BERLIN — Consistent use of condoms has a moderate protective effect against acquisition of herpes simplex virus 2, the leading cause of genital ulcer disease worldwide.
A recent pooled analysis of six prospective studies concluded that men and women who used condoms 100% of the time during sex had a 30% lower risk of HSV-2 acquisition than people who never used condoms, Dr. Laurence Le Cleach said at the annual congress of the European Academy of Dermatology and Venereology.
The pooled analysis by investigators at the University of Washington, Seattle, showed that the relationship between condom usage and HSV-2 acquisition was roughly linear. Thus, individuals who used condoms one-quarter of the time they engaged in vaginal or anal intercourse had a 7% lower relative risk of HSV-2 acquisition than never users, while those who used condoms half the time had roughly a 15% risk reduction, noted Dr. Le Cleach of Central Hospital South in Corbeil-Essonnes, France.
The analysis included three HSV-2 candidate vaccine trials, an antiviral drug study, a behavioral intervention trial, and an observational study. Collectively, the studies involved 5,384 participants who were HSV-2–negative at baseline. During more than 2 million days of follow-up, 415 laboratory-confirmed cases of HSV-2 infection occurred (Arch. Intern. Med. 2009;169:1233–40).
The impetus for the analysis was a report by a National Institute of Allergy and Infectious Diseases panel that there was insufficient evidence to conclude condoms prevent HSV-2 acquisition. The pooled analysis provides solid data demonstrating that there is, in fact, a benefit. Physician recommendations to both men and women in serodiscordant relationships that they consistently use condoms to reduce their risk of HSV-2 acquisition would have a substantial public health benefit, she said.
The 30% reduction in risk of HSV-2 acquisition with consistent use of condoms is a considerably less robust protective effect than shown in other studies involving the use of condoms to protect against other sexually transmitted infections. The explanation is thought to be that HIV is transmitted through contact with bodily fluids, while HSV-2 can be transmitted through skin-to-skin or skin-to-mucosa contact involving surfaces not covered by the condom.