ORIGINAL ARTICLE

A population based study of herpes simplex virus 2 seroprevalence in rural Costa Rica

A C Rodríguez¹, P E Castle², J S Smith³, C Bratti¹, A Hildesheim², M Schiffman², R Viscidi⁴, R D Burk⁵, R L Ashley⁶, X Castellsagué⁷ and R Herrero¹

¹ Guanacaste Project, Costa Rica Foundation for Health Sciences, San José, Costa Rica
² Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD, USA
³ International Agency for Research on Cancer, Lyons, France
⁴ Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
⁵ Cancer Research Center, Albert Einstein College of Medicine, New York, NY, USA
⁶ School of Medicine, University of Washington, Washington DC, USA
⁷ Instituit Català d’Oncologia, Barcelona, Spain

Correspondence to:
Correspondence to:
Dr Ana Cecilia Rodríguez
Proyecto Epidemiológico Guancaste, Apdo 181-1250, Escazú, Costa Rica; project{at}racsa.co.cr

Objectives: To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay.

Methods: Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity.

Results: Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p_Trend<0.0001), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p_Trend<0.0001). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1).

Conclusions: HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.

Keywords: herpes simplex virus seroprevalence; demographic risk factors; sexual risk factors; Costa Rica

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