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Chakraborty P, Norris AH, Huber-Krum S, Garver S, Hood RB, Banda V, Esber A, Patricia CR, Krysiak R, Turner AN. An Assessment of Risk Factors for Herpes Simplex Virus Type 2 Infection in Malawian Women Using 2 Classifications for the HerpeSelect 2 Test. Sex Transm Dis 2020; 47:192-196. [PMID: 31876866 PMCID: PMC7816111 DOI: 10.1097/olq.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The HerpeSelect 2 ELISA IgG test for herpes simplex virus type 2 (HSV-2) infection is widely used, convenient, and inexpensive. However, it has been shown to have lower specificity among populations in Sub-Saharan Africa compared with HSV-2 tests regarded as criterion standards. METHODS In 2016, we collected blood and survey data from 248 women participating in a community-based cohort study in rural Malawi (the Umoyo wa Thanzi project). Using multinomial logistic regression accounting for village-level clustering, we examined unadjusted associations between select demographic and sexual risk factors and HSV-2 serostatus. Because increasing the index value cutpoint for a positive result improves specificity, we coded HSV-2 serostatus in 2 ways: the manufacturer's recommended cutpoints (<0.9, negative; 0.9-1.1, indeterminate; >1.1, positive) and modified cutpoints with improved specificity (<0.9, negative; 0.9-3.5, indeterminate; >3.5, positive). We aimed to investigate whether associations between select risk factors and HSV-2 serostatus varied under the 2 approaches. RESULTS The prevalence of HSV-2 in this sample was 67% under the manufacturer's cutpoint and 22% under the modified cutpoint. Under both cutpoints, age, household size, number of marriages, and number of pregnancies were associated with HSV-2-positive serostatus. Using modified cutpoints, current bacterial vaginosis (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.35-7.47), partner concurrency (OR, 4.88; 95% CI, 2.54-9.37) and unsure about partner concurrency (OR, 1.91; 95% CI, 1.08-3.38) were associated with HSV-2 seropositivity. Household size, education, and marital status were the only variables significantly associated with indeterminate HSV-2 serostatus using the modified cutpoints. CONCLUSION HSV-2-focused interventions informed by identifying individuals likely to have or acquire HSV-2 must be aware that different target populations may emerge depending on which cutpoints are adopted.
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Affiliation(s)
| | | | - Sarah Huber-Krum
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sarah Garver
- Department of Sociology, University of Chicago, Chicago, IL
| | - Robert B Hood
- From the Division of Epidemiology, College of Public Health
| | - Venson Banda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | | | | | | | - Abigail Norris Turner
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH
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Harfouche M, Chemaitelly H, Abu-Raddad LJ. Herpes simplex virus type 1 epidemiology in Africa: Systematic review, meta-analyses, and meta-regressions. J Infect 2019; 79:289-299. [PMID: 31376458 DOI: 10.1016/j.jinf.2019.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess herpes simplex virus type 1 (HSV-1) epidemiology in Africa. METHODS This systematic review was conducted per the Cochrane Collaboration guidelines. Findings were reported following the PRISMA guidelines. Research questions were addressed using random-effects meta-analyses and meta-regressions. RESULTS Forty-three overall (and 69 stratified) HSV-1 seroprevalence measures, and 18 and eight proportions of HSV-1 viral detection in genital ulcer disease (GUD) and in genital herpes, respectively, were extracted from 37 reports. Pooled mean seroprevalence was 67.1% (95% confidence interval (CI): 54.7-78.5%) in children, and 96.2% (95% CI: 95.0-97.3%) in adults. Across age groups, pooled mean was 44.4% (95% CI: 29.9-59.3%) in ≤5 years-old, 85.6% (95% CI: 81.0-89.6%) in 6-15 years-old, 93.3% (95% CI: 89.2-96.6%) in 16-25 years-old, and 93.8% (95% CI: 84.6-99.4%) in >25 years-old. Age explained 78.8% of seroprevalence variation. Pooled mean proportion of HSV-1 detection was 0.4% (95% CI: 0.0-1.5%) in GUD, and 1.2% (95% CI: 0.0-4.0%) in genital herpes. CONCLUSIONS HSV-1 is universally prevalent in Africa, at higher levels than other regions, with no evidence for declines in seroprevalence in recent decades. Nearly every person acquires the infection in childhood through oral-to-oral transmission, before sexual debut. Sexual oral-to-genital and genital-to-genital transmission appear very limited.
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Affiliation(s)
- Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
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Debrah O, Agyemang-Yeboah F, Asmah RH, Timmy-Donkoh E, Seini MM, Fondjo LA, Sight N, Owusu-Dabo E. SERO-prevalence of herpes simplex virus type 1 and type 2 among women attending routine Cervicare clinics in Ghana. BMC Infect Dis 2018; 18:378. [PMID: 30086705 PMCID: PMC6081947 DOI: 10.1186/s12879-018-3288-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus infection is a global health concern with disproportionately high burden in low and middle-income countries. There is a paucity of data on the prevalence of HSV infection in Ghana, which necessitated the present study. The aim of the study was to provide up-to-date data on sero-prevalence of HSV-1 and HSV-2 infection among women attending Cervicare clinics in Ghana. METHODS This was a cross-sectional study in which 380 women attending routine Cervicare clinics at Regional Hospitals in Kumasi and Accra, Ghana were enrolled into the study. Serum HSV-1 IgG and HSV-2 IgG were determined by ELISA method. The Chi-square test was used to investigate the association between sero-prevalence of HSV-1 and HSV-2 and socio-demographic and behavioral factors using the Statistical Package for the Social Scientists (SPSS) version 22. Statistical significance was accepted at p < 0.05. RESULTS The overall HSV-1 and HSV-2 sero-prevalence estimates were 99.2% (95% CI: 98.0-100%) and 78.4% (95% CI: 74.5-81.8%) respectively. The study observed 78.2% cross-positive prevalence of HSV-1 and HSV-2 among the studied participants. There was no association between the presence of HSV-1 and HSV-2 infection and age (χ2 = 2.351, p = 0.799 and χ2 = 1.655, p = 0.895 respectively). Our findings however, revealed association between the prevalence of HSV-2 and the age at coitarche (p = 0.021) as well as with number of sexual partners (p = 0.022). CONCLUSIONS The sero-prevalence estimates of HSV-1 and HSV-2 among the study population of women in Ghana were found to be high. This high prevalence could be attributed to high endemicity and inadequate intervention in this population. There is the need to raise awareness through organized public health screening and education to ensure control.
