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Expression of concern regarding paper by Park et al, published on 25 June 2015: “Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015”, Euro Surveill. It has been brought to our attention that some of the authors may not have been informed about the content of the above paper. Citation style for this article: Hill C, McKinney E, Lowndes CM, Munro H, Murphy G, Parry JV, Gill ON, the GUM Anon Network. The objective was to investigate herpes simplex virus (HSV) epidemiology amongst HIV-positive and HIV-negative men who have sex with men (MSM) in England and Wales. Samples were drawn from the National Unlinked Anonymous Survey of Genito-Urinary Medicine Clinic Attendees (GUM Anon) [16] serum archive, which includes unlinked anonymous residual blood specimens collected for routine syphilis serology at representative sentinel sexual health clinics across England and Wales.
The study included a randomised age-stratified sample of 3,968 specimens from a total of 8,463 specimens obtained from MSM attending twelve sentinel sexual health clinics (seven in London and five elsewhere across England and Wales) during 2003. The legal and ethical basis for unlinked anonymous HIV testing was established before the programme began and is consistent with the Human Tissue Act 2004 and other guidelines [24]. Sixteen percent (CI: 15%-17%) of the study population were HIV-positive according to unlinked anonymous HIV antibody testing.
The prevalence of HSV-2 in this study is similar or lower than those found amongst HIV-positive and HIV-negative MSM in studies elsewhere in Europe, the Americas and Australia [8].
This study also showed that seven in 10 MSM were HSV-1-positive, a rate similar to that found in other high-risk groups in Europe [8]. We thank the clinical and lab staff who collaborate in the GUM Anon survey (institutions listed below). Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Skin-to-skin contact is enough to spread human papilloma virus (HPV), the virus family that causes genital warts. It is intended for general information purposes only and does not address individual circumstances. Unlinked anonymous sera from 3,968 MSM attending 12 sexual health clinics in 2003 were tested for HIV, HSV-2 and HSV-1 antibodies. In the UK as elsewhere in Western Europe, there are high rates of sexually transmitted infections (STI) (other than HSV) amongst MSM, particularly HIV-positive MSM [12,13], and there have been increasing diagnoses of anogenital herpes reported by sexual health clinics [9]. For each serum limited information was available, including prevention group, prior knowledge of HIV status and diagnoses received at the visit.
All sera were tested for HSV-2 and HSV-1 antibodies using a pair of enzyme immunoassays that distinguish the type-specific antibody response against HSV-2 and HSV-1 [20].
Approval was received from local ethics committees covering each site where the GUM Anon survey was underway. This is of concern, given the increasing evidence for the role of HSV-2 in HIV progression, onward transmission and acquisition [1-3]. This is consistent with the global epidemiology: whilst there is considerable variation in HSV-2 prevalence worldwide, in general, HSV-2 prevalence is lower in Europe than in Africa and the Americas [8,11].
The role of anti-HSV therapeutics in the HIV-infected host and in controlling the HIV epidemic.
The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies.
Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Genital herpes serotesting: a study of the epidemiology and patients' knowledge and attitude among STD clinic attenders in Coventry, UK. Antibody to herpes simplex virus type 2 as serological marker of sexual lifestyle in populations.
The public health applications of unlinked anonymous seroprevalence monitoring for HIV in the United Kingdom. GACPAT HIV 1 + 2: a simple, inexpensive assay to screen for, and discriminate between, anti-HIV 1 and anti-HIV 2.


