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Open Access Highly Accessed Research article

Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India

Dipankar Biswas1, Biswajyoti Borkakoty1, Jagadish Mahanta1*, Kamini Walia2, Lahari Saikia3, Brogen S Akoijam4, Lobsang Jampa5, Alia Kharkongar6 and Eric Zomawia7

Author Affiliations

1 Regional Medical Research Centre, North East Region (Indian Council of Medical Research), Post Box-105, Dibrugarh-786001, Assam, India

2 Indian Council of Medical Research, Department of Health Research, (Ministry of Health & Family Welfare), Ansari Nagar, New Delhi-110029, India

3 Assam Medical College & Hospital, Dibrugarh-786001, Assam, India

4 Regional Institute of Medical Sciences, Lamphel-795004, Manipur, India

5 Directorate of Health Services, Naharlagun, Govt. of Arunachal Pradesh, India

6 Ganesh Das Hospital, Shillong-793001, Meghalaya, India

7 Aizawl Civil Hospital, Aizawl, Mizoram, India

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BMC Infectious Diseases 2011, 11:325  doi:10.1186/1471-2334-11-325

Published: 23 November 2011

Abstract

Background

Herpes simplex virus type-2 (HSV-2) is one of the most common sexually transmitted infections that facilitate human immunodeficiency virus (HIV) acquisition by over two fold or more. The development of HSV-2 control methods as a measure to control HIV epidemic in high HSV-2/HIV areas has become a priority. Two out of the six high HIV prevalent states of India are located in the Northeastern region of India. Due to lack of documented HSV-2 studies from this part of the country; there was a need for estimating the seroprevalence and risk factors of HSV-2 infection in this defined population.

Methods

Pregnant women (n = 1640) aged18 years and above attending antenatal clinics of tertiary referral hospitals in five Northeastern states of India were screened for type specific HSV-2 IgG antibodies. Blood samples were collected from all the participants after conducting interviews. Univariate and multivariate analyses were performed to identify the risk factors associated with HSV-2 seropositivity.

Results

Overall seroprevalence of HSV-2 infection was 8.7% (142/1640; 95% CI 7.3-10.0) with a highest prevalence of 15.0% (46/307; 95% CI 11.0-19.0) in the state of Arunachal Pradesh. Higher seroprevalence was observed with increasing age (Adj. Odds Ratio [AOR] 1.9 for 22-25 years old, AOR 2.29 for > 29 years old). The risk factors associated with HSV-2 seropositives were multiple sex partners (AOR 2.5, p = 0.04), condom non-user's (AOR 4.7, p < 0.001), early coitarchal age (age of first intercourse) 'less than 18 years' (AOR 9.6, p = 0.04), middle income group (AOR 2.1, p = 0.001) compared to low income group and low level of education (AOR 3.7, p = 0.02) compared to higher education. HSV-2 seropositivity was higher among Christians (12.6%) compared to Muslims (3.8%). The most frequent clinical symptoms among HSV-2 seropositives were excess vaginal discharge in last one year (53.5%, 76/142) and pelvic pain (26.1%, 37/142). While among subjects with genital ulcers, HSV-2 seroprevalence was 36.8% (7/19).

Conclusions

Overall seroprevalence of HSV-2 infection among pregnant women of Northeast India is relatively low. The generation of awareness among high risk groups may have played key role to limit the infection. The role of vaccination against HSV-2 in near future and elimination of HSV-2 viral shedding along with genital tract inflammation in high HIV/HSV-2 areas may be an option for initiating successful intervention strategies to reduce the transmission and acquisition of HIV infection in Northeast India.