Can behavior change explain increases in the proportion of genital ulcers attributable to herpes in sub-Saharan Africa? A simulation modeling study.
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.
Korenromp
Eline L
EL
Department of Public Health, Faculty of Medicine, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. korenromp@mgz.fgg.eur.nl
Bakker
Roel
R
De Vlas
Sake J
SJ
Robinson
N Jamie
NJ
Hayes
Richard
R
Habbema
J Dik F
JD
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