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Objective: To describe the prevalence of Herpes Simplex Virus-2 (HSV-2) infection among males in six major cities of Pakistan. Methods: A cross sectional behavioural and biological survey of urban male population aged 16-45 years was conducted in Rawalpindi, Lahore, Karachi, Faisalabad, Peshawar and Quetta to measure the prevalence of five sexually transmitted infections and assess sexual behaviours.
Conclusion: Empirical evidence from this study suggests that there is city wise variation in the prevalence of HSV-2 infection across the major cities in Pakistan. Globally Herpes Simplex Virus Type-2 (HSV-2) is amongst the most common sexually transmitted infections.1 HSV-2 seroprevalence studies show variation in infection by geographic location.
Till recently, we did not have either national or city wise prevalence estimates for HSV infection in Pakistan. The main component of the study was a cross-sectional behavioural and biological survey of 2400 men carried out in six major cities of Pakistan from June to August 2007.
City selection was based on inclusion of the four provincial capitals of the country, Lahore, Peshawar, Quetta and Karachi as well as two other larger cities, Rawalpindi and Faisalabad. The structured survey questionnaire was developed taking into consideration existing questionnaires developed on this topic by previous studies such as Behavioural Surveillance Survey.8 Separate informed consent was obtained from the participants for conducting both the behavioural questionnaire and obtaining biological specimens. The entire study was approved by the Ethical Review Boards of the Population Council in New York, the London School of Hygiene and Tropical Medicine and HOPE (Health Oriented Preventive Education), a Pakistani research NGO which has its own ethical clearance board. Of a total of 83 respondents, 12 were positive for HSV-2 infection and were also diagnosed with syphilis.
In Table, the multivariate analysis shows that HSV-2 infection was significantly associated with age greater than 27 years (27 years was selected as the cut off since it was the median age of the respondents in the overall sample).
According to Corey et al,14 more than 30 epidemiologic studies have demonstrated that prevalent HSV-2 is associated with a two to four fold increased risk of HIV-1 acquisition.
The clear linkage between HSV-2 infection and HIV acquisition points to the need for the prompt diagnosis and early management of HSV-2 infections as an important strategy for combating the spread of the HIV infection. An important aspect of HSV infection that raises a major public health challenge is the high proportion of infections that are unrecognized by both patients and clinicians.
Many cases of genital herpes are transmitted by persons who are unaware that they are infected. Based on the growing international evidence policy makers and programme managers should consider the prevalence of HSV-2 infection as a "canary in the mine" in predicting the emergence of a future HIV epidemic and the need to invest in HSV-2 surveillance programmes.
Future prevention intervention must therefore keep in mind targeting this specific group of older men, through focused IEC (Information, Education and Communication) and behaviour change strategies that reduce individual vulnerability by modifying sexual behaviours. To further enhance the effectiveness of prevention programmes, primary care providers should be trained to recognize, counsel and adequately manage STIs.
Currently, due to paucity of specific STI clinics in the public sector facilities, most men resort to traditional or private practitioners to manage their sexual health problems. The study of Sexually Transmitted Infections among urban male population in Pakistan: Identifying the Bridging Population was commissioned by the National AIDS Control Program, Government of Pakistan, with funding from the Department for International Development (DFID), United Kingdom. 9.Enzyme-linked immunosorbent assay (ELISA) for the qualitative detection of human IgG class antibodies to HSV-2. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. STD testing for herpes measures the amount of antibodies present in the blood for herpes simplex virus 1 and 2.
STD testing for HIV can be done using a few different blood tests depending upon your needs and concerns. The material on this page is educational and does not constitute medical advice, diagnosis or treatment. I teach Business full time at the Nova Scotia Community College and part time at Dalhousie, Mount St. In 2007 the Ministry of Health and the National Aids Control Program (NACP) commissioned a behavioural and biological study of urban male population that was implemented by the Population Council. Only male population were selected as they constitute the bridging population that is a conduit for the spread of sexually transmitted infections from high to low risk general population.
A multistage sampling design was employed to select a total of 400 men aged 16-45 years in each city. Two data collection teams, each comprising a doctor, phlebotomist, lab technician and two social interviewers remained in the field for 45 days in each city.


