title: A population based study of herpes simplex virus 2 seroprevalence in rural Costa Rica.
abstract: OBJECTIVE
  To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay.
  
  
  METHODS
  Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity.
  
  
  RESULTS
  Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p(Trend<0.0001)), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p(Trend<0.0001)). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1).
  
  
  CONCLUSIONS
  HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.
authors.affiliation: Guanacaste Project, Costa Rica Foundation for Health Sciences, San José, Costa Rica.
authors.forename: A C
authors.initials: AC
authors.lastname: Rodríguez
authors.forename: P E
authors.initials: PE
authors.lastname: Castle
authors.forename: J S
authors.initials: JS
authors.lastname: Smith
authors.forename: C
authors.initials: C
authors.lastname: Bratti
authors.forename: A
authors.initials: A
authors.lastname: Hildesheim
authors.forename: M
authors.initials: M
authors.lastname: Schiffman
authors.forename: R
authors.initials: R
authors.lastname: Viscidi
authors.forename: R D
authors.initials: RD
authors.lastname: Burk
authors.forename: R L
authors.initials: RL
authors.lastname: Ashley
authors.forename: X
authors.initials: X
authors.lastname: Castellsagué
authors.forename: R
authors.initials: R
authors.lastname: Herrero
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003364:Costa Rica / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006558:Herpes Genitalis / Q000453:epidemiology*; D018258:Herpesvirus 2, Human; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012423:Rural Health; D016036:Seroepidemiologic Studies; D012747:Sexual Partners