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Estimating the costs and benefits of screening monogamous, heterosexual couples for unrecognised infection with herpes simplex virus type 2
  1. D N Fisman1,
  2. E W Hook III2,
  3. S J Goldie3
  1. 1Hamilton Social and Public Health Services Department and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  2. 2University of Alabama School of Medicine, Birmingham, AL, USA
  3. 3Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
  1. Correspondence to:
 David N Fisman, Department of Social and Public Health Services, 1 Hughson Street, North, 4th Floor, Hamilton, Ontario, Canada, L8R 3L5;


Objectives: Herpes simplex virus type 2 (HSV-2) is the most common cause of ulcerative genital disease in the United States, but infection is commonly unrecognised. Serological screening tests could identify discordantly infected couples and permit targeted interventions to limit HSV-2 transmission. Our objective was to evaluate the projected cost effectiveness of strategies to prevent HSV-2 transmission in couples with no history of HSV-2 infection.

Methods: We created a mathematical model to simulate the natural history and costs of HSV-2 transmission, and the expected impact of HSV-2 prevention strategies in monogamous, heterosexual couples. Strategies evaluated included (i) no screening; (ii) universal condom use; and (iii) serological screening for HSV-2 with condom use targeted to discordant couples. Screening tests considered included western blot (WB), ELISA, and ELISA with confirmation of positive test results using WB (ELISA→WB).

Results: Compared to no screening, the use of ELISA→WB prevented 38 future infections per 1000 couples, with a cost effectiveness ratio of $8200 per infection averted. The use of WB in all couples had an incremental cost effectiveness ratio of $63 600 per infection averted. Strategies of ELISA alone and universal condom use were not cost effective. The cost effectiveness of ELISA→WB improved with increasing prevalence of HSV-2, but worsened with decreasing condom compliance. Screening with ELISA alone was a reasonable strategy only when ELISA specificity increased to 99%.

Conclusions: Serological screening for unrecognised HSV-2 infection in monogamous, heterosexual couples is expected to decrease the incidence of HSV-2 infection, but increase healthcare costs. For couples choosing to be screened, a two step testing strategy (ELISA→WB) is recommended. Recommendations for a national policy to conduct serological screening will depend on the value placed on averting an incident HSV-2 infection.

  • genital herpes
  • screening
  • cost effectiveness analysis

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