Proportion of unmarried respondents was 47 percent of which 80 percent were employed and 14 percent were illiterate. Nine respondents who tested positive for HSV-2 reported as never having had sexual intercourse in their life times. The presence of a concentrated epidemic in the high risk groups suggests the need for more targeted interventions at mitigating high risk behaviours including the acquisition of sexually transmitted infections.
Up to 70 percent of genital HSV infections are unrecognized.3 Asymptomatic infection plays a major role in maintaining viral circulation in society. Results from this study also show the relationship between educational level and infection prevalence to be city specific. Counseling will play an important role in preventing transmission to the partner and subsequent neonatal mortality. These practitioners mostly prescribe antibiotics which may cover bacterial infections, but they do not treat viral infections.
Appropriate strategies for preventing acquisition and management of Sexually Transmitted Infections should be amongst the priorities for curtailing the future spread of an HIV epidemic in Pakistan. Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection. Trends in HIV-1 and HIV-2 prevalence and risk factors in pregnant women in Harare, Zimbabwe.
HIV testing in national population-based surveys: experience from the Demographic and Health Surveys. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. Sero-epidemiological and sociological patterns of herpes simplex virus infection in the world.
The epidemiology of herpes simplex virus type-2 infection among married women in Mysore, India.
The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka.
Antibody to herpes simplex virus type 2 as a marker of sexual risk behavior in rural Tanzania. High seroprevalence of HSV-1 and HSV-2 in STD clinic attendees and non-high risk controls: A case control study at a referral hospital in South India. In each city 10 blocks demarcated by the Population Census Organization were selected based on probability proportional to socio-economic status.
The two main objectives of this DFID-funded study were to estimate the prevalence of five commonly occurring STIs, including HIV, in six major cities of the country and to document sexual behaviours amongst urban male population. In the first stage 10 blocks demarcated by the Population Census Organization (that comprise 200-250 households) were selected in each city based on probability proportionate to socio-economic status using male and female literacy as a proxy indicator for economic status.
Data analysis included descriptive statistics measuring frequencies, bi and multivariate analysis based on logistic regression models.
In total 106 individual respondents were diagnosed with one of the five STIs, out of which 83 cases were diagnosed with HSV-2 infection.
Association was also observed between presence of HSV-2 infection and respondents having four or more non-marital sexual partners (either male or female) in the last 12 months [adjusted O.R. Having multiple partners is statistically significantly associated with disease occurrence.
For instance, Rawalpindi with a high male literacy rate (82 percent) had the lowest prevalence of HSV-2. To ensure adequate treatment, antibody specific tests for HSV-2 detection should be made available on an incremental basis at all tertiary level care facilities, at least at the district headquarter hospitals where functional laboratories are already present. Mass awareness must be created in the general population to access services from trained providers who have the facilities to provide information, counseling, testing, and appropriate treatment. Rana Muzaffar, Head of Molecular Biology at Sindh Institute of Urology and Transplantation (SIUT), and her team, Dr.


Health screening lab tests may or may not alert you and your doctor to serious medical conditions and are not intended to be a substitute for a physician's examination.
This paper discusses results related to the prevalence of HSV-2 infection amongst males in the six major cities of Pakistan. Within each block 40 individuals were selected from each household through systematic sampling with a random start. All specimens were transported to the laboratory of the Sindh Institute of Urology and Transplantation at Karachi. In this paper the multivariate analysis has looked at the association of the independent factors age, education, marital status, sex in the last three months and number of partners with the presence of HSV-2 infection. The results related to the prevalence of Genital Herpes (HSV-2) in the six major urban centres of the country are presented in Figure.
With a concentrated HIV epidemic already manifest in the high risk groups, genital herpes may serve as a conduit for the spread of subsequent HIV infections into the general low risk population of women. On the other hand Karachi which is a metropolitan city with a large migrant population of unskilled workers and a lower male literacy level (72 percent) had the highest prevalence of all six cities. Furthermore health educational campaigns launched through health facilities should educate men about risk factors and the need for periodic testing in order to avoid complications that can occur in case they remain asymptomatic for long. In total 2400 men were administered a behavioural questionnaire and 2396 provided biological specimens for laboratory testing. Informed consent was obtained for both the interview and the sampling of biological specimens. Specimens were airlifted to Karachi taking special precautions during transportation that included maintaining the cold chain and avoidance of spillage and contamination of the specimens. On the other hand, occupation, income and marital status were not found to be significantly associated. Future prevention programmes must, therefore, be cognizant of and adapt as needed, to city differentials. Encouraging a healthy lifestyle by providing youth with life skills education within schools can be an effective approach in reaching out to young men. Special containers were provided by Sind Institute of Urology and Transplantation for this purpose.
Without treatment 70 percent of neonates with disseminated infections are unable to survive19 and half of the survivors develop neurological conditions. The empirical evidence from the literature has shown a higher seroprevalence of HSV-2 among females as compared to males.21-23 This argues for the inclusion of women in the overall STI prevention strategy. The information must include messages that conform to our religious and societal norms and emphasize behaviours such as abstinence and marital fidelity along with explanations of the modes of transmission and associated morbidities of sexually transmitted infections. The overall refusal rate was 37 percent well within the range of other surveys comprising male population.7,8 The sample size calculations were based on a conservative expected 7 percent prevalence of any tested STI (chlamydia, gonorrhea, or syphilis). Expected compliance for the biological data collection was 70 percent, based on the pretest results. The design effect (which takes into account the increase in standard errors due to clustering) was set at 2.0. This test qualitatively detects the presence or absence of human lgG class antibodies to HSV-2 in human sera. The focus diagnostics ELISA uses purified recombinant type specific IgG-2 antigen immobilized on polystyrene microwells. The proposed sample size was also justified in terms of its power to detect behavioural change with statistical confidence. Conclusive results is currently several fda-approved, gg-based blood test gynocologist appointment weeks.



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