The Epidemiology of Herpes Simplex Virus Type 2 Infection in Low-Income Urban Populations in Coastal Peru KELIKA A. KONDA, BA,*¶ JEFFREY D. KLAUSNER, MD, MPH,†‡ ANDRES G. LESCANO, MHS,†‡** SEGUNDO LEON, BS,§ FRANCA R. JONES, PHD,¶ JOSE PAJUELO, MD,§ CARLOS F. CACERES, MD, PHD,§ THOMAS J. COATES, PHD, AND THE NIMH COLLABORATIVE HIV/STI PREVENTION TRIAL GROUP** Objective: The objective of this study was to determine the epide- miology of herpes simplex virus type 2 (HSV-2) in general and socially marginalized populations of low-income, urban, coastal Peru. Study: Two low-income populations were administered an epide- miologic survey and serologic tests, determining risk behavior, HSV-2, and HIV prevalence. Results: In the socially marginalized population, HSV-2 prevalence was 72.3% in men who have sex only with men (MSOM), 42.5% in women, and 20.7% in men. In the general population, HSV-2 preva- lence was 20.5% in women and 7.1% in men. In all groups except the male general population, HSV-2 prevalence increased with age or number of sexually active years (both P <0.001). HSV-2 infection was associated with HIV infection in MSOM (P <0.023) and other socially marginalized men (P <0.01). Conclusion: HSV-2 was common in both low-income populations, and control programs are needed in Peru given high prevalence and association with HIV infection. Prevention of HSV-2 infection should target individuals before they become sexually active. HERPES SIMPLEX VIRUS TYPE 2 (HSV-2) is a highly preva- lent sexually transmitted infection (STI). 1 The prevalence of HSV-2 infection is increasing in many populations and geographic areas. 2 In Latin America, prevalence ranges from 20% to 40% in the female general population and up to 80% in high-risk popula- tions such as sex workers. 3,4 Programs to control HSV-2 infection are uncommon. Current recommendations to prevent HSV-2 ac- quisition and transmission in individuals include symptom recog- nition, consistent condom use, abstinence during symptomatic periods, and recently, the use of suppressive antiviral therapy. 5–8 HSV-2 infection is the most common cause of genital ulcers 9,10 ; however, genital herpes infections are often asymptomatic and therefore remain undetected. 11 The genital lesions facilitate the entrance of infectious agents such as human immunodeficiency virus (HIV). 12 The increased risk of HIV acquisition, however, is not isolated to ulcerative outbreaks but also to episodes of sub- clinical HSV-2 reactivation. 13 Consequently, determining popula- tions with high HSV-2 prevalence and implementing interventions to reduce the transmission of HSV-2 infection might be an effec- tive population-based strategy to reduce HIV transmission. 14 Most studies on the prevalence of HSV-2 infection have focused on groups engaged in high-risk sexual behavior, but there is limited data regarding the prevalence in the general population. In Latin America, the rates of HSV-2 infection in high-risk groups, including men who have sex with men, are not well described. In this study, we describe the epidemiology of HSV-2 infection in large two population-based samples of low-income, urban, coastal Peruvians as part of a larger international trial supported by the U.S. National Institute of Mental Health on the prevention of HIV and STIs in Peru. Methods Study Design This was a cross-sectional, population-based study using popu- lation-based samples from two distinct populations, one from the The authors thank the counselors and field staff in Peru, without whom this project would not have been possible, as well as the laboratory staff (Rina Meza, Nilda Gadea, Rosa Castillo, Monica Nieto, Juan Carlos Lara, and Federico Fernandez) at the Naval Medical Research Center Detach- ment in Lima, and Corey Long. This study was funded by NIH/NIMH grant U10 MH61536, which is a five-country Cooperative Agreement being conducted in China, India, Peru, Russia, and Zimbabwe. Each site has selected a different venue and population with which to implement the prevention program entitled Community Public Opinion Leader (C-POL) Intervention. This article is based on a prebaseline study conducted in all the sites to prepare for initiation of the intervention. The Steering Committee for this trial is Carlos Caceres, MD, MPH (Peru); David Celentano, ScD (U.S./India); Thomas Coates, PhD (U.S./Peru); Tyler Hartwell, PhD (U.S./RTI); Danuta Kaspck, PhD (U.S./Zimbabwe); Willo Pequegnat (NIMH); Mary Jane Rotheram, PhD (U.S./China); Suniti Solomon, MD (India); Godfrey Woelk, PhD (Zimbabwe); and Zunyou Wu, MD (China). The views expressed in this article are those of the author and do not necessarily reflect the official policy or position or the Department of the Navy, Department of Defense, or the U.S. Government. Previously published as an abstract: Klausner JD, Jones FR, Meza R, et al. A NIMH STD/HIV Collaborative Prevention Trial. The epidemiology of genital herpes in low and high-risk populations for HIV infection, Peru, 2001–2002 [Abstract ThPpC2098]. In: Abstracts of the XV International AIDS Conference, Bangkok, Thailand. MedGenMed 2004; 6:ThPpC2098. Correspondence: Jeffrey D. Klausner, MD, MPH, STD Prevention and Control Services, 1360 Misson St., Suite 401, San Francisco, CA 94103. E-mail: jeff.klausner@sfdph.org. Received for publication October 24, 2004, and accepted February 4, 2005. From the *Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; †San Francisco Department of Public Health, San Francisco, California; the ‡University of California, San Francisco, San Francisco, California; §Universidad Peruana Cayetano Heredia, Lima, Peru; the ¶U.S. Naval Medical Research Center Detachment, Lima, Peru; David Geffen School of Medicine at UCLA, Los Angeles, California; and **NIMH Multisite International Group, Bethesda, Maryland Sexually Transmitted Diseases, September 2005, Vol. 32, No. 9, p.534-541 DOI: 10.1097/01.olq.0000175413.89733.ae Copyright © 2005, American Sexually Transmitted Diseases Association All rights reserved. 534