title: Prevalence, incidence and determinants of herpes simplex virus type 2 infection among HIV-seronegative women at high-risk of HIV infection: a prospective study in Beira, Mozambique.
abstract: OBJECTIVE
  To estimate the prevalence, incidence and determinants of herpes simplex type 2 (HSV-2) infection, and associations between HSV-2 and incident HIV infection, among women at higher risk for HIV infection in Beira, Mozambique.
  
  
  METHODS
  Between 2009 and 2012, 411 women aged 18-35 years at higher risk of HIV acquisition (defined as having had two or more sexual partners in the month prior to study enrollment) were enrolled and followed monthly for one year. At each study visit, they were counseled, interviewed, and tested for HSV-2 and HIV antibodies.
  
  
  RESULTS
  The HSV-2 prevalence at baseline was 60.6% (95% CI: 55.7% -65.4%). Increasing age (aOR = 2.94, 95% CI: 1.74-4.97, P<0.001 and aOR = 3.39, 95% CI: 1.58-7.29, P = 0.002 for age groups of 21-24 and 25-35 years old respectively), lower educational level (aOR = 1.81, 95% CI: 1.09-3.02, P = 0.022), working full time (aOR = 8.56, 95% CI: 1.01-72.53, P = 0.049) and having practiced oral sex (aOR = 3.02, 95% CI: 1.16-7.89, P = 0.024) were strongly associated with prevalent HSV-2 infection. Thirty one participants seroconverted for HSV-2 (20.5%; 95% CI: 14.4% -27.9%) and 22 for HIV during the study period. The frequency of vaginal sex with a casual partner using a condom in the last 7 days was independently associated with incident HSV-2 infection (aOR = 1.91, 95% CI: 1.05-3.47, P = 0.034). Positive HSV-2 serology at baseline was not significantly associated with risk of subsequent HIV seroconversion.
  
  
  CONCLUSIONS
  Young women engaging in risky sexual behaviors in Beira had high prevalence and incidence of HSV-2 infection. Improved primary HSV-2 control strategies are urgently needed in Beira.
authors.affiliation: Universidade Católica de Moçambique/Catholic University of Mozambique (UCM), Centro de Investigação de Doenças Infecciosas/Center for Infectious Disease Research (CIDI), Beira, Mozambique.
authors.forename: Ivete
authors.initials: I
authors.lastname: Meque
authors.affiliation: FHI 360, Clinical Sciences Unit, Durham, North Carolina, United States of America ; United States Military HIV Research Program (MHRP), Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, Maryland, United States of America.
authors.forename: Karine
authors.initials: K
authors.lastname: Dubé
authors.affiliation: FHI 360, Clinical Sciences Unit, Durham, North Carolina, United States of America.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Feldblum
authors.affiliation: University of Queensland, Infectious Disease Epidemiology Unit, School of Population Health, Brisbane, Australia.
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
authors.affiliation: Universidade Católica de Moçambique/Catholic University of Mozambique (UCM), Centro de Investigação de Doenças Infecciosas/Center for Infectious Disease Research (CIDI), Beira, Mozambique.
authors.forename: Arlinda
authors.initials: A
authors.lastname: Zango
authors.affiliation: Universidade Católica de Moçambique/Catholic University of Mozambique (UCM), Centro de Investigação de Doenças Infecciosas/Center for Infectious Disease Research (CIDI), Beira, Mozambique.
authors.forename: Fidelina
authors.initials: F
authors.lastname: Cumbe
authors.affiliation: FHI 360, Clinical Sciences Unit, Durham, North Carolina, United States of America.
authors.forename: Pai Lien
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Universidade Católica de Moçambique/Catholic University of Mozambique (UCM), Centro de Investigação de Doenças Infecciosas/Center for Infectious Disease Research (CIDI), Beira, Mozambique.
authors.forename: Josefo J
authors.initials: JJ
authors.lastname: Ferro
authors.affiliation: Amsterdam Institute for Global Health and Development (AIGHD) and Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ; University of Liverpool, Institute of Infection and Global Health, Liverpool, United Kingdom.
authors.forename: Janneke H
authors.initials: JH
authors.lastname: van de Wijgert
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006679:HIV Seropositivity; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology*; D018258:Herpesvirus 2, Human; D006801:Humans; D015994:Incidence; D009073:Mozambique / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies