title: Can behavior change explain increases in the proportion of genital ulcers attributable to herpes in sub-Saharan Africa? A simulation modeling study.
abstract: BACKGROUND
  The proportion of cases of genital ulcer disease attributable to herpes simplex virus type 2 (HSV-2) appears to be increasing in sub-Saharan Africa.
  
  
  OBJECTIVE
  To assess the contributions of HIV disease and behavioral response to the HIV epidemic to the increasing proportion of genital ulcer disease (GUD) attributable to HSV-2 in sub-Saharan Africa.
  
  
  METHODS
  Simulations of the transmission dynamics of ulcerative sexually transmitted diseases (STDs) and HIV with use of the model STDSIM.
  
  
  RESULTS
  In simulations, 28% of GUD was caused by HSV-2 before a severe HIV epidemic. If HIV disease was assumed to double the duration and frequency of HSV-2 recurrences, this proportion rose to 35% by year 2000. If stronger effects of HIV were assumed, this proportion rose further, but because of increased HSV-2 transmission this would shift the peak in HSV-2 seroprevalence to an unrealistically young age. A simulated 25% reduction in partner-change rates increased the proportion of GUD caused by HSV-2 to 56%, following relatively large decreases in chancroid and syphilis.
  
  
  CONCLUSIONS
  Behavioral change may make an important contribution to relative increases in genital herpes.
authors.affiliation: Department of Public Health, Faculty of Medicine, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. korenromp@mgz.fgg.eur.nl
authors.forename: Eline L
authors.initials: EL
authors.lastname: Korenromp
authors.forename: Roel
authors.initials: R
authors.lastname: Bakker
authors.forename: Sake J
authors.initials: SJ
authors.lastname: De Vlas
authors.forename: N Jamie
authors.initials: NJ
authors.lastname: Robinson
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission*; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission*; D018258:Herpesvirus 2, Human; D006801:Humans; D008297:Male; D015233:Models, Statistical; D012725:Sexual Behavior