Can behavior change explain increases in the proportion of genital ulcers attributable to herpes in sub-Saharan Africa? A simulation modeling study

Sex Transm Dis. 2002 Apr;29(4):228-38. doi: 10.1097/00007435-200204000-00008.


Background: The proportion of cases of genital ulcer disease attributable to herpes simplex virus type 2 (HSV-2) appears to be increasing in sub-Saharan Africa.

Goal: To assess the contributions of HIV disease and behavioral response to the HIV epidemic to the increasing proportion of genital ulcer disease (GUD) attributable to HSV-2 in sub-Saharan Africa.

Study design: Simulations of the transmission dynamics of ulcerative sexually transmitted diseases (STDs) and HIV with use of the model STDSIM.

Results: In simulations, 28% of GUD was caused by HSV-2 before a severe HIV epidemic. If HIV disease was assumed to double the duration and frequency of HSV-2 recurrences, this proportion rose to 35% by year 2000. If stronger effects of HIV were assumed, this proportion rose further, but because of increased HSV-2 transmission this would shift the peak in HSV-2 seroprevalence to an unrealistically young age. A simulated 25% reduction in partner-change rates increased the proportion of GUD caused by HSV-2 to 56%, following relatively large decreases in chancroid and syphilis.

Conclusion: Behavioral change may make an important contribution to relative increases in genital herpes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Africa South of the Sahara / epidemiology
  • Disease Transmission, Infectious / statistics & numerical data*
  • Female
  • HIV Infections / complications
  • HIV Infections / epidemiology*
  • HIV Infections / etiology
  • HIV Infections / transmission*
  • Herpes Genitalis / complications
  • Herpes Genitalis / epidemiology*
  • Herpes Genitalis / etiology
  • Herpes Genitalis / transmission*
  • Herpesvirus 2, Human*
  • Humans
  • Male
  • Models, Statistical
  • Sexual Behavior*