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Affiliation(s)
- Oksana Debrah
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Laboratory Department, Ridge Regional Hospital, Accra, Ghana.
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Timmy-Donkoh
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Center for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammed Mustapha Seini
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Laboratory Department, Ridge Regional Hospital, Accra, Ghana
| | - Linda Ahenkorah Fondjo
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nilok Sight
- Laboratory Department, C&J Medicare Hospital and Diagnostic Center, Accra, Ghana
| | - Ellis Owusu-Dabo
- Kumasi Center for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Global Health, School of Public Health,KNUST, Kumasi, Ghana
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4
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Vauloup-Fellous C. [Genital herpes and pregnancy: Serological and molecular diagnostic tools. Guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF)]. ACTA ACUST UNITED AC 2017; 45:655-663. [PMID: 29132769 DOI: 10.1016/j.gofs.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe serological and molecular tools available for genital and neonatal herpes, and their use in different clinical situations. METHODS Bibliographic investigations from MedLine database and consultation of international clinical practice guidelines. RESULTS Virological confirmation of genital herpes during pregnancy or neonatal herpes must rely on PCR (Professional consensus). HSV type-specific serology (IgG) will allow determining the immune status of a patient (in the absence of clinical lesions). However, there is currently no evidence to justify universal HSV serological testing during pregnancy (Professional consensus). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type-specific IgG in order to distinguish a true primary infection, a non-primary infection associated with first genital manifestation, from a recurrence (Grade C). HSV IgM is useless for diagnosis of genital herpes (Grade C). If a pregnant woman has personal history of genital herpes but no lesions, whatever the gestational age, it is not recommended to perform genital sampling nor serology (Professional consensus). In case of recurrence, if the lesion is characteristic of herpes, virological confirmation is not necessary (Professional Agreement). However, if the lesion is not characteristic, virological confirmation by PCR should be performed (Professional consensus). At birth, HSV PCR samples should be collected as soon as neonatal herpes is suspected (symptomatic neonate) (best before beginning antiviral treatment but must not delay the treatment), or after 24hours of life in case of asymptomatic neonate born to a mother with herpes lesions at delivery (Professional consensus). Clinical samples for virological confirmation should include at least blood and a peripheral location. In case of clinical manifestations of herpes in the neonate, first samples PCR positive, preterm birth, or maternal primary infection or non-primary infection associated with first genital manifestation at delivery, CSF should also be collected as well as samples of lesions in the neonate if present (Professional consensus). Sampling should be repeated in case of PCR negative but strong evidence of neonatal herpes (Professional consensus). HSV serology is useless for diagnosis of neonatal herpes (Grade C). CONCLUSIONS Virological confirmation for diagnosis of genital herpes during pregnancy or neonatal herpes must rely on PCR. PCR assays available in France are very reliable. Specific IgG are dedicated to restricted indications.
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Affiliation(s)
- C Vauloup-Fellous
- Laboratoire de virologie, hôpital Paul-Brousse, groupe hospitalier universitaire Paris-Sud, 12, rue Paul-Vaillant-Couturier, 94800 Villejuif, France.
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Patel R, Kennedy OJ, Clarke E, Geretti A, Nilsen A, Lautenschlager S, Green J, Donders G, van der Meijden W, Gomberg M, Moi H, Foley E. 2017 European guidelines for the management of genital herpes. Int J STD AIDS 2017; 28:1366-1379. [DOI: 10.1177/0956462417727194] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.
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Affiliation(s)
- Rajul Patel
- Department of Genitourinary Medicine, Southampton, UK
| | | | - Emily Clarke
- Department of Genitourinary Medicine, Southampton, UK
| | - Anna Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Arvid Nilsen
- Department of Dermatovenerology, University of Bergen, Bergen, Norway
| | | | - John Green
- Central and North West London NHS Trust, London, UK
| | - Gilbert Donders
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium
| | | | - Mikhail Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Harald Moi
- Department of Venereology, the Olafia Clinic, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
The most common specimens from immunocompromised patients that are analyzed for detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) are from skin lesions. Many types of assays are applicable to these samples, but some, such as virus isolation and direct fluorescent antibody testing, are useful only in the early phases of the lesions. In contrast, nucleic acid (NA) detection methods, which generally have superior sensitivity and specificity, can be applied to skin lesions at any stage of progression. NA methods are also the best choice, and sometimes the only choice, for detecting HSV or VZV in blood, cerebrospinal fluid, aqueous or vitreous humor, and from mucosal surfaces. NA methods provide the best performance when reliability and speed (within 24 hours) are considered together. They readily distinguish the type of HSV detected or the source of VZV detected (wild type or vaccine strain). Nucleic acid detection methods are constantly being improved with respect to speed and ease of performance. Broader applications are under study, such as the use of quantitative results of viral load for prognosis and to assess the efficacy of antiviral therapy.
