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PubMed1987

Syphilis in women of reproductive age in Mogadishu, Somalia: serological survey.

In Mogadishu, Somalia 223 women of childbearing age, including prostitutes, were tested for serum markers for syphilis by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum haemagglutination assay (TPHA). Sera reactive in either of these tests were tested for IgM antibodies by solid phase haemadsorption assay (SPHA). Three per cent of sera from 67 pregnant women and none of those from 71 educated women gave positive results that were confirmed with the TPHA. In contrast, 58% of sera from 85 prostitutes were confirmed as being positive, 26% of which were SPHA positive, which indicated active syphilis. The proportion of TPHA positive sera increased with age among the prostitutes. As venereal syphilis is highly prevalent in prostitutes in Mogadishu, a strategy of intervention based on screening followed by treatment seems to be indispensable.

Adolescent↗
PubMed1990

Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission.

Epidemiologic studies in Nairobi and elsewhere in Africa, have shown that men infected with HIV-1 more commonly have a history of genital ulcer disease compared to uninfected men. In one study, HIV infected men were three times as likely to have a recent history of genital ulcers. In a prospective study of seronegative men, those presenting with chancroid had a five-fold risk of seroconversion during follow-up compared to men presenting with urethritis. Uncircumcised men had an increased risk of seroconversion which was independent of their risk of genital ulcer disease. Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin. Genital ulcers are a major risk factor for HIV infection among prostitutes. The increased risk is about 10-fold among prostitutes with ulcers compared to a cohort who did not. We hypothesize from these studies that genital ulcers are the major portals of entry for HIV infection and also increased shedding of virus infected cells into the vaginal secretions. HIV seropositive prostitutes are more susceptible to chancroid with a two-fold increase in the prevalence of genital ulcers as compared to HIV negative women. The use of condoms by their clients prevents both genital ulcer disease and HIV acquisition among prostitutes. Chancroid is more difficult to treat in HIV infected men with one-third of patients failing single dose treatment regimens as compared to less than five percent of men without HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence↗
PubMed1993

Knowledge and attitudes about AIDS: a comparative study of Thais involved in sexual occupations, university students and immigrants living in the United States.

Knowledge about AIDS among: (a) 89 individuals involved in prostitution related occupations, (b) 465 university students, and (c) 220 Thais living in the United States was assessed to further evaluate the efficacy of Thailand's AIDS educational programs. While the average number of items answered correctly by the three groups were not equivalent (p < 0.001), all participants possessed substantial factual AIDS knowledge. As predicted, those involved in prostitution had the least accurate information (92% correct). Contrary to initial hypothesizing, however, AIDS knowledge was identical (95%) for the samples of university students living in Thailand and Thais who have been exposed to intensive AIDS information campaigns in the United States. Taken together, these findings suggest that Thailand's AIDS educational efforts have achieved considerable success. Television, newspapers, and radio provided information for most participants while a few learned about AIDS from their physician or in educational institutions. A majority expressed interest in improving their understanding about AIDS. The extent of infection among prostitutes appears to be high with nearly one-quarter of those in the sexual occupations group reporting that they knew someone with the disease. Techniques to better inform prostitutes about AIDS are discussed and a common outcome instrument to measure AIDS knowledge and attitudes is recommended.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Prevalence of Kaposi's sarcoma-associated herpesvirus infection in sex workers and women from the general population in Spain.

