Risk factors for infection with herpes simplex virus type 2: Role of smoking, douching, uncircumcised males, and vaginal flora

Background. Herpes simplex virus type 2 (HSV-2), the primary cause of genital herpes, is one of the most prevalent sexually transmitted diseases worldwide. Epidemiologic serosurveys suggest that infections occur more frequently in women than in men. Goal: The goal of the study was to identify unique correlates of HSV-2 infection in women that might contribute to their increased susceptibility of infection or suggest opportunities for decreasing the incidence of disease. Study Design: We enrolled 1207 women aged 18 to 30 years from three Pittsburgh health clinics in a cross-sectional study. Each woman provided demographic and behavioral information, vaginal swab specimens for bacterial culture, a vaginal smear for Gram stain diagnosis of bacterial vaginosis, and blood for HSV-1 and HSV-2 serology. Results: Black race, older age, cigarette smoking, douching, a greater number of lifetime sex partners, a history of intercourse with an uncircumcised partner, the presence of vaginal group B Streptococcus, and abnormal vaginal flora were among the independent predictors of HSV-2 infection. Conclusion: HSV-2 infection may be occur more often in women who douche, smoke, have sex with uncircumcised partners, or have bacterial vaginosis; these represent alterable risk factors.