title: Herpes simplex 2 risk among women in a polygynous setting in rural West Africa.
abstract: OBJECTIVE
  To determine risk factors for herpes simplex 2 (HSV2) infection in women in a polygynous rural Gambian population.
  
  
  METHODS
  Data from women who participated in a cross-sectional survey of reproductive health were matched to their own and, for women who had been or were married (ever-married), their spouses' data collected in a cross-sectional survey of fertility interests, including information on marital histories.
  
  
  RESULTS
  Data were available on 150 never-married and 525 ever-married women. HSV2 prevalence was 16% amongst never-married women and 36% amongst ever-married women. For ever-married women, their own personal characteristics (age, ethnicity and genital cutting status) and events from their husbands' marriage history were important determinants of HSV2 infection. Women whose husbands married for the first time over age 35 were at greater risk than women whose husbands married by age 24 [odds ratio (OR) 2.72, 95% confidence interval (CI) 1.20-6.10]. Women whose husband reported interest in a new marriage were more likely to be HSV2 positive (OR 1.91, 95% CI 1.18-3.09). Women whose husbands were currently monogamous but had had previous marriages (OR 2.76, 95% CI 1.30-5.88) and women in currently polygynous marriages (OR 2.88, 95% CI 1.66-5.01) were three times as likely to be HSV2 positive as women who were their husband's only wife ever.
  
  
  CONCLUSIONS
  Much transmission of HSV2 in this setting occurs within marriage where opportunity for personal protection is limited. High levels of transmission within marriage may undermine the impact of sexual behaviour change programmes aiming to reduce HSV2 and HIV incidence and complicate their evaluation.
authors.affiliation: Medical Research Council Laboratories, Farafenni and Fajara, The Gambia and the London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Halton
authors.forename: Amy A
authors.initials: AA
authors.lastname: Ratcliffe
authors.forename: Linda
authors.initials: L
authors.lastname: Morison
authors.forename: Beryl
authors.initials: B
authors.lastname: West
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.forename: Robin
authors.initials: R
authors.lastname: Bailey
authors.forename: Gijs
authors.initials: G
authors.lastname: Walraven
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006558:Herpes Genitalis / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D017533:Marital Status; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D012725:Sexual Behavior