Transmission routes of Kaposi's sarcoma-associated herpesvirus (KSHV) in the general population are poorly understood. Whereas sexual transmission appears to be common in homosexual men, the evidence for heterosexual transmission is less convincing. In our study, prevalence of KSHV infection was examined among women in the Spanish general population and among sex workers. Subjects consisted of 100 prostitutes and 100 women randomly sampled from the general population and age-matched to the prostitutes. Women had a personal interview and gynecologic examinations in which a blood sample, cervical cells and oral cells were obtained. Peripheral blood mononuclear cells (PBMC), oral and cervical samples were tested for KSHV DNA by quantitative real-time PCR. Sera were tested for antibodies against human immunodeficiency virus (HIV) by ELISA and against KSHV by latent IFA and K8.1 ELISA. Women who were positive in either serologic assay or PCR were considered infected by KSHV. Human papillomavirus (HPV) DNA in cervical scrapes were evaluated using the Hybrid Capture System. The study population had an average age of 30 years and were HIV-negative. Women from the general population were largely of Spanish nationality, and 61% reported lifetime monogamy. The majority of the prostitutes (76%) were immigrants, primarily from South America. Sex workers were twice as likely to be infected with KSHV than women in the general population (16% vs. 8%, prevalence odds ratio [OR] = 2.2). KSHV was more prevalent among HPV DNA-positive women (OR = 2.5) and among women with an early age at first sexual intercourse (OR = 2.7, p < 0.05). KSHV DNA was detected by PCR in 3% of the oral cavity samples, in 2% of the cervical samples of the prostitutes and in 1% of the cervical samples of women in the general population. All PBMC samples were negative. These results suggest that in low-risk countries for KSHV, oral shedding and heterosexual contacts are potential pathways for KSHV transmission.

Adult↗
PubMed1993

Hepatitis C virus infection among sexually promiscuous groups and the heterosexual partners of hepatitis C virus infected index cases.

To define the role of sexual transmission in the spread of hepatitis C virus (HCV) infection, a seroprevalence study of antibodies against HCV was performed in populations at high risk for sexually transmitted diseases. Subjects included 310 female prostitutes, 88 clients of prostitutes, 168 homosexual men and 147 stable heterosexual partners of index cases reactive for anti-HCV (98 of whom were partners of drug addicts coinfected with HCV and human immunodeficiency virus [HIV]). All subjects denied prior transfusion or intravenous drug use. Controls were 400 voluntary blood donors selected randomly from first-time donors. The prevalence of anti-HCV by enzyme immunoassay, confirmed by a second-generation recombinant immunoblot assay, was 6.4% in prostitutes, 6.8% in clients of prostitutes, 4.2% in homosexual men, 7.4% in heterosexual partners of index cases and 1.2% in random donors. However, the anti-HCV prevalence in stable heterosexual partners of HCV-positive/HIV-positive index cases was 2.2 times higher than in stable heterosexual partners of index cases reactive for anti-HCV only (9.2% vs. 4.1%), and sexual partners of index cases coinfected with HCV and HIV were almost three times more likely to be infected with HIV than with HCV (25.5% vs. 9.2%). These data suggest that HCV infection may be sexually transmitted but with low efficiency and that this efficiency could be increased in the presence of coexistent HIV infection in the index case.

Adolescent↗
PubMed2002

[Human herpesvirus-8 detection in Kaposi's sarcoma, multiple myeloma, and lymphoproliferative syndromes occurring in immunocompetent and immunocompromised patients].

BACKGROUND: The purposes of this study were: to study the presence of human herpesvirus-8 (HHV-8) in different Kaposi's sarcoma (KS) epidemiological groups, multiple myeloma (MM), and immunodeficiency-associated lymphoid proliferations; to investigate the potential sexual transmission of HHV-8 by analyzing its presence in women from the general population, human immunodeficiency virus (HIV) seropositive women, and prostitutes; and to establish a reliable and efficient PCR strategy for the detection of HHV-8. PATIENTS AND METHODS: HHV-8 detection was performed by PCR and positive cases were confirmed by automatic bi-directional sequencing. We selected 25 KS, 70 immunodeficiency associated non-Hodgkin's lymphomas (NHL), 30 HIV-positive Hodgkin's lymphomas (HL), and 2 primary effusion lymphomas (PEL). Bone marrow aspirates were available from 41 MM, 9 monoclonal gammopathies of undetermined significance and 24 patients with other disorders. Bone marrow dendritic cell cultures from 12 MM patients were also performed. Cells from cervical, anal, and oral cavity scrapes were examined for the presence of HHV-8 in 40 control women, 10 HIV-seropositive women, and 20 HIV-seronegative prostitutes. Serologic tests were also performed. RESULTS: HHV-8 was specifically detected in 100% KS and PEL, and in 5.7% immunodeficiency associated NHL. All cases of HIV-HL and MM were HHV-8 negative. Antibodies against HHV-8 were found in 10% of control women, 10% HIV-positive women, and 25% prostitutes. Only 1 sample was positive for HHV-8 by PCR. CONCLUSIONS: HHV-8 is associated with all epidemiological forms of KS; HHV-8 does not contribute to the pathogenesis of MM, and this virus is not ubiquitous in the human population. Seroprevalence of HHV-8 is increased in prostitutes, although this may partially be attributed to the geographical origin. For a reliable PCR detection of HHV-8, it is necessary to target different regions of the viral genome and to sequence amplification products.

