Abstract
BackgroundUnderstanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India.MethodsPersons 15-49 years old from 32 rural and 34 urban clusters were sampled using a stratified random method to represent adults in the high HIV prevalence Guntur district in Andhra Pradesh state. Interviews were conducted and dry blood spots were collected on 12,617 study participants. Testing for HSV-2 and syphilis was performed.ResultsAdjusted HSV-2 and syphilis seroprevalence rates were 4.70% and 2.08% for men and 7.07% and 1.42% for women. For men, tattooing, >3 lifetime sex partners, tobacco use, and sex with men in the past 6 months were associated with HSV-2 or syphilis (ORs, 1.66-2.95, p < 0.05). Male circumcision was positively associated with HSV-2 infection (OR, 1.37, p = 0.028) though this could be due to residual confounding. In women, greater than one lifetime partner remained significantly associated with HSV-2 in multivariate analysis (OR, 2.61; 95% CI, 1.39-4.87). Among all behavioral risk factors and other covariates in women and men, HIV infection exhibited the strongest association with HSV-2 and syphilis (ORs, 8.2-14.2, p < 0.001). The proportion of individuals with HSV-2 who were HIV infected was less than the proportion with syphilis who were HIV infected (11.8% vs. 22.7%; p = 0.001).ConclusionsNearly one in four persons surveyed in this population-based study that were seroprevalent for syphilis, were also HIV infected. Common population risk factors for syphilis, HSV-2 and HIV and high rates of co-seroprevalence suggest that HIV testing, STI testing and service strategies for these would benefit from direct linkage in India.
Highlights
Understanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India
Amongst sexually transmitted ulcerative infections, Treponema pallidum, the bacterium causing syphilis and herpes simplex virus type-2 (HSV-2) have the highest prevalence [1] followed by chancroid and donovanosis which are in decline [3]
We report seroprevalence rates and potential risk factors for HSV-2 and syphilis from a population-based study in Guntur district in the south Indian state of Andhra Pradesh
Summary
Understanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India. Amongst sexually transmitted ulcerative infections, Treponema pallidum, the bacterium causing syphilis and herpes simplex virus type-2 (HSV-2) have the highest prevalence [1] followed by chancroid and donovanosis which are in decline [3]. HSV-2 seroprevalence rates in the general adult population in India have been reported to range from 7.9 to 18.9% [4,5,6], translating into 100-200 million individuals who have acquired HSV-2 infection. While HSV-2 can be a cause of significant morbidity through genital ulcer disease, central nervous system disease, and liver involvement, one of the major reasons for interest in HSV-2 is because of its strong association with HIV infection. In a study in the state of Karnataka in India, there was significant heterogeneity of HSV-2 infection with higher rates in rural areas and amongst women [6]
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