Herpes simplex virus type-2 assay specificity and male circumcision to reduce herpes simplex virus type-2 acquisition

Wound healing rates and wound problems of conventional circumcision compared with ring circumcision: A meta-analysis

A meta-analysis investigation was executed to measure the wound healing rates (WHRs) and wound problems (WPs) of conventional circumcision (CC) compared with ring circumcision (RC). A comprehensive literature investigation till March 2023 was applied and 2347 interrelated investigations were reviewed. The 16 chosen investigations enclosed 25 838 individuals, with circumcision, were in the chosen investigations' starting point, 3252 of them were RC, and 2586 were CC. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the WHRs and WPs of CC compared with RC by the dichotomous or continuous approaches and a fixed or random model. RC had a significantly lower wound infection rate (WIR) (OR, 0.58; 95% CI, 0.37-0.91, P = .002) and wound bleeding rate (WBR) (OR, 0.22; 95% CI, 0.12-0.42, P < .001) compared with those with CC. However, RC and CC had no significant difference in WHR (OR, 2.18; 95% CI, -0.73 to 5.09, P = .14), wound edema rate (WER) (OR, 1.11; 95% CI, 0.92-1.33, P = .28), and wound dehiscence rate (WDR) (OR, 0.98; 95% CI, 0.60-1.58, P = .93). RC had significantly lower WIR, and WBR, however, no significant difference in WHR, WER, and WDR compared with those with CC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.

No-flip ShangRing circumcision in 10-12 year old boys: Results from randomized clinical trials in Kenya

Background

Attention has recently turned toward the use of device-assisted male circumcision to help scale up male circumcision services in sub-Saharan Africa, with increasing emphasis on younger age groups. We assessed the use of the ShangRing for circumcising the subset of boys aged 10 to 12 years who were enrolled in two randomized clinical trials in Kenya.

Methods

We performed a sub-analysis of outcomes in 197 boys aged 10 to 12 years; a subset who were enrolled in two randomized clinical trials to assess the use of the no-flip ShangRing circumcision technique in men and boys. One trial assessed spontaneous detachment vs. planned removal of the ShangRing 7 days post-circumcision. The second trial compared the use of topical vs. injectable anesthesia with ShangRing circumcision. Aside from baseline characteristics, data was collected and analyzed for each trial separately.

Results

All participants were successfully circumcised. Duration of circumcision, participants requiring a dorsal slit, rate of adverse events, time to complete wound healing, and participant satisfaction were similar between the two groups in each trial. Mean time required for spontaneous ShangRing detachment was 14.82±3.76 days. Topical anesthesia showed a significantly lower mean pain score at the time of application (0.64±1.71 vs. 1.55± 2.21, p = 0.03) as well as postoperatively (0.54±0.88 vs. 1.72±1.56, p<0.0001). Median dwell time of the topical anesthetic was 43 (IQR: 35.5–60) minutes, while the median time it took the injectable anesthetic to take effect was 2.04 (IQR: 1.72–3.09) minutes.

Conclusion

No-flip ShangRing circumcision had a positive safety profile among young adolescent boys, specifically ages 10–12 years. The use of spontaneous device detachment and topical anesthesia with the procedure have shown promising outcomes in this age group. This may have the potential to further increase the acceptability of ShangRing circumcision, and therefore accelerate the scle up of male circumcision services in sub-Saharan Africa.

Trial registration

ClinicalTrials.gov registration # NCT02390310.

Prevalence and incidence estimation of HSV-2 by two IgG ELISA methods among South African women at high risk of HIV

Introduction

Previous comparison studies of the Kalon and HerpeSelect 2 ELISA IgG assays on sub-Saharan samples have found differences in the sensitivity and specificity of these assays. Using longitudinal samples from an HIV prevention study, we compared both assays and determined the HSV-2 prevalence and incidence in a South African young female population at elevated risk of acquiring HIV.

Methods

Samples at baseline were tested in both assays using the manufacturers’ guidelines (cut-off > 1.10). When non-reactive in one assay, the final visit samples were tested to determine the incidence rate. Using correlation and regression analyses, the intra- and inter-assay variabilities were assessed.

