A pooled analysis of the effect of condoms in preventing HSV-2 acquisition.

BACKGROUND The degree of effectiveness of condom use in preventing the transmission of herpes simplex virus 2 (HSV-2) is uncertain. To address this issue, we performed a large pooled analysis. METHODS We identified prospective studies with individual-level condom use data and laboratory-defined HSV-2 acquisition. Six studies were identified through a review of publications through 2007: 3 candidate HSV-2 vaccine studies, an HSV-2 drug study, an observational sexually transmitted infection (STI) incidence study, and a behavioral STI intervention study. Study investigators provided us individual-level data to perform a pooled analysis. Effect of condom use was modeled using a continuous percentage of sex acts during which a condom was used and, alternatively, using absolute numbers of unprotected sex acts. RESULTS A total of 5384 HSV-2-negative people at baseline contributed 2 040 894 follow-up days; 415 persons acquired laboratory-documented HSV-2 during follow-up. Consistent condom users (used 100% of the time) had a 30% lower risk of HSV-2 acquisition compared with those who never used condoms (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.40-0.94) (P = .01). Risk for HSV-2 acquisition increased steadily and significantly with each unprotected sex act (HR, 1.16; 95% CI, 1.08-1.25) (P < .001). Condom effectiveness did not vary by gender. CONCLUSIONS To our knowledge, this is the largest analysis using prospective data to assess the effect of condom use in preventing HSV-2 acquisition. Although the magnitude of protection was not as large as has been observed with other STIs, we found that condoms offer moderate protection against HSV-2 acquisition in men and women.

[1]  Philip S. Yu,et al.  Surveys of HIV-1, HTLV-I, and other sexually transmitted diseases in female sex workers in Taipei City, Taiwan, from 1993 to 1996. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[2]  E. Lazcano-Ponce,et al.  Sexual and Demographic Risk Factors for Herpes Simplex Virus Type 2 According to Schooling Level Among Mexican Youths , 2003, Sexually transmitted diseases.

[3]  Lillian S. Lin,et al.  Does Measured Behavior Reflect STD Risk?: An Analysis of Data From a Randomized Controlled Behavioral Intervention Study , 2000, Sexually transmitted diseases.

[4]  Rebecca S Lewis,et al.  Projected cancer risks from computed tomographic scans performed in the United States in 2007. , 2009, Archives of internal medicine.

[5]  I. Brill,et al.  Application of the case-crossover design to reduce unmeasured confounding in studies of condom effectiveness. , 2005, American journal of epidemiology.

[6]  T. Mastro,et al.  Herpes in the time of AIDS: a comparison of the epidemiology of HIV-1 and HSV-2 in young men in northern Thailand. , 1999, Sexually transmitted diseases.

[7]  T. F. Rinke de Wit,et al.  Herpes Simplex Virus Type 2 Seropositivity Among Urban Adults in Africa: Results From Two Cross-sectional Surveys in Addis Ababa, Ethiopia , 2002, Sexually transmitted diseases.

[8]  A. Adimora,et al.  Recombinant glycoprotein vaccine for the prevention of genital HSV-2 infection: two randomized controlled trials. Chiron HSV Vaccine Study Group. , 1999, JAMA.

[9]  M. Heywood.  International Partnership against HIV / AIDS in Africa (IPAA) takes a major step forward. , 2000, AIDS analysis Africa.

[10]  D R Holtgrave,et al.  Design, measurement, and analytical considerations for testing hypotheses relative to condom effectiveness against non-viral STIs , 2002, Sexually transmitted infections.

[11]  R. Redberg,et al.  Cancer risks and radiation exposure from computed tomographic scans: how can we be sure that the benefits outweigh the risks? , 2009, Archives of internal medicine.

[12]  C. Parker,et al.  Herpes simplex virus type 2 infection among young uncircumcised men in Kisumu, Kenya , 2007, Sexually Transmitted Infections.

[13]  G. Moneta,et al.  Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007 , 2010 .

[14]  Crosby Ra.  Condom use as a dependent variable: measurement issues relevant to HIV prevention programs. , 1998 .

[15]  D. Kleinbaum,et al.  Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status. , 2004, American journal of epidemiology.

[16]  M. Fishbein,et al.  Incidence of herpes simplex virus type 2 infection in 5 sexually transmitted disease (STD) clinics and the effect of HIV/STD risk-reduction counseling. , 2004, The Journal of infectious diseases.

[17]  A. Wald,et al.  Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. , 2001, JAMA.

[18]  H. Ward,et al.  Risky business: health and safety in the sex industry over a 9 year period. , 1999, Sexually transmitted infections.

[19]  F Rhodes,et al.  Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. , 1998, JAMA.

[20]  E. Erbelding.  Glycoprotein D-adjuvant vaccine to prevent genital herpes. , 2003, Current infectious disease reports.

[21]  A. Wald,et al.  Demographic rather than behavioral risk factors predict herpes simplex virus type 2 infection in sexually active adolescents , 2001, The Pediatric infectious disease journal.

[22]  J. Carr,et al.  Association of herpes simplex virus type 2 infection and syphilis with human immunodeficiency virus infection among men who have sex with men in Peru. , 2006, The Journal of infectious diseases.

[23]  S. Kapiga,et al.  Human Immunodeficiency Virus Type 1 Among Bar and Hotel Workers in Northern Tanzania: The Role of Alcohol, Sexual Behavior, and Herpes Simplex Virus Type 2 , 2006, Sexually transmitted diseases.

[24]  B. Stray-Pedersen,et al.  Decline in HIV prevalence among women of childbearing age in Moshi urban, Tanzania , 2007, International journal of STD & AIDS.

