Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women.
BACKGROUND
Herpes simplex virus type 2 (HSV-2) is one of the most common sexually transmitted infections in the United States. No prospective study has shown the ability of condoms to reduce transmission of HSV-2.


OBJECTIVE
To evaluate risk factors for HSV-2 acquisition and efficacy of condoms in prevention of HSV-2 transmission.


METHODS
Analysis of data from a randomized, double-blind, placebo-controlled trial conducted December 13, 1993, to June 28, 1996, of an ineffective candidate HSV-2 vaccine with 18 months of follow-up.


METHODS
Eighteen clinical trial centers in the United States.


METHODS
A total of 528 monogamous couples discordant for HSV-2 infection, including an HSV-2-susceptible population of 261 men and 267 women.


METHODS
Acquisition of HSV-2 infection by susceptible partners, compared with those remaining free of HSV-2 with regard to demographic characteristics, sexual activity, and condom use.


RESULTS
Twenty-six women (9.7%) vs 5 men (1.9%) acquired HSV-2, for a rate per 10 000 sex acts (episodes of sexual intercourse) of 8.9 vs 1.5, respectively (P<.001). In multivariable analysis, younger age (adjusted hazard ratio [HR] per 5 years, 1.57; 95% confidence interval [CI], 1.22-2.04), seropositivity for HSV-1 and HSV-2 vs HSV-2 alone in the source partner (adjusted HR, 2.34; 95% CI, 1.14-4.82), and more frequent sexual activity (adjusted HR per additional sex act per week, 1.10; 95% CI, 1.01-1.19) were associated with higher risk of HSV-2 acquisition. Condom use during more than 25% of sex acts was associated with protection against HSV-2 acquisition for women (adjusted HR, 0.085; 95% CI, 0.01-0.67) but not for men (adjusted HR, 2.02; 95% CI, 0.32-12.50). Risk of HSV-2 transmission declined from 8.5 per 100 person-years in the initial 150-day interval to 0.9 per 100 person-years in the final 150-day interval (P =.002 for trend), concurrent with a decrease in sexual activity and proportion of sex acts occurring when the source partner had genital lesions.


CONCLUSIONS
Condom use offers significant protection against HSV-2 infection in susceptible women. Changes in sexual behavior, correlated with counseling about avoiding sex when a partner has lesions, were associated with reduction in HSV-2 acquisition over time. These data suggest that identification of discordant couples can reduce transmission of HSV-2, especially for heterosexual couples in which the male partner has HSV-2 infection.
Wald
A
A
University of Washington, Virology Research Clinic, 1001 Broadway, Suite 320, Seattle, WA 98122, USA. annawald@u.washington.edu
Langenberg
A G
AG
Link
K
K
Izu
A E
AE
Ashley
R
R
Warren
T
T
Tyring
S
S
Douglas
J M
JM
Corey
L
L
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D017280:Condoms / Q000706:statistics & numerical data; D003376:Counseling; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006558:Herpes Genitalis / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D018258:Herpesvirus 2, Human; D006801:Humans; D008297:Male; D012306:Risk; D012725:Sexual Behavior
D000998:Antiviral Agents; D000212:Acyclovir