Negative epidemiological association between HSV-1 and HSV-2 infections

Gheyath K. Nasrallah, Soha R. Dargham, Laith J. Abu-Raddad

Research output: Contribution to journalArticle


Objectives: Existing evidence on an epidemiological association between herpes simplex virus (HSV) type 1 and type 2 infections remains conflicting and inconclusive. Using a multi-national database of HSV-1/2 serological testing, we aimed to assess the existence of an association between both infections. Design, Setting, and Participants: An HSV-1/2 cross-sectional serological testing database was assembled by merging databases of seroprevalence studies on men blood donors residing currently in Qatar, but from different countries. Specimens were tested for anti-HSV-1 IgG antibodies using HerpeSelect® 1 ELISA, and for anti-HSV-2 IgG antibodies following a two-test algorithm: HerpeSelect® 2 ELISA to test the sera, and Euroline-WB to confirm positive and equivocal specimens. Logistic regressions were conducted to estimate unadjusted and adjusted infection odds ratios. Results: Serological testing for HSV-1/2 was performed on 2522 specimens. Sero-positivity for HSV-1 and HSV-2 was identified in 2053 (81.5%) and 87 (3.5%) specimens, respectively. Univariable analyses estimated higher odds of HSV-2 infection with increasing age and increasing country income level, and an unadjusted odds ratio with HSV-1 sero-positivity of 0.71 (95% CI 0.43–1.17; p-value 0.172). Adjusting for age and country income level, the adjusted odds ratio of HSV-2 infection with HSV-1 sero-positivity was 0.51 (95% CI 0.30–0.87; p-value 0.013). Sensitivity analyses confirmed this association. Conclusions: There is a negative association between HSV-1 and HSV-2 infections, suggestive of a protective effect for HSV-1 sero-positivity against HSV-2 acquisition. This finding supports earlier pooled but inconclusive evidence from prospective studies, yet contrasts with pooled findings of earlier cross-sectional studies.

Original languageEnglish
Article numbere02549
Issue number10
Publication statusPublished - Oct 2019



  • Asia
  • Epidemiological association
  • Epidemiology
  • Herpes
  • Infectious disease
  • Interaction
  • Middle East and North Africa
  • Prevalence
  • Serological testing
  • Sexually transmitted infection
  • Virology

ASJC Scopus subject areas

  • General

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