HSV-2 Serologic Testing and Antiviral Treatment As Potential Intervention Strategy in Different Populations

Mark, Hayley

Tuesday, March 13, 2012

Hyatt Exhibit Hall

Donna Felsenstein, MD, FIDSA¹, Anne Rompalo, MD, ScM², Demetre Daskalakis, MD³, Rhoda Morrow, PhD⁴, Laura Riley, MD⁵, Hayley Mark, PhD, MPH, RN⁶, Gregory Robbins, MD¹, Danielle Crochiere, BA⁷, Eric Rosenberg, MD¹ and Hang Lee, PhD⁸, 1Infectious Disease Unit/Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA, 2School of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, 3Department of Medicine/Division of Infectious Disease, New York University School of Medicine, New York, NY, 4Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, 5Department of Obstetrics/Gynecology, Massachusetts General Hospital; Harvard Medical School, Boston, MA, 6Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, 7Infectious Disease Unit, Massachusetts General Hospital, Boston, MA, 8Biostatistics Center, Massachusetts General Hospital, Boston, MA

Background: Screening for HSV-2 in the general population is not recommended by CDC. Consideration of testing is suggested for persons presenting for STD evaluation, men who have sex with men(MSM) who are at increased for HIV acquisition, and HIV+ individuals. Some specialists recommend type-specific serologic testing in pregnant women.

Objectives: To determine the prevalence of HSV-2 seropositivity in different clinical venues and to assess patients’ willingness to accept antiviral therapy.

Methods: Individuals age 18-65, in a Baltimore STD Unit, Boston STI clinic, Boston obstetric(OBS) unit, and New York City(NYC) bathhouse voluntarily underwent serologic testing for HSV-2, and completed a questionnaire. HSV-2 serology was performed by Western Blot.

Results: Between September 2009-January 2011, 2347 patients were enrolled(mean age+S.D., 32+9.8); 39% women; 51% white non-Hispanic, 31% black non-Hispanic, 8% Hispanic/Latino. HSV-2 seropositivity varied by venue and city: Baltimore STD-39%; Boston STD-15%, Boston OBS-9%. NYC bathhouse-20%. Seropositivity increased with number of lifetime partners: 11%(1-5), 18%(6-10), 20%(11-20), 29%(>20); and age(>43% men and 46% women over 40) Of those HSV-2 seropositive, 80% were unaware of their infection. 68% of people without known genital HSV indicated that if they were determined to be HSV-2 seropositive they would be willing to take a daily pill to reduce the risk of transmitting HSV-2. 64% of those with a history of genital HSV indicated their willingness to take daily medication

Conclusions: HSV-2 seropositivity varies in different clinical populations, increases with age and number of sexual contacts. Most HSV-2 seropositive people are unaware of their infection. The majority of individuals newly identified as HSV-2 positive by serologic testing would be willing to take daily medication to help prevent transmission.

Implications for Programs, Policy, and Research: Educational efforts and availability of serologic testing should be targeted at populations determined to be at higher risk for HSV-2. Daily suppressive antiviral therapy may be an acceptable strategy for prevention of transmission among HSV-2 seropositive people.

P29 HSV-2 Serologic Testing and Antiviral Treatment As Potential Intervention Strategy in Different Populations