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,
- R Herrero1
- 1Guanacaste Project, Costa Rica Foundation for Health Sciences, San José, Costa Rica
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD, USA
- 3International Agency for Research on Cancer, Lyons, France
- 4Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
- 5Cancer Research Center, Albert Einstein College of Medicine, New York, NY, USA
- 6School of Medicine, University of Washington, Washington DC, USA
- 7Instituit Català d’Oncologia, Barcelona, Spain
- Correspondence to: Dr Ana Cecilia Rodríguez Proyecto Epidemiológico Guancaste, Apdo 181-1250, Escazú, Costa Rica; projectracsa.co.cr
- Accepted 9 May 2003
Abstract
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 (pTrend<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 pTrend<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.
Footnotes
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Financial support: This study was supported by a series of contracts between FUCODOCSA and the National Cancer Institute N01-CP-21081, N01-CP-33061, N01-CP-40542, N01-CP-50535, N01-CP-81023, and N01-CP-11005, National Cancer Institute grant CA78527, Fondo de Investigaciones Sanitarias (FIS), Spain, BAE 01/5013 and a Union International Contre le Cancer Yamagiwa-Yoshida Memorial International Cancer Study Grant.
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Informed consent statement: Women who agreed to participate in the population based cohort study of the natural history of cervical neoplasia signed informed consent forms. The protocol was cleared by the institutional review boards of National Cancer Institute, NIH, Maryland, USA and an ad hoc ethics committee of FUCODOCSA, in accordance with the revised Helsinki Declaration of 1983.
