|Year : 2008 | Volume
| Issue : 1 | Page : 34-39
Community-based study on seroprevalence of herpes simplex virus type 2 infection in New Delhi
R Chawla1, P Bhalla1, K Bhalla1, M Meghachandra Singh2, S Garg2
1 Department of Microbiology, Maulana Azad Medical College, BSZ Marg, New Delhi - 110 002, India
2 Department of Community Medicine, Maulana Azad Medical College, BSZ Marg, New Delhi - 110 002, India
|Date of Submission||09-Jan-2007|
|Date of Acceptance||12-Aug-2007|
Department of Microbiology, Maulana Azad Medical College, BSZ Marg, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
Purpose: To determine the seroprevalence of herpes simplex virus type 2 (HSV-2) in two urban communities in Delhi and to correlate the presence of HSV-2 seroprevalence with sociodemographic profile, risk factors and presence of other reproductive tract infections (RTIs). Methods: Men and women aged between 15-49 years from an urban slum and an urban middle class colony were invited to participate in the study. They provided interview information; blood for HSV-2, HIV and syphilis serology; first void urine specimens for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis infection; and genital specimens for diagnosis of bacterial vaginosis, vaginal candidiasis and trichomoniasis. Results: The prevalence of HSV-2 seropositivity was found to be 7 and 8.6% in men and women, respectively. HSV-2 seropositivity was found to be significantly associated with urban middle class community and older age. No statistically significant correlation was found between HSV-2 seropositivity and other laboratory-confirmed RTIs. Conclusions: The findings of our study indicate a relatively low prevalence of HSV-2 seropositivity and other sexually transmitted infections in the two communities that were studied.
Keywords: Herpes simplex virus type 2, seroprevalence, urban community
|How to cite this article:|
Chawla R, Bhalla P, Bhalla K, Singh M M, Garg S. Community-based study on seroprevalence of herpes simplex virus type 2 infection in New Delhi. Indian J Med Microbiol 2008;26:34-9
|How to cite this URL:|
Chawla R, Bhalla P, Bhalla K, Singh M M, Garg S. Community-based study on seroprevalence of herpes simplex virus type 2 infection in New Delhi. Indian J Med Microbiol [serial online] 2008 [cited 2019 Dec 12];26:34-9. Available from: http://www.ijmm.org/text.asp?2008/26/1/34/38855
Herpes simplex virus type 2 (HSV-2), the primary cause of genital herpes, is one of the most common causes of genital ulcer disease worldwide.  HSV-2 is transmitted primarily through sexual contact. Genital herpes is considered to be a relatively benign infection, but the chronic, recurrent nature of this infection can cause considerable morbidity in the form of psychosocial impairment.  Neonatal herpes can manifest as a generalized systemic infection, encephalitis or localized central nervous system infection, causing permanent neurological damage despite appropriate antiviral therapy.  Furthermore, studies have demonstrated an important role of HSV-2 infection in the spread of HIV infection. ,
HSV-1 and HSV-2 are closely related antigenically and both viruses cause lifelong infections with intermittent reactivation; therefore, definitive tests for HSV-2 antibodies must be based on type-specific antigens. This has been made possible with the advent of glycoprotein G-based enzyme immunoassays, which are able to detect type-specific antibodies to HSV. These immunoassays have been found to be more useful for diagnosis of HSV-2 infection in asymptomatic patients, pregnant women and for epidemiological studies than in symptomatic patients, where virological methods such as culture and antigen detection are more important. 
Most studies of HSV-2 seroprevalence have been limited to select populations attending specialized clinics such as antenatal, family planning and sexually transmitted disease clinics. Such studies have found a wide range of seroprevalence of HSV-2, which varies according to the populations studied, from 11.3% in women attending antenatal clinics to over 70% in commercial sex workers. ,, Various population-based studies conducted in developed and developing countries have reported HSV-2 seroprevalence in the range of 5.6-42.2%. ,,, However, very few population-based studies on the seroprevalence of HSV-2 have been carried out in India.  The present study was carried out to determine the seroprevalence of HSV-2 in two urban communities in Delhi and to correlate the presence of HSV-2 seroprevalence with sociodemographic profile, risk factors and presence of other reproductive tract infections (RTIs).
