Epidemiology of herpes simplex virus type 2 in the Middle East and North Africa: Systematic review, meta‐analyses, and meta‐regressions

Abstract

AbstractHerpes simplex virus type 2 (HSV‐2) infection is a prevalent, sexually transmitted infection with poorly characterized prevalence in the Middle East and North Africa (MENA) region. This study characterized HSV‐2 epidemiology in MENA. HSV‐2 reports were systematically reviewed as guided by the Cochrane Collaboration Handbook and findings were reported following PRISMA guidelines. Random‐effects meta‐analyses and meta‐regressions were performed to estimate pooled mean outcome measures and to assess predictors of HSV‐2 antibody prevalence (seroprevalence), trends in seroprevalence, and between‐study heterogeneity. In total, sixty‐one overall (133 stratified) HSV‐2 seroprevalence measures and two overall (four stratified) proportion measures of HSV‐2 detection in laboratory‐confirmed genital herpes were extracted from 37 relevant publications. Pooled mean seroprevalence was 5.1% (95% confidence interval [CI]: 3.6%–6.8%) among general populations, 13.3% (95% CI: 8.6%–18.7%) among intermediate‐risk populations, 20.6% (95% CI: 5.3%–42.3%) among female sex workers, and 18.3% (95% CI: 3.9%–39.4%) among male sex workers. Compared to Fertile Crescent countries, seroprevalence was 3.39‐fold (95% CI: 1.86–6.20) and 3.90‐fold (95% CI: 1.78–8.57) higher in Maghreb and Horn of Africa countries, respectively. Compared to studies published before 2010, seroprevalence was 1.73‐fold (95% CI: 1.00–2.99) higher in studies published after 2015. Pooled mean proportion of HSV‐2 detection in genital herpes was 73.8% (95% CI: 42.2%–95.9%). In conclusion, MENA has a lower HSV‐2 seroprevalence than other world regions. Yet, 1 in 20 adults is chronically infected, despite conservative prevailing sexual norms. Seroprevalence may also be increasing, unlike other world regions. Findings support the need for expansion of surveillance and monitoring of HSV‐2 infection in MENA.