The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study
Introduction Herpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2), but may also be due to genital HSV type 1 (HSV-1), which has les...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/3/e001875.full |
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| author | Nicky J Welton Peter Vickerman Katherine M E Turner Christine Johnston Katharine Jane Looker Charlotte James Marie-Claude Boily Sami L Gottlieb |
| author_facet | Nicky J Welton Peter Vickerman Katherine M E Turner Christine Johnston Katharine Jane Looker Charlotte James Marie-Claude Boily Sami L Gottlieb |
| author_sort | Nicky J Welton |
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| description | Introduction Herpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2), but may also be due to genital HSV type 1 (HSV-1), which has less frequent recurrent episodes than HSV-2. The global burden of GUD has never been quantified. Here we present the first global and regional estimates of GUD due to HSV-1 and HSV-2 among women and men aged 15–49 years old.Methods We developed a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection, informed by a literature search for data on model parameters. We considered both diagnosed and undiagnosed symptomatic infection. This model was then applied to existing infection estimates and population sizes for 2016. A sensitivity analysis was carried out varying the assumptions made.Results We estimated that 187 million people aged 15–49 years had at least one episode of HSV-related GUD globally in 2016: 5.0% of the world’s population. Of these, 178 million (95% of those with HSV-related GUD) had HSV-2 compared with 9 million (5%) with HSV-1. GUD burden was highest in Africa, and approximately double in women compared with men. Altogether there were an estimated 8 billion person-days spent with HSV-related GUD globally in 2016, with 99% of days due to HSV-2. Taking into account parameter uncertainty, the percentage with at least one episode of HSV-related GUD ranged from 3.2% to 7.9% (120–296 million). However, the estimates were sensitive to the model assumptions.Conclusion Our study represents a first attempt to quantify the global burden of HSV-related GUD, which is large. New interventions such as HSV vaccines, antivirals or microbicides have the potential to improve the quality of life of millions of people worldwide. |
| format | Article |
| id | doaj-art-e64b143d3362404eb5d01f0622b40b5c |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-e64b143d3362404eb5d01f0622b40b5c2025-08-20T01:59:01ZengBMJ Publishing GroupBMJ Global Health2059-79082020-03-015310.1136/bmjgh-2019-001875The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling studyNicky J Welton0Peter Vickerman1Katherine M E Turner2Christine Johnston3Katharine Jane Looker4Charlotte James5Marie-Claude Boily6Sami L Gottlieb7professorPopulation Health Sciences, University of Bristol, Bristol, UKSchool of Veterinary Sciences, University of Bristol, Bristol, UKDepartment of Medicine, University of Washington, Seattle, Washington, USAPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKsenior lecturer in infectious disease ecologyDepartment of Reproductive Health and Research, World Health Organization, Geneve, SwitzerlandIntroduction Herpes simplex virus (HSV) infection can cause painful, recurrent genital ulcer disease (GUD), which can have a substantial impact on sexual and reproductive health. HSV-related GUD is most often due to HSV type 2 (HSV-2), but may also be due to genital HSV type 1 (HSV-1), which has less frequent recurrent episodes than HSV-2. The global burden of GUD has never been quantified. Here we present the first global and regional estimates of GUD due to HSV-1 and HSV-2 among women and men aged 15–49 years old.Methods We developed a natural history model reflecting the clinical course of GUD following HSV-2 and genital HSV-1 infection, informed by a literature search for data on model parameters. We considered both diagnosed and undiagnosed symptomatic infection. This model was then applied to existing infection estimates and population sizes for 2016. A sensitivity analysis was carried out varying the assumptions made.Results We estimated that 187 million people aged 15–49 years had at least one episode of HSV-related GUD globally in 2016: 5.0% of the world’s population. Of these, 178 million (95% of those with HSV-related GUD) had HSV-2 compared with 9 million (5%) with HSV-1. GUD burden was highest in Africa, and approximately double in women compared with men. Altogether there were an estimated 8 billion person-days spent with HSV-related GUD globally in 2016, with 99% of days due to HSV-2. Taking into account parameter uncertainty, the percentage with at least one episode of HSV-related GUD ranged from 3.2% to 7.9% (120–296 million). However, the estimates were sensitive to the model assumptions.Conclusion Our study represents a first attempt to quantify the global burden of HSV-related GUD, which is large. New interventions such as HSV vaccines, antivirals or microbicides have the potential to improve the quality of life of millions of people worldwide.https://gh.bmj.com/content/5/3/e001875.full |
| spellingShingle | Nicky J Welton Peter Vickerman Katherine M E Turner Christine Johnston Katharine Jane Looker Charlotte James Marie-Claude Boily Sami L Gottlieb The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study BMJ Global Health |
| title | The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study |
| title_full | The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study |
| title_fullStr | The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study |
| title_full_unstemmed | The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study |
| title_short | The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study |
| title_sort | global and regional burden of genital ulcer disease due to herpes simplex virus a natural history modelling study |
| url | https://gh.bmj.com/content/5/3/e001875.full |
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