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Loughman T, Singh B, Seddon B, Noone P, Santhosh P. Validation of a membrane touch biosensor for the qualitative detection of IgG class antibodies to herpes simplex virus type 2. Analyst 2017; 142:2725-2734. [DOI: 10.1039/c7an00666g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 1920s dead-stop end-point titration technique revisited for blood antibody analysis.
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Affiliation(s)
| | - Baljit Singh
- MiCRA Biodiagnostics Technology Gateway
- Synergy Centre - CASH Building
- Institute of Technology Tallaght
- Dublin 24
- Ireland
| | - Brian Seddon
- MiCRA Biodiagnostics Technology Gateway
- Synergy Centre - CASH Building
- Institute of Technology Tallaght
- Dublin 24
- Ireland
| | | | - Padmanabhan Santhosh
- MiCRA Biodiagnostics Technology Gateway
- Synergy Centre - CASH Building
- Institute of Technology Tallaght
- Dublin 24
- Ireland
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8
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Van Der Pol B. Type-specific detection of herpes simplex virus type 1 and type 2 using the cobas® HSV 1 and 2 test on the cobas® 4800 platform. Expert Rev Mol Diagn 2016; 16:1145-1154. [PMID: 27687862 DOI: 10.1080/14737159.2016.1243473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION HSV-1 and HSV-2 are among the most common causes of sexually transmitted infections (stis) globally. these infections are strongly associated with increased risk of hiv acquisition and rare, but devastating, neonatal disease. available treatment options can reduce HSV transmission and improve quality of life. accurate diagnosis early in disease can improve patient management. Areas covered: This paper describes the clinical manifestations of HSV infection often used for clinical diagnostic purposes. The paper then describes the evolution of laboratory diagnostic assays. Serology, culture and molecular diagnostics are described since all are currently in use. The features and performance characteristics of the cobas 4800 HSV1 and HSV2 Test (cobas HSV) on the cobas 4800® system (cobas 4800) are described in detail. Expert commentary: Diagnosis of HSV has historically been unreliable or technically difficult, but the availability of molecular assays such as the cobas HSV test for detection and typing of herpes can improve our ability to correctly manage this disease. Utilization of tools such as the cobas HSV assay may help shorten the time to accurate diagnosis and treatment thus potentially reducing the risk of transmission and the global burden of HSV.
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Affiliation(s)
- Barbara Van Der Pol
- a Department of Medicine , University of Alabama at Birmingham School of Medicine , Birmingham , AL , USA
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9
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Genital HSV Shedding among Kenyan Women Initiating Antiretroviral Therapy. PLoS One 2016; 11:e0163541. [PMID: 27683204 PMCID: PMC5040248 DOI: 10.1371/journal.pone.0163541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/09/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Genital ulcer disease (GUD) prevalence increases in the first month of antiretroviral treatment (ART), followed by a return to baseline prevalence by month 3. Since most GUD is caused by herpes simplex virus type 2 (HSV-2), we hypothesized that genital HSV detection would follow a similar pattern after treatment initiation. METHODS We conducted a prospective cohort study of 122 HSV-2 and HIV-1 co-infected women with advanced HIV disease who initiated ART and were followed closely with collection of genital swab specimens for the first three months of treatment. RESULTS At baseline, the HSV detection rate was 32%, without significant increase in genital HSV detection noted during the first month or the third month of ART. HIV-1 shedding declined during this period; no association was also noted between HSV and HIV-1 shedding during this period. CONCLUSION Because other studies have reported increased HSV detection in women initiating ART and we have previously reported an increase in GUD during early ART, it may be prudent to counsel HIV-1 infected women initiating ART that HSV shedding in the genital tract may continue after ART initiation.
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Poudel KC, Poudel-Tandukar K, Palmer PH, Mizoue T, Jimba M, Kobayashi J, Acharya B, Pandey BD, Oka S. Coinfection of Sexually Transmitted Infections among HIV-Positive Individuals: Cross-Sectional Results of a Community-Based Positive Living with HIV (POLH) Study in Nepal. J Int Assoc Provid AIDS Care 2015; 16:338-346. [PMID: 26527219 DOI: 10.1177/2325957415614644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In Asian concentrated HIV epidemics, data on coinfection of sexually transmitted infections (STIs) among HIV-positive individuals are limited. The authors measured the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and syphilis, and their correlates among 319 HIV-positive individuals in Kathmandu, Nepal. The authors tested blood samples for syphilis and urine samples for CT and NG. Overall, 17 (5.3%) participants had at least 1 STI (CT: 1.3%, NG: 2.8%, and syphilis: 1.2%). Of 226 participants who had sex in past 6 months, 51.3% did not always use condoms. Older (aged 35-60 years) participants were more likely (adjusted odds ratio [AOR] = 3.83; 95% confidence interval [CI] = 1.19-12.33; P = .024) and those who were currently married (AOR = 0.30; 95% CI = 0.09-0.97; P = .046) or on antiretroviral therapy (AOR = 0.21; 95% CI = 0.06-0.71; P = .012) were less likely to have at least 1 STI. Our results suggest the need to strengthen the efforts to screen and treat STIs and to promote safer sexual practices among Nepalese HIV-positive individuals.
