppressive antiviral therapy against HSV2 has been shown to reduce symptomatic recurrences and asymptomatic HSV shedding; in clinical trials, suppressive therapy did not reduce the excess risk of HIV acquisition or transmission due to HSV-2 nor fully suppress HSV-2 shedding [15,16,17]
Summary
Herpes simplex virus type 2 (HSV-2) infection is mainly sexually transmitted, causing genital herpes. The high burden of HSV-2 infection is thought to have contributed substantially to HIV prevalence in a number of settings, most notably in sub-Saharan Africa [5, 13], it is difficult to control for shared sexual risk driving both epidemics [14]. We present new global estimates for 2012 of the burden of prevalent (existing) and incident (new) HSV-2 infection among females and males aged 15–49 years, using updated methodology to adjust for test performance and estimate by World Health Organization (WHO) region. In 2012, we estimate that there were 417 million people aged 15–49 years (range: 274–678 million) living with HSV-2 infection world-wide (11.3% global prevalence), of whom 267 million were women. Conclusions: The global burden of HSV-2 infection is large, leaving over 400 million people at increased risk of genital ulcer disease, HIV acquisition, and PLOS ONE | DOI:10.1371/journal.pone.0114989. Conclusions: The global burden of HSV-2 infection is large, leaving over 400 million people at increased risk of genital ulcer disease, HIV acquisition, and PLOS ONE | DOI:10.1371/journal.pone.0114989 January 21, 2015
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