| ~ Materials and Methods|| |
The communities studied were randomly selected and included one urban slum (Census enumeration block: Lal Bag, Charge No.: 77) and one urban middle class colony (Census enumeration block: Tilak Vihar, Charge No.: 49). Initial house-to-house survey was carried out in 100 households in each area; these households were selected by systematic random sampling method. The number of eligible women (15-49 years of age) enumerated was 137 in Lal Bag and 132 in Tilak Vihar, while the number of eligible men (15-49 years of age) enumerated was 142 and 147 in Lal Bag and Tilak Vihar, respectively. The target men and women to be studied were 65 each in both areas and were selected out of the eligible men and women enumerated in each area by systematic random sampling. Camps were held in the health centres located in these areas. During the camps, demographic, risk factor and clinical data were collected using a structured questionnaire. Relevant specimens (genital specimens, blood and urine) were collected for laboratory diagnosis of various RTIs after obtaining informed consent from all participants. The subjects who had taken antibiotics in the preceding 2 weeks and women who were menstruating or pregnant were excluded from the study. Blood samples were collected from the enrolled subjects. Serum was separated and stored at -20 °C until tested.
Serum specimens were screened for HSV-2 infection by detecting IgG class antibodies against HSV-2 specific glycoprotein G-2 by enzyme-linked immunosorbent assay (ELISA) kit (Euroimmun AG, Seekamp, Germany). All positive samples were confirmed by Western Blot (Anti-HSV-2 gG-2 Euroline-WB, Euroimmun AG, Seekamp, Germany).
For diagnosis of syphilis, serum samples were screened by Venereal Disease Research Laboratory (VDRL) test using antigen from serologist to the Government of India, Kolkata. All sera positive by VDRL were confirmed by Treponema pallidum haemagglutination (TPHA) test using Immunotrep TPHA (Omega Diagnostics Limited, Scotland, UK) kit.
Serodiagnosis of HIV infection was performed according to NACO strategy II. Initial screening for HIV infection was performed by detection of specific antibodies by ELISA (HIVASE 1+2, General Biologicals Corporation, Taiwan) and positive results were confirmed by a second rapid and simple test (Capillus HIV1/HIV2, Trinity Biotech PLC, Ireland).
First-void urine specimens were collected from males and females for diagnosis of Neisseria More Details gonorrhoeae and Chlamydia trachomatis infection by using a commercially available multiplex polymerase chain reaction kit (Amplicor CT/NG test, Roche Molecular Systems, Branchburg, NJ, USA). The urine specimens were transported, stored and tested as per kit literature.
Two vaginal swabs were collected from each woman; one was used for preparation of saline and potassium hydroxide (KOH) wet mount and smear for gram staining. The second swab was used for culture of Trichomonas vaginalis and Candida spp. A urethral swab was collected from males for preparation of saline mount and culture of Trichomonas vaginalis . Culture for T. vaginalis was performed by inoculation of Kupferberg medium followed by incubation at 37 °C; wet mounts were prepared and examined after 2, 4 and 7 days of incubation. For culture of Candida spp, inoculated Sabouraud dextrose agar tube was incubated at 37 °C and examined for growth after 72 hours of incubation. Diagnosis of trichomoniasis and candidiasis was made on the basis of positivity in direct microscopy and/or culture. For diagnosis of bacterial vaginosis, gram stained vaginal smear was examined under oil immersion objective (1000× magnification) and graded as per standardized, quantitative, morphological classification developed by Nugent. 
Statistical analysis was conducted using SPSS V9.0 and Epi Info version 3.2.2 for correlation of HSV-2 seroprevalence with sociodemographic profile, risk factors and presence of other laboratory-confirmed RTIs.
| ~ Results|| |
Out of the total of 130 males invited to participate, 90 (69.2%) enrolled for the study. Forty-six (51.2%) belonged to urban slum, while 44 (48.8%) belonged to urban middle class community. The majority of men were 30-34 years of age (21.3%), married (86.6%), Hindus (88.8%) and educated till primary level (32.2%).
Out of the total of 130 females invited to participate, 120 (92.3%) enrolled for the study. Half belonged to urban slum, while the other half belonged to urban middle class community. The majority of women were 30-34 years of age (28.3%), married (93.3%), Hindus (80.8%) and illiterate (53.3%).
The average monthly income of the urban slum and urban middle class community was Rs 2137.7 and Rs 2663.5, respectively, and this difference was found to be statistically significant ( P = 0.01).