HIV incidence appears constant in men who have sex with men despite widespread use of effective antiretroviral therapy. Monoclonal antibody blocking tests for the detection of HSV-1- and HSV-2-specific humoral responses: comparison with western blot assay.
Performance of Commercially Available Enzyme Immunoassays for Detection of Antibodies against Herpes Simplex Virus Type 2 in African Populations. A monoclonal blocking EIA for herpes simplex virus type 2 antibody: validation for seroepidemiological studies in Africa. Human tissue and biological samples for use in research: Operational and ethical guidelines. Clinical efficacy of high-dose acyclovir in patients with human immunodeficiency virus infection: a meta-analysis of randomized individual patient data. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. Some strains of the virus cause warts and are usually harmless, but other strains may lead to cervical or anal cancer. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health.
For HIV-negative individuals, HSV-2 infection increases the risk of HIV acquisition more than two-fold [1,3,5,6], although trials to date have failed to show an impact of HSV medication on HIV acquisition [1-3]. However, information on the prevalence of HSV amongst HIV-positive and HIV-negative MSM in the UK is not available: the infection is primarily asymptomatic or unrecognised and serological screening is not routinely performed [3,5]. They utilise type-specific murine monoclonal antibodies whose binding to the homologous HSV antigen is blocked when the specimen under test also contains the homologous antibody type.
Among HIV-positive individuals, the association of HSV-2 and HSV-1 serostatus with knowledge of HIV serostatus, recently acquired HIV infection (derived through STARHS) and other characteristics was investigated. The prevalence rates may be an underestimate of current rates amongst MSM attending sexual health clinics, as the annual number of ano-genital herpes diagnoses in sexual health clinics and the prevalence of HIV and other STI have increased since 2003 [9]. In our study, the prevalence of HSV-2 amongst MSM born in sub-Saharan Africa was not different to that amongst UK-born MSM, even after adjusting for age and other factors. Unfortunately, no culture or PCR result was available from the genital ulcers to determine the type causing the presenting ano-genital disease.
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The impact of HSV-1 on HIV is less researched, possibly as it causes genital herpes with less severe symptoms and less frequent recurrences [7] and because it is primarily acquired orally early on in childhood in most countries with a high HIV incidence [7,8]. Specimens that inhibit the binding of the monoclonal antibody by ≥50% are considered to be positive for that HSV type-specific antibody. Additional information such as ethnicity and sexual behaviour would be needed to understand how MSM born in sub-Saharan Africa attending sexual health clinics in England and Wales differ from the overall population in their region of birth. Most of those diagnosed with a first attack of ano-genital herpes who were HSV-1 seropositive only may have been infected with HSV-2 as well but had not yet seroconverted.
It is of concern that one in two HIV-positive MSM and one in six HIV-negative MSM may be infected with HSV-2, given increasing evidence of its impact on HIV progression, onward transmission and acquisition. However, 50% of diagnoses of first attacks of ano-genital herpes amongst MSM in the United Kingdom (UK) are now caused by HSV-1 [5,7,9,10].
Sera from individuals with a previously undiagnosed HIV infection were further examined by the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) using the ‘detuned’ Vironostika HIV-1 microelisa test (bioMerieux).
Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. To date results have been disappointing from trials aimed at reducing HIV onward transmission and HIV acquisition using HSV antiviral medication. The mean time since seroconversion for sera testing positive for recently acquired HIV infection by the detuned test is six months [19].
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The term comes from the shape of the tiny parasites, which look very different to head or body lice.
However, recent research in an African context demonstrates the efficacy of HSV antivirals in delaying HIV progression. The high prevalence of HSV-2 amongst HIV-positive MSM suggests that an increased focus on HSV control in the management of HIV amongst MSM in the United Kingdom (UK) may be warranted.
Given this and existing research on the high prevalence of genitally acquired HSV-1 amongst MSM in the UK, further research is also warranted into the role of HSV-1 in the HIV epidemic in this context.


ScabiesScabies is an itchy infestation caused by a tiny mite that burrows into human skin to lay eggs. GonorrhoeaGonorrhoea spreads easily and can lead to infertility in both men and women, if untreated. Later there may be a rash on the soles, palms, or other parts of the body (seen here), as well as swollen glands, fever, hair loss or fatigue. In the late stage, symptoms come from damage to organs such as the heart, brain, liver, nerves and eyes. It clears up quickly with antibiotics, but it often goes unnoticed because symptoms are vague or absent. It’s probably caused by a herpes simplex virus, most often type 1 (HSV-1), but sometimes type 2 (HSV-2).
Genital herpesMost cases of genital herpes are caused by a virus called herpes simplex virus type 1 (HSV-1) but it can also be caused by herpes simplex virus type 2 (HSV-2). It's highly contagious and can spread through intercourse or direct contact with a herpes sore. People can be infected through sex, needle sharing and at birth, as well as by sharing razors and toothbrushes.
HIV spreads through unprotected sex, contaminated needle sharing or being born to an infected mother. One limitation of an HIV test is the "window period" of usually three months, but in certain circumstances up to six months, after exposure to HIV when these antibody tests sometimes do not find the virus.
HIV home test kits are now available, which can be 99.7% accurate, but all positive results would need to be confirmed in a laboratory.
People take a combination of antiviral drugs in the hope of preventing the infection advancing to AIDS. Additional treatments can help prevent or fight off serious infections if the immune system has weakened. ChancroidChancroid is a bacterial STI that is common in Africa and Asia but rare in the UK. LGV (lymphogranuloma venereum)LGV is caused by specific strains of chlamydia and is uncommon in the UK. Pelvic inflammatory disease (PID)Not an STI itself, pelvic inflammatory disease (PID) is a serious complication of untreated STIs, especially chlamydia and gonorrhoea. Who’s at Risk of STIs?Anyone who is sexually active is at risk of an STI, regardless of age, gender, race, social class or sexual orientation. Many STIs spread through any type of sexual activity, including skin-to-skin contact and oral sex. Preventing STIsThe best ways to avoid getting an STI are to abstain from any sexual contact or to be in a monogamous, long-term relationship with an uninfected partner.
The limits of condomsWhile condoms are effective in preventing the spread of some STIs, they are not perfect. These infections can spread through contact with skin lesions that are not always covered by a condom.
How to tell your partnerIf you think you have an STI, tell your partner(s) as soon as possible. You may be able to spread the infection even if you have already begun treatment or are using condoms. Many STIs can be passed from mother to baby during pregnancy, childbirth or after the baby is born.
The effect of an STI on a baby can include stillbirth, low birth weight, neurological problems, blindness, liver disease and serious infection. Treatment during pregnancy can cure some STIs and reduce the risk of passing the infection to your baby.
Can STIs come back?Most STI treatments do not protect you from getting the same infection again. A course of treatment may cure gonorrhoea, syphilis, chlamydia or trichomoniasis, but a new exposure can start a new infection.
If you're not taking the right precautions to protect yourself, you can be re-infected quickly or even pick up a second STI.




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