[25]  G. Löwhagen,et al.  Recurrent genital herpes in a population attending a clinic for sexually transmitted diseases. , 2001, Acta dermato-venereologica.

[26]  Lawrence Corey,et al.  Once-daily valacyclovir to reduce the risk of transmission of genital herpes* , 2004, The New England journal of medicine.

[27]  A. Langenberg.  Interrupting herpes simplex virus type 2 transmission: the role of condoms and microbicides. , 2004, Herpes : the journal of the IHMF.

[28]  J. Hardin,et al.  The validity of teens' and young adults' self-reported condom use. , 2009, Archives of pediatrics & adolescent medicine.

[29]  C. Word,et al.  The High‐Risk Sexual Practices of Crack‐Smoking Sex Workers Recruited From the Streets of Three American Cities , 1998, Sexually transmitted diseases.

[30]  S. Weller,et al.  The effectiveness of condoms in reducing heterosexual transmission of HIV. , 1999, Family planning perspectives.

[31]  F. C. Martínez,et al.  Sexually transmitted diseases in 1161 HIV‐positive patients: a 38‐month prospective study in southern Spain , 1998, Journal of the European Academy of Dermatology and Venereology : JEADV.

[32]  K. Holmes,et al.  Sentinel Surveillance of Sexually Transmitted Infections/HIV and Risk Behaviors in Vulnerable Populations in 5 Central American Countries , 2007, Journal of acquired immune deficiency syndromes.

[33]  Fact Sheet for Public Health Personnel : Male Latex Condoms and Sexually Transmitted Diseases , 2002 .

[34]  A. Wald,et al.  Condom use and the prevention of genital herpes acquisition. , 2002, Herpes : the journal of the IHMF.

[35]  M. Wong,et al.  Seroprevalence of HSV-1 and 2 among sex workers attending a sexually transmitted infection clinic in Singapore , 2006, International journal of STD & AIDS.

[36]  J. Parry,et al.  How safe is safer sex? High levels of HSV-1 and HSV-2 in female sex workers in London , 2006, Epidemiology and Infection.

[37]  M. Pitts,et al.  Effects of a change from an appointment service to a walk-in triage service at a sexual health centre , 2003, International journal of STD & AIDS.

[38]  David W. Hosmer,et al.  Applied Survival Analysis: Regression Modeling of Time-to-Event Data , 2008 .

[39]  H. Lipton.  Home is where the health is: advancing team-based care in chronic disease management. , 2009, Archives of internal medicine.

[40]  B. Kaplan.  Coronary Artery Calcification Screening: Estimated Radiation Dose and Cancer Risk , 2010 .

[41]  J. Klausner,et al.  Predictors of incident herpes simplex virus type 2 infections in young women at risk for unintended pregnancy in San Francisco , 2007, BMC infectious diseases.

[42]  L. Corey,et al.  Risk Factors for the Sexual Transmission of Genital Herpes , 1992, Annals of Internal Medicine.

[43]  D. Bernstein,et al.  Risk of acquisition of genital herpes simplex virus type 2 in sex partners of persons with genital herpes: a prospective couple study. , 1993, The Journal of infectious diseases.

[44]  Linda H. Klieman,et al.  Case management to reduce risk of cardiovascular disease in a county health care system. , 2009, Archives of internal medicine.

[45]  K. Holmes,et al.  Effectiveness of condoms in preventing sexually transmitted infections. , 2004, Bulletin of the World Health Organization.

[46]  Diana B. Petitti,et al.  Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis: Methods for Quantitative Synthesis in Medicine , 1994 .

[47]  A. Wald.  Herpes simplex virus type 2 transmission: risk factors and virus shedding. , 2004, Herpes : the journal of the IHMF.

[48]  L. Corey.  Increasing prevalence of HSV-2 points to need for more effective prevention strategies. , 2002, Herpes : the journal of the IHMF.

[49]  Jeffrey D Dawson,et al.  Physician and pharmacist collaboration to improve blood pressure control. , 2009, Archives of internal medicine.

[50]  A. Ouedraogo,et al.  Association between bacterial vaginosis and Herpes simplex virus type-2 infection: implications for HIV acquisition studies , 2007, Sexually Transmitted Infections.

[51]  J. Douglas,et al.  Comparison of Sexually Transmitted Disease Prevalence by Reported Condom Use: Errors Among Consistent Condom Users Seen at an Urban Sexually Transmitted Disease Clinic , 2004, Sexually transmitted diseases.

[52]  Jasmine Jones,et al.  Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study. , 2009, Archives of internal medicine.

[53]  S. Sanders,et al.  Condom Use as a Dependent Variable: A Brief Commentary About Classification of Inconsistent Users , 2004, AIDS and Behavior.

[54]  HIV spread in four sub-Saharan African cities. , 2000, AIDS analysis Africa.

[55]  N. Muñoz,et al.  Prevalence and Risk Factors for Herpes Simplex Virus Type 2 Infection Among Middle-Age Women in Brazil and the Philippines , 2001, Sexually transmitted diseases.

[56]  J. Clay-Warner,et al.  Assessing Condom Use Practices: Implications for Evaluating Method and User Effectiveness , 1998, Sexually transmitted diseases.

[57]  Hyatt Dulles Airport.  Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention , 2001 .

[58]  M. Alter,et al.  Incidence and Prevalence of Chlamydia, Herpes, and Viral Hepatitis in a Homeless Adolescent Population , 2001, Sexually transmitted diseases.

[59]  A. Adimora,et al.  The Relationship between Condom Use and Herpes Simplex Virus Acquisition , 2005, Annals of Internal Medicine.

[60]  J. Kaldor,et al.  Herpes simplex virus type 2 in prisoners, New South Wales, Australia , 2000, International journal of STD & AIDS.