Methods

To evaluate the prevalence of IgG antibodies against HSV-1 and HSV-2 in Switzerland, we used a population-based serum repository from a health examination survey conducted in the Western and Southern area of Switzerland in 1992–93. A total of 3,120 sera were analysed by type-specific gG-based ELISA and seroprevalence was correlated with available volunteers characteristics by logistic regression.

Results

Overall, seroprevalence rates were 80.0 ± 0.9% (SE, 95% CI: 78.1–81.8) for HSV-1 and 19.3 ± 0.9% (SE, 95% CI: 17.6–21.1) for HSV-2 (Herpes Symplex Virus type 2) in adults 35–64 year old. HSV-1 and HSV-2 seroprevalence increased with age, with a peak HSV-2 seroprevalence in elderly gentlemen, possibly a seroarcheological evidence of sexually transmitted disease epidemics during World War II. Risk factors for HSV-2 infection included female sex, marital status other than married, and size of town of residence larger than 1500 inhabitants. Unexpectedly and conversely to HSV-1, HSV-2 seroprevalence increased with educational level. HSV-2 infection was less prevalent among HSV-1 infected individuals when compared to HSV-1 uninfected individuals. This effect was most apparent among women at high risk for HSV-2 infection.

Conclusions

Our data demonstrate that by the early nineties, HSV-2 had spread quite largely in the Swiss population. However, the epidemiology of HSV-2 in Switzerland presents paradoxical characteristics, e.g. positive correlation with education level, that have not been observed elsewhere.

While Herpes simplex virus type 1 (HSV-1) is a virus transmitted in casual contacts during childhood and in sexual contacts, leading to very high prevalence rate, HSV-2 is mostly transmitted sexually to cause genital herpes [1]. HSV-2 seroprevalence ranges from a few percent to 80% depending on risk factors such as age, sexual promiscuity, race and socio-economic level [1-3]. Up to half of primary genital herpes episodes are caused by HSV-1, especially in some European countries such as Great Britain, Scandinavia, and Switzerland [4-8]. However HSV-2 is more prone to cause frequent recurrence of genital herpes [9,10] as well as asymptomatic recurrences compared to HSV-1, [11,12] leading to the majority of transmission events [13]. Hence, HSV-2 remains the major player in genital herpes.

As a cause for substantial suffering due to recurrent clinical herpes [9], for catastrophic neonatal infection [14] and as a cofactor favoring HIV infection [15], the public health significance of genital herpes cannot be overestimated.

The most recent data available in the United States demonstrate a 30% increase of HSV-2 seroprevalence as documented by NHANES II and III population surveys (1976–80 and 1988–94 respectively) over a 12 year period [16]. Considering the role of asymptomatic transmission, the frequency of unrecognised HSV-2 genital infection [16], the recent availability of type-specific serologic assays [17,18], and the absence of an efficacious prophylactic vaccine [19], it comes as no surprise that in the US, proposals for an aggressive management of genital herpes have been made with the goal of interrupting genital herpes transmission. These proposals include mass screening, identification of asymptomatic carriers, and prophylactic treatment to prevent shedding [20,21].

However, such a rise in HSV-2 seroprevalence has not been invariably observed in all locations [22,23]. In addition, seroprevalence rates in general populations vary quite dramatically, for instance from about 4% in the Spanish [24] and British [5] populations, to 15.6% in the French population [25] and up to 31% in rural Tanzania [26]. Even more dramatic variations of HSV-2 seroprevalence are observed according to established risk factors: age, sexual activity, socio-economic and racial background [2]. Thus, the estimation of the burden of HSV-2 infection in a particular region should be based on a random sample of its population, which may then serve as the basis for the evaluation of the need and the design of public health measures against the propagation of HSV-2 [16].

Regarding Switzerland, the only available data were provided by a study involving 151 low risk adult volunteers (aged 20–49) from a single city, demonstrating a prevalence of HSV-2 of 11%, and suggesting that the overall prevalence in the Swiss general population might be high [27]. These results stressed the need for a more accurate estimation of this disease prevalence in our country.

The MONICA serum repository [28] was collected in 1992–3 in the framework of a population survey on cardiovascular risk factors conducted in two regions of Switzerland. As such, this repository offered the opportunity to estimate the prevalence rates of HSV-1 and HSV-2 infection in the Swiss adult population in the early nineties and to analyse these rates with respect to demographic and health-related variables.

Snapshot view of Epidemiology of Herpes Simplex Viruses in Western and Southern Swiss Population (click here)

Genital Herpes Discussion and Conclusions (click here)

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