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Affiliation(s)
- Krishna C Poudel
- 1 Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Paula H Palmer
- 3 School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Tetsuya Mizoue
- 4 Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masamine Jimba
- 5 Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Kobayashi
- 6 Department of Global Health, School of Health Sciences, University of the Ryukyus, Okinawa, Japan.,7 Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Bishnu Acharya
- 8 Laboratory of Cell and Gene Therapy, Institute for Advanced Medical Sciences, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Basu Dev Pandey
- 9 Everest International Clinic and Research Center, Kathmandu, Nepal
| | - Shinichi Oka
- 10 AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Patel EU, Manucci J, Kahle EM, Lingappa JR, Morrow RA, Piwowar-Manning E, James A, Maluzi KF, Cheeba MM, Gray G, Kosloff B, Delany-Moretlwe S, Inambao M, Vwalika B, Quinn TC, Laeyendecker O. Precision of the Kalon Herpes Simplex Virus Type 2 IgG ELISA: an international inter-laboratory assessment. BMC Infect Dis 2015; 15:398. [PMID: 26423888 PMCID: PMC4591065 DOI: 10.1186/s12879-015-1130-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The commercial Kalon HSV-2 IgG ELISA is currently recommended for research use in sub-Saharan Africa because of its superior accuracy compared to other serologic assays. However, there are no data on key precision parameters of Kalon such as inter-operator variation, repeatability, and reproducibility, thus contributing to a barrier for its acceptance and use in clinical trials in sub-Saharan Africa. We evaluated the analytical and field precision of the Kalon HSV-2 IgG ELISA. METHODS A total of 600 HIV-infected and uninfected serum samples from South Africa and Zambia, previously tested by the gold standard University of Washington HSV western blot (UW-WB), were tested using Kalon by two technologists in an United States reference laboratory. Aliquots of 183 samples were retested using Kalon by an on-site technologist in a South African laboratory and a Zambian laboratory. RESULTS Intra-assay variation was below 10 %. Intra-assay, intra-laboratory, and inter-laboratory correlation and agreement were significantly high (p < 0.01). In comparison to the UW-WB, accurate performance of Kalon was reproducible by each operator and laboratory. Receiver operating characteristic curve analysis indicated high selectivity of Kalon in the overall study population (area under the curve = 0.95, 95%CI = 0.92-0.97). DISCUSSION Kalon is a robust assay with high precision and reproducibility. Accordingly, operator errorlikely does not contribute to the variability observed in Kalon's specificity throughout sera from sub-Saharan Africa. CONCLUSIONS In populations with optimal diagnostic accuracy, Kalon is a reliable stand-alone method for on-site HSV-2 IgG antibody detection.
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Affiliation(s)
- Eshan U Patel
- Laboratory of Immunoregulation, Division of Intramural Research, NIAID, NIH, Baltimore, MD, USA
| | - Jordyn Manucci
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Erin M Kahle
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jairam R Lingappa
- Departments of Medicine, Global Health, and Pediatrics, University of Washington, Seattle, WA, USA
| | - Rhoda Ashley Morrow
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Anelet James
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Glenda Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute and University of the Witwatersrand, Johannesburg, South Africa
| | - Mubiana Inambao
- Zambia-Emory Research Project and Ndola Central Hospital, Ndola, Zambia
| | | | - Thomas C Quinn
- Laboratory of Immunoregulation, Division of Intramural Research, NIAID, NIH, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, Division of Intramural Research, NIAID, NIH, Baltimore, MD, USA. .,Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. .,NIAID, NIH and SOM, JHU, 855 North Wolfe St., Rangos Building, Room 538A, Baltimore, MD, 21205, USA.
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12
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De Baetselier I, Menten J, Cuylaerts V, Ahmed K, Deese J, Van Damme L, Crucitti T. Prevalence and incidence estimation of HSV-2 by two IgG ELISA methods among South African women at high risk of HIV. PLoS One 2015; 10:e0120207. [PMID: 25799522 PMCID: PMC4370866 DOI: 10.1371/journal.pone.0120207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
| | - Joris Menten
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Khatija Ahmed
- Setshaba Research Center, Soshanguve, Pretoria, South Africa
| | - Jennifer Deese
- FHI-360, Durham, North Carolina, United States of America
| | - Lut Van Damme
- FHI-360, Durham, North Carolina, United States of America
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
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Hochberg CH, Schneider JA, Dandona R, Lakshmi V, Kumar GA, Sudha T, Akbar M, Ahmed GMM, Ramgopal SP, Armbruster B, Alary M, Dandona L. Population and dyadic-based seroincidence of herpes simplex virus-2 and syphilis in southern India. Sex Transm Infect 2015; 91:375-82. [PMID: 25605970 PMCID: PMC4518737 DOI: 10.1136/sextrans-2014-051708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/24/2014] [Indexed: 11/11/2022] Open
Abstract
Objectives Herpes simplex virus-2 (HSV-2) and syphilis are associated with increased risk of HIV, highlighting the importance of understanding their transmission dynamics. In India, most studies of HSV-2 and syphilis incidence are in high-risk populations and may not accurately reflect infectious activity. In this study, we aim to define HSV-2/syphilis incidence and risk factors in a population sample. Methods We conducted a longitudinal population-based survey in Andhra Pradesh, India, in two rounds: 2004–2005 and 2010–2011. Sociodemographic and behavioural data were collected, and dried blood spots tested for HSV-2 and Treponema pallidum IgG. After calculating sexually transmitted infection (STI) incidence, associated factors were assessed using modified Poisson regression and within-couple transmission rates modelled using seroconcordance/discordance data. Results 12 617 adults participated at baseline with 8494 at follow-up. Incidence of HSV-2 and syphilis per 1000 person-years was 25.6 (95% CI 24.1 to 27.2) and 3.00 (95% CI 2.52 to 3.54). Incidence of HSV-2 was higher in women vs men (31.1 vs 20.2) and in rural vs urban residents (31.1 vs 19.0) (p<0.05 for both). STI seroincidence increased in a step-wise fashion with age and was associated with spousal seropositivity for both sexes (incidence rate ratio (IRR) 2.59 to 6.78). Within couples the rate of transmission per 1000 couple-years from men to women vs women to men was higher for HSV-2 (193.3 vs 119.0) compared with syphilis (27.6 vs 198.8), p<0.05 for both. Conclusions HSV-2 has higher incidence among subpopulations such as women, rural residents and older-aged individuals, suggesting a need for more generalised STI prevention approaches among populations traditionally considered low risk.
