Seroepidemiological study of herpes simplex virus type 2 infection in HIV positive patients, Delhi, India, 2007

Background: Herpes simplex virus type 2 (HSV-2) infection is the primary cause of genital herpes worldwide and also has potential role in facilitating human immunodeficiency virus (HIV) transmission. Materials and Methods: In our analytical cross-sectional study we interviewed and collected serum samples from 91 HIV positive subjects coming to antiretroviral therapy center at a government hospital in Delhi, to determine the seroprevalence and relative prevalence of HSV-2 among subjects with specific risk attributes. The patients were interviewed using a structured questionnaire and their serum samples were tested for HSV-2 specific immunoglobulin G (IgG) antibodies. We compared prevalence of HSV-2 antibodies between exposed and unexposed; to demographic, socioeconomic, and behavioral variables. Results: Fifty-two (57.1%) male and 39 (42.9%) female HIV positive subjects participated in the study. Seroprevalence of HSV-2 was 48.4% (males: 51.9% and females: 43.6%). Only 4.5% had given current history of genital ulcer. Overall increasing number of lifetime sexual partners showed significant association with HSV-2 seropositivity (Chi-square for trend: 19.17; P = 0.00001). Among men sexual contact with commercial sex workers (prevalence ratio (PR) = 6.6; 95% confidence interval (CI) =1.76-24.83; P = 0.0002) and age at first sexual intercourse <19 years (PR = 2.3; 95% CI = 0.98-5.6; P = 0.021) were significantly associated with HSV-2 seropositivity. Use of condom during sexual intercourse among men, showed significant protective effect (PR = 0.57; 95% CI = 0.356-0.902; P = 0.037). Among women history of past genital ulcer was significantly associated (PR = 2.25; 95% CI = 1.14-4.45; P = 0.026) with HSV-2 seroposititvity. Conclusions: The prevalence of HSV-2 is high in the study group with high proportions of undiagnosed HSV-2 infections. HSV type-specific serological testing in the HIV infected subpopulation should be used to diagnose HSV-2 infections and high risk groups should be targeted for interventions like behavioral intervention messages. Consistent condom use should be promoted.