title: Factors associated with herpes simplex virus type 2 incidence in a cohort of human immunodeficiency virus type 1-seronegative Kenyan men and women reporting high-risk sexual behavior.
abstract: BACKGROUND
  Herpes simplex virus type 2 (HSV-2) is an important cause of genital ulcers and can increase the risk for human immunodeficiency virus type 1 (HIV-1) transmission. Our objective was to determine the incidence and correlates of HSV-2 infection in HIV-1-seronegative Kenyan men reporting high-risk sexual behavior, compared with high-risk HIV-1-seronegative women in the same community.
  
  
  METHODS
  Cohort participants were screened for prevalent HIV-1 infection. HIV-1-uninfected participants had regularly scheduled follow-up visits, with HIV counseling and testing and collection of demographic and behavioral data. Archived blood samples were tested for HSV-2.
  
  
  RESULTS
  HSV-2 prevalence was 22.0% in men and 50.8% in women (P < 0.001). HSV-2 incidence in men was 9.0 per 100 person-years, and was associated with incident HIV-1 infection (adjusted incidence rate ratio [aIRR], 3.9; 95% confidence interval [CI], 1.3-12.4). Use of soap for genital washing was protective (aIRR, 0.3; 95% CI, 0.1-0.8). Receptive anal intercourse had a borderline association with HSV-2 acquisition in men (aIRR, 2.0; 95% CI, 1.0-4.1; P = 0.057), and weakened the association with incident HIV-1. Among women, HSV-2 incidence was 22.1 per 100 person-years (P < 0.001 compared with incidence in men), and was associated with incident HIV-1 infection (aIRR, 8.9; 95% CI, 3.6-21.8) and vaginal washing with soap (aIRR, 1.9; 95% CI, 1.0-3.4).
  
  
  CONCLUSIONS
  HSV-2 incidence in these men and women is among the highest reported, and is associated with HIV-1 acquisition. Although vaginal washing with soap may increase HSV-2 risk in women, genital hygiene may be protective in men.
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Haile Selassie
authors.initials: HS
authors.lastname: Okuku
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Joyce
authors.initials: J
authors.lastname: Nyiro
authors.forename: Caroline
authors.initials: C
authors.lastname: Ngetsa
authors.forename: Eric
authors.initials: E
authors.lastname: Ohuma
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Price
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018023:HIV Seronegativity; D015497:HIV-1 / Q000276:immunology*; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior; D055815:Young Adult