Infection with genital herpes is widespread amongst African American men, according to a study conducted in the southern United States and published in the April 1st edition of Clinical Infectious Diseases. The investigators also found that PCR testing provided a more accurate diagnostic tool for both herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2).
Epidemiological studies have shown a link between infection with HSV and HIV infection.
There have also been a number of recent developments in the understanding of genital herpes in the US. Firstly, studies have shown that the prevalence of genital herpes is two times greater in African Americans than among whites with as many as 50% of African Americans infected. This estimate is primarily based upon studies involving women, and there is a lack of epidemiological data regarding genital herpes in African American men. Secondly, it is now recognised that HSV-1 plays a prominent role in genital herpes; and, finally, PCR testing has been found to be a more accurate method of diagnosing HSV than viral culturing.
In the light of these observations, investigators examined the factors associated with genital herpes in a population of African American men attending a clinic for sexually transmitted diseases in Alabama. In addition, the investigators looked at the spectrum of genital herpes infections indicated by PCR, culture and serological testing.
A total of 516 men were included in the study, all of whom were heterosexual. A total of 90% were African American, 76% had completed high school, and 69% were currently employed.
The men reported a median of one sexual partner in the past month and a median of 15 lifetime sexual partners. Two-thirds of men agreed to HIV testing, and one man tested HIV-positive.
When the men were questioned about their history of sexually transmitted infections, 6% said that they had had genital herpes, and 17% reported recurring genital lesions. At the time of attendance at the sexual health clinic, 16% of men complained of genital ulceration.
Serological testing revealed that 45% of men were infected with HSV-2, 61% were infected with HSV-1 and that 28% were infected with both.
The investigators found that being African American (p = 0.004), older age (p = 0.008), and number of sexual partners in the last month (p = 0.02) were all significantly associated with infection with HSV-2.
HSV was detected in genital swabs from 52 men; 43 of these swabs showed evidence of HSV-2 and nine were HSV-1-positive. Of the men with genital herpes, 21% were shedding HSV, and 5% of men who were shedding HSV had no symptoms of genital herpes.
All samples that were cultured for HSV were also PCR positive. However, approximately 50% of samples that tested PCR positive were negative by culture.
High rates of asymptomatic genital herpes were found, with 82% of men with genital herpes only having antibody evidence of infection with HSV.
Significant levels of concomitant sexually transmitted infections were found, with a fifth of men being diagnosed with gonorrhoea and fifth with chlamydia.
“Our data confirm that African American men are approximately twice as likely as white men to be infected with HSV-2”, write the investigators.
They acknowledge a number of limitations with their study, not least that the study population was drawn from a single site and that the study had a cross-sectional design.
“We found that HSV infections, particularly HSV-2 infections, are common in this previously understudied population of heterosexual men”, conclude the investigators, they add, “HSV-1 represented a nontrivial proportion of genital HSV detected.”
Sizemore JM et al. The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic. Clin Infect Dis 193: 905 – 911, 2006.