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Affiliation(s)
- Chad H Hochberg
- Pritzker School of Medicine, University of Chicago Chicago, Illinois, USA
| | - John A Schneider
- Department of Medicine and Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | | | - Vemu Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Talasila Sudha
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | | | - Michel Alary
- Département de médecine sociale et préventive, URESP, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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LeGoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J 2014; 11:83. [PMID: 24885431 PMCID: PMC4032358 DOI: 10.1186/1743-422x-11-83] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/01/2014] [Indexed: 01/13/2023] Open
Abstract
Since the type of herpes simplex virus (HSV) infection affects prognosis and subsequent counseling, type-specific testing to distinguish HSV-1 from HSV-2 is always recommended. Although PCR has been the diagnostic standard method for HSV infections of the central nervous system, until now viral culture has been the test of choice for HSV genital infection. However, HSV PCR, with its consistently and substantially higher rate of HSV detection, could replace viral culture as the gold standard for the diagnosis of genital herpes in people with active mucocutaneous lesions, regardless of anatomic location or viral type. Alternatively, antigen detection—an immunofluorescence test or enzyme immunoassay from samples from symptomatic patients--could be employed, but HSV type determination is of importance. Type-specific serology based on glycoprotein G should be used for detecting asymptomatic individuals but widespread screening for HSV antibodies is not recommended. In conclusion, rapid and accurate laboratory diagnosis of HSV is now become a necessity, given the difficulty in making the clinical diagnosis of HSV, the growing worldwide prevalence of genital herpes and the availability of effective antiviral therapy.
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Affiliation(s)
- Jérôme LeGoff
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology laboratory, Inserm U941, Hôpital Saint-Louis, APHP, 1 Avenue Claude Vellefaux, Paris 75010, France.
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Al-Shobaili H, Hassanein KM, Mostafa MS, Al Duways AS. Evaluation of the HerpeSelect Express rapid test in the detection of herpes simplex virus type 2 antibodies in patients with genital ulcer disease. J Clin Lab Anal 2014; 29:43-6. [PMID: 24687953 DOI: 10.1002/jcla.21725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 11/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND A rapid point-of-care test with high sensitivity and specificity is required in order to fulfill the need for early detection and screening of Herpes simplex virus type 2 (HSV-2) infection among patients with genital ulcer disease (GUD), for better management and control of virus transmission. METHODS The goal of this study is to evaluate the performance of the commercially available HerpeSelect Express rapid test in comparison with three ELISA assays: HerpeSelect ELISA, Kalon HSV-2 glycoprotein G2 assay, and monoclonal antibody blocking enzyme immunoassay, which was used as the gold standard for the detection of HSV-2 antibodies. RESULTS This study showed high sensitivity (ranging from 82.6 to 100%) and specificity (100%) of the HerpeSelect Express rapid test when compared to the three ELISA assays. The agreement between the HerpeSelect Express rapid test with the three ELISAs ranged from 93.3 to 100%. CONCLUSION The HerpeSelect Express rapid test has adequate sensitivity and specificity for confirming HSV-2 infection in patients with GUD, indicating its suitability for epidemiological studies.
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Affiliation(s)
- Hani Al-Shobaili
- Department of Dermatology, College of Medicine, Qassim University, Buraydah, Kingdom of Saudi Arabia
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Daily oral emtricitabine/tenofovir preexposure prophylaxis and herpes simplex virus type 2 among men who have sex with men. PLoS One 2014; 9:e91513. [PMID: 24637511 PMCID: PMC3956614 DOI: 10.1371/journal.pone.0091513] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/08/2014] [Indexed: 02/04/2023] Open
Abstract
Background In addition to protecting against HIV acquisition, antiretroviral preexposure prophylaxis (PrEP) using topical 1% tenofovir gel reduced Herpes simplex virus type 2 (HSV-2) acquisition by 51% among women in the CAPRISA 004 study. We examined the effect of daily oral emtricitabine/tenofovir (FTC/TDF) PrEP on HSV-2 seroincidence and ulcer occurrence among men who have sex with men (MSM) in the iPrEx trial. Methods HSV-2 serum testing was performed at screening and every six months. Among HSV-2-seronegative individuals, we used Cox regression models to estimate hazard ratios (HRs) of HSV-2 seroincidence associated with randomization to FTC/TDF. We used multiple imputation and Cox regression to estimate HRs for HSV-2 seroincidence accounting for drug exposure. We assessed ulcer occurrence among participants with prevalent or incident HSV-2 infection. Results Of the 2,499 participants, 1383 (55.3%) tested HSV-2-seronegative at baseline, 892 (35.7%) tested positive, 223 (8.9%) had indeterminate tests, and one test was not done. Of the 1,347 HSV-2-seronegative participants with follow-up, 125 (9.3%) had incident HSV-2 infection (5.9 per 100 person-years). Compared with participants receiving placebo, there was no difference in HSV-2 seroincidence among participants receiving FTC/TDF (HR 1.1, 95% CI: 0.8–1.5; P = 0.64) or among participants receiving FTC/TDF with a concentration of tenofovir diphosphate >16 per million viable cells (HR 1.0, 95% CI: 0.3–3.5; P = 0.95). Among participants with HSV-2 infection, the proportion with ≥1 moderate or severe ulcer adverse event was twice as high in the placebo vs. active arm (5.9% vs. 2.9%, P = 0.02), but there were no differences in the proportions with ≥1 clinical examination during which perianal or groin ulcers were identified. Conclusions Tenofovir in daily oral FTC/TDF PrEP may reduce the occurrence of ulcers in individuals with HSV-2 infection but does not protect against HSV-2 incidence among MSM.
