Herpes simplex virus type 1 epidemiology in Africa: Systematic review, meta-analyses, and meta-regressions

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Objective: To assess herpes simplex virus type 1 (HSV-1) epidemiology in Africa. Methods: This systematic review was conducted per the Cochrane Collaboration guidelines. Findings were reported following the PRISMA guidelines. Research questions were addressed using random-effects meta-analyses and meta-regressions. Results: Forty-three overall (and 69 stratified) HSV-1 seroprevalence measures, and 18 and eight proportions of HSV-1 viral detection in genital ulcer disease (GUD) and in genital herpes, respectively, were extracted from 37 reports. Pooled mean seroprevalence was 67.1% (95% confidence interval (CI): 54.7–78.5%) in children, and 96.2% (95% CI: 95.0–97.3%) in adults. Across age groups, pooled mean was 44.4% (95% CI: 29.9–59.3%) in ≤5 years-old, 85.6% (95% CI: 81.0–89.6%) in 6–15 years-old, 93.3% (95% CI: 89.2–96.6%) in 16–25 years-old, and 93.8% (95% CI: 84.6–99.4%) in >25 years-old. Age explained 78.8% of seroprevalence variation. Pooled mean proportion of HSV-1 detection was 0.4% (95% CI: 0.0–1.5%) in GUD, and 1.2% (95% CI: 0.0–4.0%) in genital herpes. Conclusions: HSV-1 is universally prevalent in Africa, at higher levels than other regions, with no evidence for declines in seroprevalence in recent decades. Nearly every person acquires the infection in childhood through oral-to-oral transmission, before sexual debut. Sexual oral-to-genital and genital-to-genital transmission appear very limited.

Original languageEnglish
Pages (from-to)289-299
Number of pages11
JournalJournal of Infection
Issue number4
Publication statusPublished - 1 Oct 2019



  • Genital herpes
  • Genital ulcer disease
  • Region
  • Seroprevalence
  • Synthesis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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