Anal Canal↗
PubMed1986

HTLV-III infection among 315 intravenous drug abusers: seroepidemiological, clinical, and pathological findings.

Seroepidemiological, clinical, immunological, and pathological features were studied in 315 intravenous drug abusers (IVDA) seen in five centers for drug addicts' assistance in the Friuli Venezia-Giulia region of Italy, close to the borders of Austria and Yugoslavia. No case of AIDS has been observed. Sixty-five (21%) were affected by persistent generalized lymphadenopathy (PGL). HTLV-III seropositivity was noted in 86 (27%) of the overall 315 IVDA, in 50 (77%) of 65 patients with PGL, and in 1 (0.5%) of 205 blood donors tested as a control group. Patients with PGL had a significantly lower OKT4/OKT8 ratio than the rest of the IVDA population and controls. Systemic symptoms were present in 52% of the patients with PGL, the most frequent symptoms being fatigue and night sweats. In 20 patients with PGL, DR typing revealed a significant increase in DR-5 frequency and a significant decrease of DR-2 frequency. The predominant histological features in the lymph nodes taken from 25 patients consisted of an exuberant follicular hyperplasia, capillary vessel proliferation, and plasmacytosis. Nineteen (22%) females reporting occasional prostitution were compared to 10 non-IVDA female prostitutes and concomitantly evaluated. HTLV-III seropositivity was noted in 11 (58%) of 19 IVDA female prostitutes and in none of the 10 non-IVDA prostitutes. Thirty-five couples composed of both IVDA were compared to 24 couples composed of an IVDA and a non-IVDA. Among the 24 couples of whom one or both partners were seropositive, concordance in HTLV-III seropositivity was present in 5/11 (45%) couples composed of both IVDA, and in only 1/13 (8%) couples composed of an IVDA and a non-IVDA. This suggests that the sharing of contaminated needles, universally practiced by our IVDA population, plays a more important role in the transmission of HTLV-III than sexual contact.

AIDS-Related Complex↗
PubMed1999

Analysis of herpes simplex virus 1 and 2 infection in women with high risk sexual behaviour in Mexico.

BACKGROUND: This paper describes the seroprevalence and risk factors of Herpes simplex virus (HSV) infection in a group of female prostitutes from Mexico City. METHODS: Women who consented to participate in the study voluntarily attended a sexually transmitted disease (STD) clinic during 1992. A standardized questionnaire was administered and a blood sample was obtained from each participant. Type-specific Western blot serology was performed to determine the serostatus of HSV-1 and HSV-2 for participants. Bivariate and multivariate analyses were applied to identify variables associated with an increased risk for HSV infection. RESULTS: Prevalences of infection among the 997 prostitutes studied were 93.9% for HSV-1 and 60.8% for HSV-2. Only 1.8% of the women were seronegative for both viruses. The only variable associated with HSV-1 seropositivity was crowding index. The following variables were associated with an increased risk for infection with HSV-2: age, level of education, working site, born outside Mexico City and increasing time as a prostitute. CONCLUSIONS: This is the first assessment of HSV infection in Mexico and may be useful for the development and application of control and preventive measures among the prostitute population at risk of acquiring and transmitting human immunodeficiency virus (HIV) and other STD.

Adolescent↗
PubMed1987

Retrospective seroepidemiology of AIDS virus infection in Nairobi populations.

Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Prevalence of antibody to human T cell leukemia virus type 1 (HTLV-1) in populations of Ivory Coast, West Africa.