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Factors associated with herpes simplex virus type 2 incidence in a cohort of human immunodeficiency virus type 1-seronegative Kenyan men and women reporting high-risk sexual behavior. Sex Transm Dis 2013; 38:837-44. [PMID: 21844740 DOI: 10.1097/olq.0b013e31821a6225] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) is an important cause of genital ulcers and can increase the risk for human immunodeficiency virus type 1 (HIV-1) transmission. Our objective was to determine the incidence and correlates of HSV-2 infection in HIV-1-seronegative Kenyan men reporting high-risk sexual behavior, compared with high-risk HIV-1-seronegative women in the same community. METHODS Cohort participants were screened for prevalent HIV-1 infection. HIV-1-uninfected participants had regularly scheduled follow-up visits, with HIV counseling and testing and collection of demographic and behavioral data. Archived blood samples were tested for HSV-2. RESULTS HSV-2 prevalence was 22.0% in men and 50.8% in women (P < 0.001). HSV-2 incidence in men was 9.0 per 100 person-years, and was associated with incident HIV-1 infection (adjusted incidence rate ratio [aIRR], 3.9; 95% confidence interval [CI], 1.3-12.4). Use of soap for genital washing was protective (aIRR, 0.3; 95% CI, 0.1-0.8). Receptive anal intercourse had a borderline association with HSV-2 acquisition in men (aIRR, 2.0; 95% CI, 1.0-4.1; P = 0.057), and weakened the association with incident HIV-1. Among women, HSV-2 incidence was 22.1 per 100 person-years (P < 0.001 compared with incidence in men), and was associated with incident HIV-1 infection (aIRR, 8.9; 95% CI, 3.6-21.8) and vaginal washing with soap (aIRR, 1.9; 95% CI, 1.0-3.4). CONCLUSIONS HSV-2 incidence in these men and women is among the highest reported, and is associated with HIV-1 acquisition. Although vaginal washing with soap may increase HSV-2 risk in women, genital hygiene may be protective in men.
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Human immunodeficiency virus, sexually transmitted infections, and risk behaviors among clients of sex workers in Guatemala: are they a bridge in human immunodeficiency virus transmission? Sex Transm Dis 2012; 38:735-42. [PMID: 21844725 DOI: 10.1097/olq.0b013e31821596b5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Clients of female sex workers (FSWs) are an important target group for human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention. This study aimed to estimate their HIV and other STI prevalence, examine their risk behaviors, and evaluate their role as a bridge population in the spread of HIV/STIs. METHODS A cross-sectional study was performed among 553 clients recruited in commercial sex sites in the province of Escuintla, Guatemala. They were interviewed and tested for HIV and other STIs. RESULTS Half of the clients who were approached refused participation. Median age was 28.9 years; 57.7% had a regular partner, of whom, 10.1% had concurrent noncommercial partnerships. Consistent condom use with FSWs and regular partners was 72.5% and 17.1%, respectively. Approximately 18% formed a bridge, and 40.0% a potential bridge. Among those who provided samples (70.5% provided a blood sample and 89.7%, urine sample), prevalence of HIV, syphilis, gonorrhea, chlamydia, and herpes simplex virus 2 was 1.5%, 1.0%, 0.8%, 5.5%, and 3.4%, respectively. Unprotected sex with FSWs and drug use just before sex were risk factors for having any STI (9.8% of participants). Bridge clients were significantly less educated, more employed, paid lower prices to the FSW just visited, and had a previous STI. CONCLUSIONS There is a relatively high prevalence of HIV in clients compared to national estimates, and a substantial proportion of them act as a bridge for HIV/STI transmission between FSWs and the general population in Escuintla. Given that this is fuelling the current HIV epidemic, preventive interventions addressing this hard-to-reach group are urgently required.
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Patel R, Alderson S, Geretti A, Nilsen A, Foley E, Lautenschlager S, Green J, van der Meijden W, Gomberg M, Moi H. European guideline for the management of genital herpes, 2010. Int J STD AIDS 2011; 22:1-10. [PMID: 21364059 DOI: 10.1258/ijsa.2010.010278] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This is the guideline for genital herpes simplex virus (HSV) management for the IUSTI/WHO Europe, 2010. They describe the epidemiology, diagnosis, clinical features, treatment and prevention of genital HSV infection. They include details on the management of HSV in pregnancy, those who are immunocompromised and the clinical investigation and management of suspected HSV-resistant disease.
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Affiliation(s)
- R Patel
- Department of Genitourinary Medicine, Southampton Medical School, Southampton, UK.
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Nyiro JU, Sanders EJ, Ngetsa C, Wale S, Awuondo K, Bukusi E, Price MA, Amornkul PN, Nokes DJ. Seroprevalence, predictors and estimated incidence of maternal and neonatal Herpes Simplex Virus type 2 infection in semi-urban women in Kilifi, Kenya. BMC Infect Dis 2011; 11:155. [PMID: 21627803 PMCID: PMC3123214 DOI: 10.1186/1471-2334-11-155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/31/2011] [Indexed: 11/19/2022] Open
Abstract
Background Herpes Simplex Virus type 2 (HSV-2) has public health importance as a leading cause of genital ulcers, a co-factor in HIV-1 acquisition and transmission and as a cause of neonatal herpes infections. Little is known of its epidemiology and burden in Coastal Kenya. Methods We screened plasma samples for HSV-2 infection from 826 women aged 15-34 years who participated in an HIV-1 survey in Kilifi in 2004. The sample comprised 563 women selected randomly from a demographic surveillance system (DSS) and 263 women who presented for voluntary counseling and testing (VCT). Predictors for HSV-2 seropositivity were determined using multivariate logistic regression. The incidence of HSV-2 infection and risk of neonatal herpes were estimated by a simple catalytic model fitted to age-seroprevalence data. Results HSV-2 prevalence was 32% in the DSS recruits vs. 44% in the VCT recruits (P < 0.001), while, HIV-1 prevalence was 8% in the DSS recruits vs. 12% in the VCT recruits (P = 0.12). Independent risk factors for HSV-2 infection in all women were: older age (30-34 years; odds ratio (OR) 10.5, 95% confidence interval (CI): 5.2 - 21.0), recruitment from VCT (OR 1.5, 95% CI: 1.1 - 2.1), history of genital ulcers (OR 1.7, 95% CI: 1.2 - 2.3) and HIV infection (OR 2.7, 95% CI: 1.6-4.6). Education beyond primary (OR 0.7, 95% CI: 0.5 - 0.9) was inversely associated with HSV-2 infection. In the DSS sample, HSV-2 incidence was estimated at 4 cases (95% CI: 3.3 - 4.4) per 100 women per year, 17 cases (95% CI: 16-18) per 1,000 pregnancies per year and 33 neonatal cases (95% CI: 31-36) per 100,000 births per year. Conclusions HSV-2 transmission is rapid following the onset of sexual activity and likely to result in a significant burden of genital ulcer disease. Nevertheless, the burden of neonatal HSV-2 can be predicted to be low. Educating young women about HSV-2 infection may help in reducing its burden in this semi-urban population.