Results

The prevalence rate was 41.1% and 44.9% for Kalon and HerpeSelect using the manufacturer guidelines, respectively. Agreement between the two tests were high (kappa = 0.92). The original optical density values of both assays were highly correlated (R = 0.94), but the calibrator and correspondingly cut-off index values differed between the assays. Lowering the index value cut-off for the Kalon assay by 40% (to 0.66) resulted in a HSV-2 prevalence of 43.2%, and increased agreement between the assays (to kappa = 0.96). The incidence rate was 16.3/100 Person Years using the lower cut-off for the Kalon assay.

Discussion

In this longitudinal study, we showed that the performance of the two assays was very similar. After lowering the cut-off for the Kalon assay to 0.66 early infections were detected without impairing its specificity. The prevalence and incidence rates are in line with previously described rates for sub-Saharan African cohorts.

A systematic review and meta-analysis of circumcision with Shang Ring vs conventional circumcision

Herein, we conduct a systematic review and meta-analysis of the current evidence to compare the safety and efficacy of Shang Ring circumcision (SRC) with conventional circumcision (CC) for male patients. Articles were searched by 2 independent reviewers. Overall, 8 randomized controlled trials involving 3314 patients were included. Compared with the CC group, SRC is associated with shorter operative time, lower intraoperative pain score, higher satisfaction with penile appearances, less intraoperative blood loss, lower adverse event rate, and lower wound bleeding rate. SRC appears to be a safer and more effective choice in comparison with CC for male patients.

Incidence of herpes simplex virus type 2 infections in Africa: a systematic review

The burden of HSV type 2 varies substantially by region, with the highest incidence and prevalence in sub-Saharan Africa. We undertook a systematic review to identify studies reporting prospective data on incidence rates in men and women in Africa. Of 18 eligible studies, 7 were conducted in high-risk populations. Among women, incidence rates appeared to be higher in those with high-risk sexual behavior, with rates ranging from 3 to 23 per 100 person-years. In contrast, incidence rates in men appeared to be lower, ranging from 1 to 12 per 100 person-years. Risk factors for HSV-2 in women included prevalent human immunodeficiency virus (HIV) infection, younger age at sexual initiation, and sexual activity. Among men, condom use and circumcision had a protective effect, whereas prevalent HIV increased the risk of HSV-2 acquisition. This review draws attention to the high HSV-2 acquisition rates reported in Africa, thereby identifying an efficient setting for preventative HSV-2 vaccine trials.

Medical male circumcision and herpes simplex virus 2 acquisition: posttrial surveillance in Kisumu, Kenya

BACKGROUND

We estimated the 72-month efficacy of medical male circumcision (MMC) against herpes simplex virus 2 (HSV-2) incidence among men in the Kisumu MMC randomized trial.

METHODS

From 2002 to 2005, 2784 men aged 18-24 were enrolled and randomized 1:1 to immediate circumcision or control. Cox proportional hazards regression incorporating stabilized inverse probability of treatment and censoring weights generated through marginal structural modeling was used to estimate the efficacy of MMC on HSV-2 risk. Conventional conditional Cox regression identified multivariable risks for HSV-2 seroconversion.

RESULTS

Among 2044 HSV-2 seronegative men at baseline, the cumulative 72-month HSV-2 incidence was 33.5% (32.7% among circumcised men, 34.6% among uncircumcised men). In weight-adjusted Cox regression, the hazard ratio was 0.88 (95% confidence interval, .77-1.10). In multivariable analyses, risks for HSV-2 included human immunodeficiency virus (HIV) infection, genital ulcer disease (GUD), penile epithelial trauma, multiple recent sex partners, and being married /cohabiting.

CONCLUSIONS

MMC had no effect on acquisition of HSV-2 during 72 months of follow-up. The temporal sequence and limited correlation between HSV-2, GUD, and penile epithelial trauma suggests that these are distinct phenomena rather than misclassification of HSV-2 symptoms. Determining the etiology of non-sexually transmitted infection GUD and penile epithelial trauma is needed, as both are commonly occurring risks for HSV-2 and HIV acquisition.

CLINICAL TRIALS REGISTRATION

NCT0005937.