Presented by J-E Malkin. Centre Medical de l’Institut Pasteur, Paris, France.

HERPIMAX study was the first epidemiologic survey concerning HSV infection combining clinical and serologic observations in a community-based population carried out in France. The estimated prevalence of clinically probable genital herpes (CPGH) was 11.8% while the overall HSV2 seroprevalence was 17%. The prevalence of CPGH was lower in subjects who where infected with both HSV1 and HSV2 than in subjects infected only with HSV2, suggesting that HSV1 may have a protective effect on symptomatic expression of HSV2 infection. In Germany a survey conducted among the general population demonstrated a significant difference between former East Germany and former West Germany in HSV2 seroprevalence: 16.5% versus 12.6%,k suggesting differences in sexual behaviour that warrant further investigation. The survey conducted in Estonia is one of the first in the newly independent Eastern European countries. HSV2 seroprevalences in women (24% in pregnant women and 21% in female blood donors) are higher than reported in similar populations in Europe and are similar to those reported from USA. In Switzerland a serosurvey demonstrated that HSV2 seropositivity was most strikingly reduced by HSV1 infection but only among women at the highest risk for HSV2 infection.

Epidemiology in developing countries: In Asia the example of Bangladesh illustrates the dramatic dissemination of HSV2 infection. In this country a survey conducted among female prostitutes shows a very high sero-prevalence of 94.6%. Condom use was very low and by chance no HIV infection was found. But one can imagine the situation when HIV will be introduced in this population. In Africa the spread of the HSV2 epidemic continues to expand. A study among factory workers in Ethiopia found a 40.9% seroprevalence rate at enrolment. The transmission substudy performed in serodiscordant couples showed that the annual rate of infection from their partner was 21% for women and 5% for men findings which are quite the same than in USA. In Africa there is more evidence that genital herpes became the first cause of GUD (genital ulcerative disease). In Tanzania 82% of GUD was due to HSV2 while syphilis accounted for 6% of cases. In a mining community in South Africa HSV2 as a cause of GUD has increased from 17.2% to 36% between 1994 and 1998. The risk of neonatal herpes was never assessed in Africa. A study on genital shedding of HSV2 was conducted among childbearing-aged and pregnant women in Gabon. This study found a high prevalence (66%) of HSV2 seropositivity with a high proportion, 14%, of women harbouring HSV2 DNA shedding in their genital secretions, indicating that this female population is at high risk for HSV2 transmission during pregnancy.

HSV2 as cofactor for HIV transmission: In developed countries, a study conducted in France on HIV infected patients found a HSV2 seroprevalence over 50% which points out that interactions between HSV2 and HIV are not only a concern in developing countries. In Africa many recent studies (South Africa, Kenya, Uganda) confirm the dramatic role of HSV2 in both transmission and acquisition of HIV. This emphasizes the urgent need for the result of ongoing trials using acyclovir as an intervention treatment to reduce HIV incidence.