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Affiliation(s)
- Joyce U Nyiro
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya.
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Performance of the BioPlex 2200 multiplexing immunoassay platform for the detection of herpes simplex virus type 2 specific antibodies in African settings. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1191-3. [PMID: 21562116 DOI: 10.1128/cvi.05003-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The BioPlex platform was evaluated for the detection of herpes simplex virus 2 (HSV-2) antibodies in sub-Saharan Africa individuals in comparison to clinicovirological standards and compared to HerpeSelect. The sensitivities and specificities were, respectively, 88.9% and 93.5% for BioPlex and 89.9% and 92.7% for HerpeSelect. The agreement between both assays was 95.7%.
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22
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Performance of commercial herpes simplex virus type-2 antibody tests using serum samples from Sub-Saharan Africa: a systematic review and meta-analysis. Sex Transm Dis 2011; 38:140-7. [PMID: 20706175 DOI: 10.1097/olq.0b013e3181f0bafb] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several commercial type-specific serologic tests are available for herpes simplex virus type 2 (HSV-2). Poor specificity of some tests has been reported on samples from sub-Saharan Africa. METHODS To summarize the performance of the tests using samples from sub-Saharan Africa, we conducted a systematic review of publications reporting performance of commercially available HSV-2 tests against a gold standard (Western Blot or monoclonal antibody-blocking EIA). We used random-effects meta-analyses to summarize sensitivity and specificity of the 2 most commonly evaluated tests, Kalon gG2 enzyme-linked immunosorbent assay (ELISA), and Focus HerpeSelect HSV-2 ELISA. RESULTS We identified 10 eligible articles that included 21 studies of the performance of Focus, and 12 of Kalon. The primary analyses included studies using the manufacturers' cut-offs (index value = 1.1). Focus had high sensitivity (random effects summary estimate 99%, 95% confidence interval [CI]: 99%-100%) but low specificity (69%, 95% CI: 59%-80%). Kalon had sensitivity of 95% (95% CI: 93%-97%) and specificity of 91% (95% CI: 86%-95%). Specificity of Focus was significantly lower (P = 0.002) among HIV-positive (54%, 95% CI: 40%-68%) than HIV-negative individuals (69%, 95% CI: 56%-82%). When the cut-off optical density index was increased above the recommended value of 1.1 to between 2.2 and 3.5, the specificity of Focus increased to 85% (95% CI: 77%-92%). CONCLUSIONS Sensitivity and specificity of HSV-2 tests used in sub-Saharan Africa vary by setting, and are lower than reported from studies in the United States and Europe. Increasing the cut-off optical density index may improve test performance. Evaluation of test performance in a given setting may help deciding which test is most appropriate.
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Schneider JA, Lakshmi V, Dandona R, Kumar GA, Sudha T, Dandona L. Population-based seroprevalence of HSV-2 and syphilis in Andhra Pradesh state of India. BMC Infect Dis 2010; 10:59. [PMID: 20214795 PMCID: PMC2848152 DOI: 10.1186/1471-2334-10-59] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 03/09/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND 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. METHODS Persons 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. RESULTS Adjusted 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). CONCLUSIONS Nearly 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.
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Affiliation(s)
- John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Health Studies, University of Chicago, Chicago, IL, USA
| | - Vemu Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- George Institute for International Health - India, Hyderabad, India
- School of Public Health and George Institute for International Health, University of Sydney, Sydney, Australia
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
- George Institute for International Health - India, Hyderabad, India
| | - Talasila Sudha
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- George Institute for International Health - India, Hyderabad, India
- School of Public Health and George Institute for International Health, University of Sydney, Sydney, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Kane CT, Diawara S, Ndiaye HD, Diallo PAN, Wade AS, Diallo AG, Belec L, Mboup S. Concentrated and linked epidemics of both HSV-2 and HIV-1/HIV-2 infections in Senegal: public health impacts of the spread of HIV. Int J STD AIDS 2009; 20:793-6. [DOI: 10.1258/ijsa.2008.008414] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this article is to report seroprevalences on HIV and herpes simplex virus 2 (HSV-2) in female sex workers (FSW) and in two sentinel populations of pregnant women living in Senegal. Serosurveys of HIV and HSV-2 were conducted in two unselected sentinel populations from Dakar, Senegal, and its provinces, including in 2003 only pregnant women and 2006 pregnant women and FSW. The population study involved 888 pregnant women and 604 FSW. In pregnant women, HIV and HSV-2 seroprevalences were, respectively, 1.01% and 15.65%. There was no association between HSV-2 and HIV infection, whatever the age. In contrast, the seroprevalence of HIV infection in the group of FSW was high, reaching 22.9% in women over 30 years old. FSW above 20 years of age harboured much higher HSV-2 seroprevalences that those found in pregnant women of similar age groups. In FSW, strong associations between HSV-2 and age, and among HSV-2 and HIV-1 as well HIV-2, were evidenced. In conclusion, HIV epidemic remains concentrated in high-risk groups of the Senegalese population, such as the FSW population in which the seroprevalence of HSV-2 infection is very high. Intervention against STI including HSV-2 is urgently needed to prevent the spreading of HIV epidemic.