A large cross-sectional serologic survey for human T cell leukemia virus type 1 (HTLV-1) antibody was conducted in 3,177 Ivory Coast residents to evaluate the prevalence of HTLV-1 and to determine possible risk factors and correlates of HTLV-1 infection. Of the 3,177 serum samples, 110 (3.5%) were positive for antibody to HTLV-1 by indirect immunofluorescence assay and Western blot. The prevalence of HTLV-1 antibody in the general adult population was 1.8% and increased significantly with age. No difference between males (1.5%) and females (2%) was found. The highest prevalences were observed in female prostitutes (7.4%), patients with neurologic syndromes (5.8%), and lepers (13.7%). The high prevalence of HTLV-1 infection in prostitutes suggests that heterosexual contact is involved in the transmission of HTLV-1 and that prostitutes could play an important role in the spread of the virus in Africa. The high prevalence of HTLV-1 in patients with neurologic syndromes confirms the association between HTLV-1 and some type of neuropathies, as has been observed in the West Indies and Japan. The high prevalence observed in lepers deserves further investigation to find the cause of the association. Twenty-five individuals, including prostitutes, were coinfected with HTLV-1 and human immunodeficiency virus (HIV). Prospective studies are necessary to evaluate the exact role of HTLV-1 alone or in combination with HIV in inducing specific diseases.

Child↗
PubMed2003

Prevalence of HIV and other sexually transmitted infections, and risk behaviours in unregistered sex workers in Dakar, Senegal.

OBJECTIVES: To estimate the prevalence rates of HIV and other sexually transmitted infections (STI) among unregistered sex workers, and to describe their sociodemographic characteristics and sexual behaviours, and the reasons why they were not officially registered as sex workers, in order to design specific public health interventions. METHODS: A one-stage cluster-sample survey was conducted in Dakar in 2000. Unregistered sex workers were interviewed in randomly selected establishments (official and clandestine bars, brothels and nightclubs), and blood, endocervical and vaginal samples were collected for laboratory diagnosis. RESULTS: A total of 390 women with a median age of 29 years were recruited. One-seventh of them were under the legal age for prostitution in Senegal (21 years). The median length of prostitution was 24 months and 73.5% of the women stated regular prostitution. Three-quarters of the women were found to have markers for at least one infection. The prevalence rates were as follows: HIV-1, 6.0%; HIV-2, 3.6%; HIV-1+2, 0.4%; syphilis, 23.8%; gonorrhea, 22.0%; chlamydial infection, 20.0%; trichomoniasis, 22.4%; candidiasis, 19.0%; and bacterial vaginosis, 28.8%. The main reported reason for non-registration was ignorance of the legal system and its procedures (19.4%); 18.9% of the women refused to register. One-third of the women reported that their clients used condoms inconsistently or never. CONCLUSION: This survey suggests that a multidimensional public health response is needed in Senegal, comprising legal information, downwards revision of the legal age for prostitution, and specific medical follow-up based on education, condom promotion and management of STI for non-registered sex workers.

Adult↗
PubMedDate not supplied

The use and physical effects of intravaginal substances in Zairian women.

Women in Kananga, Zaire, sometimes insert substances into the vagina to enhance sexual pleasure. The objective of this study was to ascertain: 1) what intravaginal substances are used, 2) the prevalence and frequency of their use, and 3) the visible effects they produce on the female genitalia. Focus group discussions with women and men were conducted, and both prostitutes and non-prostitutes were interviewed individually about their sexual preferences and practices. The cervices and vaginae of eight women were inspected and photographed before and after the insertion of commonly used substances. It was found that Kananga residents preferred a "dry-tight" vagina during coitus. They named thirty substances (leaves and powders) that women insert to produce this sensation. Twenty-one of 50 prostitutes (42%), and 17 of 49 non-prostitutes (35%), had used such intravaginal substances. Inspection of the genitalia showed that five different leaves produced inflammatory reactions that lasted up to a week. These genital irritations might facilitate the transmission of pathogenic organisms. Investigators elsewhere should study the use of intravaginal substances and their relationship to sexually transmitted diseases.

Administration, Intravaginal↗
PubMed1999

Invoking, monitoring, and relinquishing a public health power: the health hold order.

