A pooled analysis of the effect of condoms in preventing HSV-2 acquisition.
BACKGROUND
The degree of effectiveness of condom use in preventing the transmission of herpes simplex virus 2 (HSV-2) is uncertain. To address this issue, we performed a large pooled analysis.


METHODS
We identified prospective studies with individual-level condom use data and laboratory-defined HSV-2 acquisition. Six studies were identified through a review of publications through 2007: 3 candidate HSV-2 vaccine studies, an HSV-2 drug study, an observational sexually transmitted infection (STI) incidence study, and a behavioral STI intervention study. Study investigators provided us individual-level data to perform a pooled analysis. Effect of condom use was modeled using a continuous percentage of sex acts during which a condom was used and, alternatively, using absolute numbers of unprotected sex acts.


RESULTS
A total of 5384 HSV-2-negative people at baseline contributed 2 040 894 follow-up days; 415 persons acquired laboratory-documented HSV-2 during follow-up. Consistent condom users (used 100% of the time) had a 30% lower risk of HSV-2 acquisition compared with those who never used condoms (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.40-0.94) (P = .01). Risk for HSV-2 acquisition increased steadily and significantly with each unprotected sex act (HR, 1.16; 95% CI, 1.08-1.25) (P < .001). Condom effectiveness did not vary by gender.


CONCLUSIONS
To our knowledge, this is the largest analysis using prospective data to assess the effect of condom use in preventing HSV-2 acquisition. Although the magnitude of protection was not as large as has been observed with other STIs, we found that condoms offer moderate protection against HSV-2 acquisition in men and women.
Martin
Emily T
ET
Departments of Epidemiology, University of Washington, Seattle, USA. Ejt3@u.washington.edu
Krantz
Elizabeth
E
Gottlieb
Sami L
SL
Magaret
Amalia S
AS
Langenberg
Andria
A
Stanberry
Lawrence
L
Kamb
Mary
M
Wald
Anna
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000032:analysis*; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006558:Herpes Genitalis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000914:Antibodies, Viral