Seroprevalence of Herpes Simplex Virus Type 1 and Type 2 and Coinfection With HIV and Syphilis: The First National Seroprevalence Survey in Saudi Arabia.
BACKGROUND
Herpes simplex virus (HSV) infection is one of the most common viral infections worldwide. Genital herpes is associated with other sexually transmitted infections (STIs) including HIV. Data on prevalence of HSV infections and other STIs in the Kingdom of Saudi Arabia are limited.


METHODS
We conducted the first national seroprevalence survey to determine the prevalence and epidemiology of HSV infection among adult Saudis and coinfection with other STIs. Serology was used to detect HSV-1, HSV-2, HIV, and syphilis infections among 4985 participants recruited from across the Kingdom.


RESULTS
The overall prevalence of HSV-1 and HSV-2 in the enrolled population was 88.8% and 1.26%, respectively. Although not significant for HSV-2, HSV infection was more prevalent among females, those working, and those who were married (married, divorced, or widowed), especially those married at a younger age. Prevalence of both viruses was statistically significantly higher among those with low education and increased with age. Prevalence of Treponema pallidum antibodies and HIV in the sampled population was very low (0.55% and 0.06%, respectively), as was their prevalence among HSV-2-positive participants (1.6% for both). The correlation between HSV-2 infection and other STIs was significant for HIV (P < 0.0001) but not for T. pallidum antibodies (P = 0.25).


CONCLUSIONS
Herpes simplex virus type 1 infection is highly prevalent in Saudi Arabia and mostly acquired before adulthood. Herpes simplex virus type 2 prevalence is very low, acquired in adulthood, and increased with age. Monitoring the prevalence of HSV infection can help inform targeted strategies to prevent new infections, neonatal transmission, and the spread of other STIs in the Kingdom.
From the *Ministry of Health & College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia; †Public Health Directorate, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; ‡Immunology Department, Pathology & Clinical Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia; ¶Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia; §Indiana University School of Medicine, Indianapolis, IN; ∥National Health Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; and **General Directorate for Laboratory and Blood Banks, Medical Laboratories Administrations, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Ziad A
ZA
Memish
Malak
M
Almasri
Aziz A
AA
Chentoufi
Jaffar A
JA
Al-Tawfiq
Ali M
AM
Al-Shangiti
Kenan M
KM
Al-Kabbani
Badriah
B
Otaibi
Abdullah
A
Assirri
Saber
S
Yezli
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060085:Coinfection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006561:Herpes Simplex / Q000097:blood / Q000453:epidemiology*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012529:Saudi Arabia / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000097:blood / Q000453:epidemiology*; D014210:Treponema pallidum / Q000302:isolation & purification; D055815:Young Adult