OBJECTIVE: To describe a quarter-century's use of a public health power (Health Hold Orders) as an adjunct to noncoercive sexually transmitted disease (STD) control efforts in a middle-American city. METHODS: Persons arrested for prostitution were involuntarily detained for up to 72 hours if they had not been tested for STD within 30 days of arrest. Such persons were mandatorily tested/treated for STD and voluntarily tested for HIV by health department providers in Colorado Springs from mid-1970 through 1994. RESULTS: Prostitutes viewed temporary detention as inconvenient, but not as inappropriate. Over the 25-year interval, 4,965 examinations in prostitutes yielded 818 positive gonorrhea tests; the 1,564 tests performed under the health-hold order yielded 218 positive results. Positivity rates among prostitutes locally for reportable STD/HIV declined substantially during the period of observation, providing support for termination of the involuntary detention system. CONCLUSIONS: The involuntary detention system contributed to observed communitywide declines in STD/HIV prevalence. Our experience demonstrates the importance of surveillance and empiric validation in public health practice.

AIDS Serodiagnosis↗
PubMed1989

The sex industry, alcohol and illicit drugs: implications for the spread of HIV infection.

A review is presented of the association between the sex industry and the use and misuse of alcohol and illicit drugs. It is concluded that both the latter are associated with 'high risk' sexual activities and that heavy drinking and illicit drug use are commonplace amongst prostitutes and their clients. Outside Africa evidence suggests that in some, though by no means all, areas prostitutes have low or zero levels of HIV seropositivity. It is concluded that far more information is needed on the patterns of AIDS-related knowledge, beliefs, attitudes and behaviours amongst male and female prostitutes and their clients. Vigorous policies are needed to increase levels of knowledge about AIDS risks amongst prostitutes and their clients and to foster the adoption of 'safer sex' practices.

Acquired Immunodeficiency Syndrome↗
PubMed1994

High rate of nonspecific anti-hepatitis C reactivity amongst homosexual men in comparison with that found in other sexually active groups and blood donors. Viral Hepatitis and AIDS Study Group.

OBJECTIVES: To investigate the concordance of anti-hepatitis C virus (anti-HCV) reactivity by a second-generation enzyme immunoassay (EIA-2) and by a four-antigen recombinant immunoblot assay (4-RIBA) in homosexual men, in comparison with that found in other sexually active groups and blood donors. DESIGN: Prospective study. SETTING: Tertiary referral centre, Seville, Spain. SUBJECTS: A total of 1203 subjects were studied. Eight hundred and three were sexually active individuals: 547 female prostitutes, 88 heterosexual men who had frequent sexual intercourse with prostitutes, and 168 homosexual men. All of them denied blood transfusion and parenteral drug use. In addition, 400 voluntary blood donors were selected at random. MAIN OUTCOME MEASURES: All serum samples were screened for anti-HCV by EIA-2 and repeatedly reactive sera were tested by 4-RIBA. Homosexual men were also screened for anti-human immunodeficiency virus (anti-HIV), hepatitis B virus (HBV) markers and gammaglobulin concentration. Finally, serum samples from homosexual men reactive for anti-HCV by EIA-2 were analyzed for HCV-RNA by polymerase chain reaction (PCR). RESULTS: Concordance between EIA-2 and 4-RIBA in female prostitutes (71.4%), clients of prostitutes (75.0%), and blood donors (83.3%) was significantly higher than in homosexual men (38.8%) (P < 0.04). In this collective the concordance between 4-RIBA and PCR was 85.7% for positive cases and 88.8% for negative ones, and EIA-2 ratios in reactive sera were significantly higher in 4-RIBA confirmed cases (P < 0.0001). No correlation between false positive EIA-2 results and presence of HIV infection, HBV markers or hypergammaglobulinaemia was found in homosexual men by univariate analysis. CONCLUSIONS: There is a high level of non-specific anti-HCV reactivity by EIA-2 amongst homosexual men in comparison with that found in other sexually active groups and blood donors. The true prevalence of HCV infection amongst homosexual men could be even lower than previously described.

Adult↗
PubMed1997

Decreasing hepatitis D virus infection in Taiwan: an analysis of contributory factors.