Out of the 90 males enrolled for the study, blood, urine and urethral swabs were collected from 85, 90 and 83 subjects, respectively. Out of the 120 women enrolled for the study, blood, urine and vaginal swabs were collected from 116, 120 and 113 women, respectively. The prevalence of various laboratory-confirmed RTIs in males and females is presented in [Table - 1].
All 16 serum specimens that were positive for specific IgG antibodies to HSV-2 by ELISA were also found to be positive by Western Blot.
[Table - 2],[Table - 3] show the correlation between HSV-2 seropositivity and various sociodemographic and risk factors of males and females, respectively. HSV-2 seropositivity was found to be significantly associated with older age in men ( P = 0.03) as well as women ( P = 0.02) and women residing in urban middle class community ( P = 0.01).
No statistically significant correlation was found between HSV-2 seropositivity and other laboratory-confirmed RTIs in males and females [Table - 4].
| ~ Discussion|| |
In the present study, HSV-2 seropositivity was found in a higher proportion of women (8.6%) as compared to men (7%); however, this difference was not found to be statistically significant ( P = 0.68). Various other studies have demonstrated a higher HSV-2 seroprevalence in women as compared to men. , This disparity in infection rates between genders may reflect anatomic differences in susceptibility to infection and greater efficiency of transmission from men to women than from women to men, as has been noted for many other sexually transmitted infections.
The HSV-2 seroprevalence in our study is similar to the prevalence reported in a population-based study conducted in Bangladesh.  In contrast to the present study, a much higher HSV-2 seroprevalence has been reported from various urban and rural populations from Africa, South America and North America. ,, This could be because of a higher prevalence of promiscuous sexual behaviour, larger number of lifetime sexual partners or a higher prevalence of other sexually transmitted infections in these communities.
Similar to other studies, our study also found significant association between HSV-2 seropositivity and older age in both men and women. , This can be explained by the fact that herpes virus infections persist for life; therefore, the prevalence increases with age through the sexually active years.
Surprisingly, HSV-2 seroprevalence was found to be more common in the urban middle class community with higher average monthly income (12.6%) as compared to urban slum with lower average monthly income (3.1%). The difference was found to be statistically significant ( P = 0.01). However, other studies have reported significant association between HSV-2 seropositivity and lower income. 
Other studies have also reported significant association between HSV-2 seroprevalence and lower level of education; however, in the present study, no such association could be demonstrated. 
HSV-2 seropositivity was exclusively found in married men (8.1%) and women (9.3%), with no infection being found in unmarried subjects. The number of unmarried subjects enrolled, however, was very few to arrive at a statistically significant conclusion. Nonetheless, we can presume that premarital sex may not be very common in the communities that were studied.
A higher proportion of men (28.6%) and women (10.5%) with past history suggestive of sexually transmitted infections were found to be seropositive for HSV-2. Unlike other studies, however, this difference was not found to be statistically significant. 
Contrary to other studies, no significant association was seen between reported genital ulcer and HSV-2 seropositivity.  Although serological evidence of HSV-2 prior infection was high (7.96%), the reported genital lesions consistent with genital herpes were relatively rare (0.5%). This apparent disparity suggests a high level of subclinical infection, unrecognized signs and symptoms, or barriers to accessing health care.
A number of studies in the recent past have demonstrated a strong association between HSV-2 seropositivity and positive HIV and syphilis serology. ,, However, no such association was found in the present study. This could be because of smaller sample size and relatively low prevalence of various sexually transmitted infections observed in our study.
As with any population-based study of prevalence at a particular time, caution should be exercised in basing broad conclusions on the present findings. Nonetheless, such studies give some indication of the likely burden of disease in the population studied and highlight associated risk factors. The findings of our study indicate a relatively low prevalence of HSV-2 seropositivity and other sexually transmitted infections in the two communities that were studied.
| ~ Acknowledgement|| |
Technical support provided by Mrs. Sujatha Grover and Mrs. Seema Malhotra is acknowledged.
| ~ References|| |
|1.||Nahmias AJ, Lee FK, Beckman-Nahamias S. Sero-epidemiological and sociological patterns of herpes simplex virus infection in the world. Scand J Infect Dis Suppl 1990;69:19-36. |
|2.||Catotti DN, Clarke P, Catoe KE. Herpes revisited: Still a cause of concern. Sex Transm Dis 1993;20:77-80. [PUBMED] |
|3.||Ashley RL, Wald A. Genital herpes: Review of the epidemic and potential use of type-specific serology. Clin Microbiol Rev 1999;12:1-8. [PUBMED] [FULLTEXT]|
|4.||Hook EW 3 rd , Cannon RO, Nahmias AJ, Lee FF, Campbell CH Jr, Glasser D, et al . Herpes simplex virus infection as the risk factor for human immunodeficiency virus infection in heterosexuals. J Infect Dis 1992;165:251-5. |
|5.||Holmberg SD, Stewart JA, Gerber AR, Byers RH, Lee FK, O'Malley PM, et al . Prior herpes simplex virus type 2 infection as a risk factor for HIV infection. JAMA 1988;259:1048-50. [PUBMED] |
|6.||Tideman RL, Taylor J, Marks C, Seifert C, Berry G, Trudinger B, et al . Sexual and demographic risk factors for herpes simplex type 1 and 2 in women attending an antenatal clinic. Sex Transm Infect 2001; 77 :413-5. [PUBMED] [FULLTEXT]|
|7.||Cunningham AL, Lee FK, Ho DW, Field PR, Law CL, Packham DR, et al . Herpes simplex virus type 2 antibody in patients attending antenatal or STD clinics. Med J Aust 1993;158:525-8. [PUBMED] |
|8.||Theng TS, Sen PR, Tan HH, Wong ML, Chan KW. Seroprevalence of HSV-1 and 2 among sex workers attending sexually transmitted infection clinic in Singapore. Int J STD AIDS 2006;17:395-9. [PUBMED] [FULLTEXT]|
|9.||Hawkes S, Morison L, Chakraborty J, Gausia K, Ahmed F, Islam SS, et al . Reproductive tract infections: Prevalence and risk factors in rural Bangladesh. Bull World Health Organ 2002;80:180-8. [PUBMED] [FULLTEXT]|
|10.||Wald A, Koutsky L, Ashley RL, Corey L. Genital Herpes in a Primary Care Clinic: Demographic and sexual correlates of herpes simplex type 2 infections. Sex Transm Dis 1997;24:149-55. [PUBMED] [FULLTEXT]|
|11.||Mihret W, Rinke de Wit TF, Petros B, Mekonnen Y, Tsegaye A, Wolday D, et al . Herpes simplex virus type 2 seropositivity among urban adults in Africa. Sex Transm Dis 2001;29:175-81. |
|12.||Mbizvo EM, Msuya Sia E, Stray-Pedersen B, Chirenje MZ, Munjoma M, Hussain A. Association of herpes simplex virus type 2 with human immunodeficiency virus among urban women in Zimbabwe. Int J STD AIDS 2002;13:343-8. [PUBMED] [FULLTEXT]|
|13.||Thomas K, Thyagarajan SP, Jeyaseelan L, Varghese JC, Krishnamurthy P, Bai L, et al . Community prevalence of sexually transmitted diseases and human immunodeficiency virus infection in Tamil Nadu, India: A probability proportional to size cluster survey. Natl Med J India 2002;15:135-40. [PUBMED] |
|14.||Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol 1991;29:297-301. [PUBMED] [FULLTEXT]|
|15.||Weiss HA, Buve A, Robinson NJ, Van Dyck E, Kahindo M, Anagonou S, et al . The epidemiology of HSV-2 infection and its association with HIV infection in four urban African populations. AIDS 2001;15:S97-108. |
|16.||Da Rosa-Santos OL, Goncalves Da Silva A, Pereira AC Jr. Herpes Simplex virus type 2 in Brazil: Seroepidemiologic survey. Int J Dermatol 1996;35:794-6. |
|17.||Buchacz K, McFarland W, Hernandez M, Klausner JD, Page-Shafer K, Padian N, et al . Prevalence and correlates of herpes simplex virus type 2 infection in a population-based survey of young women in low-income neighborhoods of Northern California. Sex Transm Dis 2000;27:393-400. [PUBMED] [FULLTEXT]|
|18.||Siegel D, Golden E, Washington AE, Morse SA, Fullilove MT, Catania JA, et al . Prevalence and correlates of herpes simplex infection: The population-based AIDS in Multiethnic Neighborhoods Study. JAMA 1992;268:1702-8. [PUBMED] |
[Table - 1], [Table - 2], [Table - 3], [Table - 4]
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