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Affiliation(s)
- C Toure Kane
- Laboratoire de Bacteriologie-virologie, Hopital Aristide Le Dantec
| | - S Diawara
- Hopital Militaire de Ouakam, Dakar, Senegal
| | - H D Ndiaye
- Laboratoire de Bacteriologie-virologie, Hopital Aristide Le Dantec
| | - P A N Diallo
- Laboratoire de Bacteriologie-virologie, Hopital Aristide Le Dantec
| | - A S Wade
- Ministry of Health, Division against AIDS/STIs, Senegal
| | - A G Diallo
- Laboratoire de Bacteriologie-virologie, Hopital Aristide Le Dantec
| | - L Belec
- Université Paris Descartes (Paris V), Laboratoire de Virologie, Hopital Européen Georges Pompidou, Paris, France
| | - S Mboup
- Laboratoire de Bacteriologie-virologie, Hopital Aristide Le Dantec
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Delany-Moretlwe S, Jentsch U, Weiss H, Moyes J, Ashley-Morrow R, Stevens W, Mayaud P. Comparison of focus HerpesSelect and Kalon HSV-2 gG2 ELISA serological assays to detect herpes simplex virus type 2 antibodies in a South African population. Sex Transm Infect 2009; 86:46-50. [PMID: 19837726 DOI: 10.1136/sti.2009.036541] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sero-epidemiological studies of herpes simplex virus (HSV) type 2 infection in Africa remain difficult to interpret as a result of the high rate of false-positive results observed when using the new recombinant gG2 HSV-2 ELISA tests. The performance of two widely used gG2 ELISA was compared to derive an appropriate testing algorithm for use in South Africa. METHODS Sera from 210 women attending family planning clinics in Johannesburg were tested using HerpeSelect and Kalon HSV-2 gG2 assays. Sera from 20 discordant pairs, 44 concordant positive and 33 concordant negative samples were further tested by HSV Western blot. The sensitivity and specificity of each test and of combination algorithms compared with Western blot were calculated. RESULTS HerpeSelect had a sensitivity of 98% (95% CI 95 to 100) and specificity of 61% (95% CI 48 to 74). Kalon was less sensitive (89%, 95% CI 83 to 94) but more specific (85%, 95% CI 61 to 100). Seroprevalence may have been overestimated by as much as 14% by HerpeSelect. Specificity was improved by raising the cut-off index for the determination of a positive result for HerpeSelect (to >or=3.5), but not for Kalon. HIV-1 infection reduced the specificity of HerpeSelect to 30%. Improved sensitivity and specificity were obtained by a two-test algorithm using HerpeSelect (>or=3.5) as the first test and Kalon to resolve equivocal results (sensitivity 92%, 95% CI 82 to 98; specificity 91%, 95% CI 79 to 98). CONCLUSION Newer HSV-2 serological tests have low specificity in this South African population with a high HIV-1 prevalence. Two-step testing strategies could provide rational testing alternatives to Western blot.
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Affiliation(s)
- Sinéad Delany-Moretlwe
- Reproductive Health and HIV Research Unit, University of the Witwatersrand, PO Box 18512, Hillbrow, Johannesburg 2038, South Africa.
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Chohan V, Baeten JM, Benki S, Graham SM, Lavreys L, Mandaliya K, Ndinya-Achola JO, Jaoko W, Overbaugh J, McClelland RS. A prospective study of risk factors for herpes simplex virus type 2 acquisition among high-risk HIV-1 seronegative women in Kenya. Sex Transm Infect 2009; 85:489-92. [PMID: 19457873 DOI: 10.1136/sti.2009.036103] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Several studies have demonstrated an association between herpes simplex virus type 2 (HSV-2) and HIV-1, but available data on risk factors for HSV-2 acquisition are limited. The objective of this analysis was to determine the incidence and risk factors for HSV-2 acquisition among HIV-1-seronegative female sex workers in Kenya. METHODS Between February 1993 and December 2006, HIV-1-seronegative women attending a municipal sexually transmitted infection (STI) clinic were invited to enroll in a prospective cohort study. Screening for HIV-1 and STIs were done at monthly follow-up visits. Archived blood samples were tested for HSV-2. RESULTS Of 1527 HIV-1-seronegative women enrolled, 302 (20%) were HSV-2 seronegative at baseline of whom 297 had at least one follow-up visit. HSV-2 incidence was high (23 cases/100 person-years; 115 cases). In multivariate analysis, HSV-2 was significantly associated with more recent entry into sex work, workplace and higher number of sex partners per week. Condom use was protective, although this was statistically significant only for the intermediate strata (25-75% condom use; HR 0.43; p = 0.05). There were statistical trends for bacterial vaginosis to increase HSV-2 risk (HR 1.56; p = 0.07) and for oral contraceptive use to decrease risk (HR 0.50; p = 0.08). The 23% annual HSV-2 incidence in this study is among the highest reported anywhere in the world. CONCLUSIONS Women were at increased risk if they had recently entered sex work, had a higher number of sex partners or worked in bars. HSV-2 risk reduction interventions are urgently needed among high-risk African women.
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Affiliation(s)
- V Chohan
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
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