Superinfection of hepatitis D virus (HDV) among hepatitis B virus (HBV) carriers is mainly through heterosexual contact in Taiwan. This study investigated the change of HDV endemicity and its associated contributory factors. Seventy-seven patients with acute HDV superinfection among 527 consecutive exacerbating hepatitis B surface antigen (HBsAg) carriers were identified over the past 12 years. The prevalence decreased significantly by each 3-year period from June 1983 to May 1995 (23.7, 15.5, 13.1 and 4.2%, respectively, P < 0.001). This trend was more significant in the hepatitis B e antigen (HBeAg)-negative group (P < 0.001) than in the HBeAg-positive group (P = 0.073). Subjects with a history of paid sex and prostitutes were also recruited for analysis both in 1989 and 1996. Although not statistically significant, there was a trend showing a decrease in the prevalence of serum antibody against HDV (anti-HDV) in each risk group: it was lower in 1996 among HBsAg-positive brothel-goers (10.3 vs 6.9%), licensed prostitutes (54.5 vs 50%) and unlicensed prostitutes (36.1 vs 30.8%). Accumulation of anti-HDV-positive subjects in risk groups may mask the actual decrease of new HDV-infected cases. The prevalence of the HBsAg carrier rate among all prostitutes has significantly decreased (18.3 vs 12.2%, P = 0.015). The efficacy of each preventive strategy was examined and mapped with the trend. It was concluded that active preventive measures directed against promiscuity and sexually transmitted disease and the promotion of disposable needles may have contributed to the decrease in HDV endemicity.

Adolescent↗
PubMed1986

Effect of ano-receptive homosexual practice on T lymphocytes and delayed hypersensitivity in transsexuals.

To determine whether ano-receptive sexual intercourse adversely affects a person's cellular immunity, we compared several immunological parameters among 100 transsexual male prostitutes and 40 heterosexual male controls, and also among different durations of prostitution. The mean ratios of CD-4 (helper/inducer) lymphocytes to CD-8 (suppressor/cytotoxic) lymphocytes and the delayed-type cutaneous hypersensitivity (DTH) scores were significantly lower in transsexuals than they were in heterosexual controls; these parameters also showed a decreasing trend with increasing duration of prostitution. Transsexuals have a significantly higher CD-8 lymphocyte count than have heterosexuals. No significant differences between transsexuals and heterosexuals were found for lymphocyte counts, pan T cells, and CD-4 cell counts. We postulate that in these subjects cellular immunity is progressively reduced, probably through repeated and prolonged antigenic challenge via receptive anal intercourse. The impairment in cellular immunity is associated with the duration of prostitution, independent of the man's age.

Adult↗
PubMed2002

Evaluation of confirmatory strategies for detection of type-specific antibodies against herpes simplex virus type 2.

In this study, the optimal combination of three commercial glycoprotein G-2 (gG-2)-based herpes simplex virus type 2 (HSV-2) type-specific enzyme-linked immunosorbent assays (Euroimmun anti-HSV-2 immunoglobulin G [IgG] ELISA [Eu2], Gull HSV-2-specific IgG ELISA [Gu2], and Radim HSV-2 IgG ELISA [Ra2]) and one gG-2-based HSV-2-specific immunoblot (Euroimmun anti-HSV-1/HSV-2 gG Western blot [EuW]) was determined with regard to diagnostic performance and cost efficiency. Two hundred fifty serum samples were included in this study, 194 of which were from female prostitutes. When a formal primary "gold standard" was defined based on majority agreement of the commercial tests, with EuW being decisive in stand-off situations, the sensitivity and specificity of the assays in the samples from prostitutes were as follows: Eu2, 100 and 89.22%; Gu2, 94.44 and 96.08%; Ra2, 61.18 and 95.10%; and EuW, 98.90 and 100%. The most cost-effective confirmatory strategy in the samples from prostitutes was screening with Eu2, retesting positive and equivocal samples with Gu2, and resolving the remaining discordant results with EuW (estimated additional costs per sample, 79.02%; sensitivity, 100%; positive predictive value, 96.81%). Applying a self-developed gG-2-independent assay to the discordant and concordant negative samples in the samples from prostitutes suggested that the primary gold standard may have missed six HSV-2-positive samples. In conclusion, confirmatory strategies based on commercial gG-2-dependent seroassays result in an increase in the specificity of HSV-2-specific serology. However, further improvement of the sensitivity of current HSV-2-specific serology may require the additional exploitation of the gG-2-independent type-specific antibody response.

Antibodies, Viral↗