Herpes simplex virus: global infection prevalence and incidence estimates, 2016

James, Charlotte; Harfouche, Manale; Welton, Nicky J; Turner, Katherine Mary Elizabeth; Abu‐Raddad, Laith J.; Gottlieb, Sami L.; Looker, Katharine J

doi:10.2471/blt.19.237149

Cited by 385 publications

(372 citation statements)

References 118 publications

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“…The GUD burden measures therefore required considering and summing the percentage and time spent in each relevant possible GUD state. GUD burden estimates were generated using natural history parameter estimates for genital HSV-1 and HSV-2 infection (obtained from a literature search) with published HSV-2 and genital HSV-1 infection estimates2 and population sizes for 2016 28…”

Section: Methodsmentioning

confidence: 99%

“…To align with our previous WHO estimates of the annual incidence and prevalence of HSV-2 and genital HSV-1 infection,2 we defined an individual as having ‘recently-acquired’ infection if up to 1 year since HSV infection acquisition, and as having an ‘established infection’ if more than 1 year since HSV acquisition. We defined a first episode of GUD as the first noted GUD symptoms, regardless of whether those symptoms occur before or after HSV seroconversion (ie, development of new HSV type-specific antibodies on infection).…”

Section: Methodsmentioning

confidence: 99%

“…Genital herpes is a lifelong sexually transmitted infection caused by herpes simplex virus type 2 (HSV-2) and type 1 (HSV-1) and is characterised by recurrent, self-limited outbreaks of painful genital lesions in a proportion of those infected 1. We estimated that in 2016, 491 million people aged 15–49 years had HSV-2 infection, which is almost all sexually transmitted 2. HSV-1, although predominately an oral infection, is increasing as a cause of genital herpes in some settings 3–5.…”

Section: Introductionmentioning

confidence: 99%

“…HSV-1, although predominately an oral infection, is increasing as a cause of genital herpes in some settings 3–5. We estimated that 192 million people had genital HSV-1 infection in 2016 2. Symptoms of genital HSV infection include vesicles, ulcers, fissures or other painful lesions on or near the genital skin and mucosa, collectively termed genital ulcer disease (GUD).…”

Section: Introductionmentioning

confidence: 99%

“…A more complete understanding of the morbidity associated with HSV infection, and in particular GUD, would help elucidate the full potential public health value of HSV interventions 27. Here we present the first global and regional estimates of GUD due to HSV-1 and HSV-2 among women and men aged 15–49 years old using a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection with existing HSV-2 and genital HSV-1 infection estimates for 2016 2…”

Section: Introductionmentioning

confidence: 99%

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The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study

et al. 2020

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IntroductionHerpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2), but may also be due to genital HSV type 1 (HSV-1), which has less frequent recurrent episodes than HSV-2. The global burden of GUD has never been quantified. Here we present the first global and regional estimates of GUD due to HSV-1 and HSV-2 among women and men aged 15–49 years old.MethodsWe developed a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection, informed by a literature search for data on model parameters. We considered both diagnosed and undiagnosed symptomatic infection. This model was then applied to existing infection estimates and population sizes for 2016. A sensitivity analysis was carried out varying the assumptions made.ResultsWe estimated that 187 million people aged 15–49 years had at least one episode of HSV-related GUD globally in 2016: 5.0% of the world’s population. Of these, 178 million (95% of those with HSV-related GUD) had HSV-2 compared with 9 million (5%) with HSV-1. GUD burden was highest in Africa, and approximately double in women compared with men. Altogether there were an estimated 8 billion person-days spent with HSV-related GUD globally in 2016, with 99% of days due to HSV-2. Taking into account parameter uncertainty, the percentage with at least one episode of HSV-related GUD ranged from 3.2% to 7.9% (120–296 million). However, the estimates were sensitive to the model assumptions.ConclusionOur study represents a first attempt to quantify the global burden of HSV-related GUD, which is large. New interventions such as HSV vaccines, antivirals or microbicides have the potential to improve the quality of life of millions of people worldwide.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study

et al. 2020

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Viral Shedding 1 Year Following First-Episode Genital HSV-1 Infection

Johnston

Magaret

Son

et al. 2022

JAMA

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ImportanceHerpes simplex virus type 1 (HSV-1) is the leading cause of first-episode genital herpes in many countries.ObjectiveTo inform counseling messages regarding genital HSV-1 transmission, oral and genital viral shedding patterns among persons with first-episode genital HSV-1 infection were assessed. The trajectory of the development of HSV-specific antibody and T-cell responses was also characterized.Design, Setting, and ParticipantsProspective cohort followed up for up to 2 years, with 82 participants followed up between 2013 and 2018. Participants were recruited from sexual health and primary care clinics in Seattle, Washington. Persons with laboratory-documented first-episode genital HSV-1 infection, without HIV infection or current pregnancy, were referred for enrollment.ExposuresFirst-episode genital HSV-1 infection.Main Outcomes and MeasuresGenital and oral HSV-1 shedding and lesion rates at 2 months, 11 months, and up to 2 years after initial genital HSV-1 infection. Participants self-collected oral and genital swabs for HSV polymerase chain reaction testing for 30 days at 2 and 11 months and up to 2 years after diagnosis of genital HSV-1. Blood samples were collected at serial time points to assess immune responses to HSV-1. Primary HSV-1 infection was defined as absent HSV antibody at baseline or evolving antibody profile using the University of Washington HSV Western Blot. HSV-specific T-cell responses were detected using interferon γ enzyme-linked immunospot.ResultsAmong the 82 participants, the median (range) age was 26 (16-64) years, 54 (65.9%) were women, and 42 (51.2%) had primary HSV-1 infection. At 2 months, HSV-1 was detected from the genital tract in 53 participants (64.6%) and in the mouth in 24 participants (29.3%). Genital HSV-1 shedding was detected on 275 of 2264 days (12.1%) at 2 months and declined significantly to 122 of 1719 days (7.1%) at 11 months (model-predicted rate, 6.2% [95% CI, 4.3%-8.9%] at 2 months vs 3.2% [95% CI, 1.8%-5.7%] at 11 months; relative risk, 0.52 [95% CI, 0.29-0.93]). Genital lesions were rare, reported on 65 of 2497 days (2.6%) at 2 months and 72 of 1872 days (3.8%) at 11 months. Oral HSV-1 shedding was detected on 88 of 2247 days (3.9%) at 2 months. Persons with primary HSV-1 infection had a higher risk of genital shedding compared with those with nonprimary infection (model-predicted rate, 7.9% [95% CI, 5.4%-11.7%] vs 2.9% [95% CI, 1.7%-5.0%]; relative risk, 2.75 [95% CI, 1.40-5.44]). Polyfunctional HSV-specific CD4+ and CD8+ T-cell responses were maintained during the follow-up period.Conclusions and RelevanceGenital HSV-1 shedding was frequent after first-episode genital HSV-1, particularly among those with primary infection, and declined rapidly during the first year after infection.

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Reducing HSV-2 Morbidity and Mortality

Pearlman

2023

JAMA

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Herpes simplex virus: global infection prevalence and incidence estimates, 2016

Cited by 385 publications

References 118 publications

The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study

The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study

Viral Shedding 1 Year Following First-Episode Genital HSV-1 Infection

Reducing HSV-2 Morbidity and Mortality

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