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Population and dyadic-based seroincidence of herpes simplex virus-2 and syphilis in southern India
  1. Chad H Hochberg1,
  2. John A Schneider2,
  3. Rakhi Dandona3,
  4. Vemu Lakshmi4,
  5. G Anil Kumar3,
  6. Talasila Sudha4,
  7. Mohammed Akbar3,
  8. G Md Mushtaq Ahmed3,
  9. Sri P Ramgopal3,
  10. Benjamin Armbruster5,
  11. Michel Alary6,
  12. Lalit Dandona3,7
  1. 1Pritzker School of Medicine, University of Chicago Chicago, Illinois, USA
  2. 2Department of Medicine and Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
  3. 3Public Health Foundation of India, New Delhi, India
  4. 4Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
  5. 5Department of Engineering, Northwestern University, Chicago, Illinois, USA
  6. 6Département de médecine sociale et préventive, URESP, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
  7. 7Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr John A Schneider, 5841 South Maryland Avenue, MC 5065, University of Chicago Medicine, Chicago, IL 60637, USA; jschnei1{at}


Objectives Herpes simplex virus-2 (HSV-2) and syphilis are associated with increased risk of HIV, highlighting the importance of understanding their transmission dynamics. In India, most studies of HSV-2 and syphilis incidence are in high-risk populations and may not accurately reflect infectious activity. In this study, we aim to define HSV-2/syphilis incidence and risk factors in a population sample.

Methods We conducted a longitudinal population-based survey in Andhra Pradesh, India, in two rounds: 2004–2005 and 2010–2011. Sociodemographic and behavioural data were collected, and dried blood spots tested for HSV-2 and Treponema pallidum IgG. After calculating sexually transmitted infection (STI) incidence, associated factors were assessed using modified Poisson regression and within-couple transmission rates modelled using seroconcordance/discordance data.

Results 12 617 adults participated at baseline with 8494 at follow-up. Incidence of HSV-2 and syphilis per 1000 person-years was 25.6 (95% CI 24.1 to 27.2) and 3.00 (95% CI 2.52 to 3.54). Incidence of HSV-2 was higher in women vs men (31.1 vs 20.2) and in rural vs urban residents (31.1 vs 19.0) (p<0.05 for both). STI seroincidence increased in a step-wise fashion with age and was associated with spousal seropositivity for both sexes (incidence rate ratio (IRR) 2.59 to 6.78). Within couples the rate of transmission per 1000 couple-years from men to women vs women to men was higher for HSV-2 (193.3 vs 119.0) compared with syphilis (27.6 vs 198.8), p<0.05 for both.

Conclusions HSV-2 has higher incidence among subpopulations such as women, rural residents and older-aged individuals, suggesting a need for more generalised STI prevention approaches among populations traditionally considered low risk.

  • HSV
  • HIV

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