Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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  Table of Contents  
Year : 2020  |  Volume : 41  |  Issue : 2  |  Page : 219-221

Partner age difference and sociodemographic correlates of herpes simplex virus type 2 seropositivity: A community-based study in South India

1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
2 Public Health Research Institute of India, Mysore, Karnataka, India
3 David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles, California, USA
4 Public Health Research Institute of India, Mysore, Karnataka, India; Department of Health Promotion Sciences Mel & Enid Zuckerman College of Public Health, University of Arizona, Tuscon, Arizona
5 Department of Anthropology, Ball State University, Muncie, Indiana, USA

Date of Submission31-Oct-2018
Date of Decision10-Feb-2019
Date of Acceptance16-Jun-2019
Date of Web Publication31-Jul-2020

Correspondence Address:
Dr. Caitlyn D Placek
Department of Anthropology, Ball State University, Burkhardt Building, Room No. 315, Muncie, Indiana 47306
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijstd.IJSTD_90_18

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How to cite this article:
Coudray MS, Degarege A, Khan A, Ravi K, Srinivas V, Klausner JD, Madhivanan P, Placek CD. Partner age difference and sociodemographic correlates of herpes simplex virus type 2 seropositivity: A community-based study in South India. Indian J Sex Transm Dis 2020;41:219-21

How to cite this URL:
Coudray MS, Degarege A, Khan A, Ravi K, Srinivas V, Klausner JD, Madhivanan P, Placek CD. Partner age difference and sociodemographic correlates of herpes simplex virus type 2 seropositivity: A community-based study in South India. Indian J Sex Transm Dis [serial online] 2020 [cited 2021 Apr 13];41:219-21. Available from:


Herpes simplex virus 2 (HSV-2) is one of the most prevalent sexually transmitted infections worldwide and is the leading cause of genital herpes and genital ulcer disease.[1] Studies have found that the seroprevalence of HSV-2 is lowest in Asia.[2] Age-disparate relationships (partner age difference of at least 5 years) have been shown to increase the risk of HIV and HSV-2 infections in sub-Saharan Africa in rural Zimbabwe and Uganda, where the prevalence of HIV/HSV-2 has been shown to be higher among women in age-disparate relationships.[3],[4],[5] Although past studies have explored numerous predisposing factors for HSV-2 infection, there is a paucity of data that explores the age difference between partners as a risk factor for HSV-2 infection in India. This study examined the role of age-disparate relationships in HSV-2 infection in South India.

The study was conducted in Mysore by the Public Health Research Institute of India (PHRII) in collaboration with partners from Florida International University. A type-specific enzyme-linked immunosorbent assay (ELISA) test was used to detect HSV-2 (Focus Diagnostics HerpeSelect® 2 ELISA Immunoglobulin G [IgG], Focus Technologies, Cypress, CA, USA) antibodies according to manufacturer's instructions. The laboratory where the HSV-2 testing was being conducted was overseen by a National Accreditation Board for Testing and Calibration Laboratories-accredited laboratory in Mysore to ensure that all the standard laboratory procedures were followed. Out of 351 individuals enrolled, 176 were women (50.14%), aged at least 25 years (77.8%), educated (≥1 year of schooling) (90.6%), married (96.3%), Hindu by religion (94.9%), and lived in urban areas (62.7%). Of the 351 individuals, 9.4% (95% confidence interval [CI]: 6.3%, 12.5%) had HSV-2 IgG antibodies. This study highlights an overlooked predictor of HSV-2 infection, i.e., age difference between partners.

The average age difference of the study participants with their sexual partner was 5.8 years (range: 0–25 years). The prevalence of HSV-2 infection was highest among individuals who had an age difference of 11–25 years (17.9%), followed by those with 6–10 years (13.9%) and 1–5 years (4.4%) with their sexual partner. The odds of HSV-2 infection increased among the study participants with an increase in the age difference with their sexual partner (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12). These odds remained significant after adjusting for sociodemographic variables, risky sexual behaviors, history of stress, and use of birth control (adjusted OR [aOR]: 1.22, 95% CI: 1.06, 1.40). The odds of HSV-2 infection was significantly lower among Hindus (9%) as compared to nonHindus (16.7%) (aOR: 0.19, 95% CI: 0.04, 0.84). Increasing age difference between sexual partners was associated with factors such as lower levels of condom use, increased frequency of sex, and long-lasting relationships.[6] These behavioral characteristics may be associated with higher rates of HIV transmission.[6] It is plausible that the same mechanism and factors can explain the increased odds of HSV-2 with increasing age difference between sexual partners. More research is needed to investigate the mechanisms seen in HIV transmission with respect to HSV-2 infection.

Despite several limitations (potential information bias and misclassification of HSV2 status, cross-sectional analysis, and nonprobability sampling), this study presents the first data (to our knowledge) which suggests that an increasing age difference between partners can predict HSV2 infection in South India, a phenomenon which is commonly observed with HIV. It is necessary to further explore the findings of this study in a larger population to ascertain the possible adverse effects of an increasing age difference between partners associated with HSV-2 infection and the potential social and medical implications.


The authors would like to thank the study participants, research assistants, and PHRII staff for their assistance in the study design and data collection process.

Financial support and sponsorship

Abraham Degarege was supported by Florida International University Dissertation Year Fellowship. Makella Coudray and Purnima Madhivanan were supported by the National Institutes of Health grant (R15AI28714-01). Caitlyn Placek was supported by the Global Health Equity Scholars Training Grant from Fogarty International Center at the National Institutes of Health (R25 TW009338). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Florida International University.

Conflicts of interest

There are no conflicts of interest.

   References Top

Johnston C, Corey L. Current concepts for genital herpes simplex virus infection: Diagnostics and pathogenesis of genital tract shedding. Clin Microbiol Rev 2016;29:149-61.  Back to cited text no. 1
Biswas D, Borkakoty B, Mahanta J, Walia K, Saikia L, Akoijam BS, et al. Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India. BMC Infect Dis 2011;11:325.  Back to cited text no. 2
Schaefer R, Gregson S, Eaton JW, Mugurungi O, Rhead R, Takaruza A, et al. Age-disparate relationships and HIV incidence in adolescent girls and young women: Evidence from Zimbabwe. AIDS 2017;31:1461-70.  Back to cited text no. 3
Kelly RJ, Gray RH, Sewankambo NK, Serwadda D, Wabwire-Mangen F, Lutalo T, et al. Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. J Acquir Immune Defic Syndr 2003;32:446-51.  Back to cited text no. 4
Bauer GR, Khobzi N, Coleman TA. Herpes simplex virus type 2 seropositivity and relationship status among U.S. adults age 20 to 49: A population-based analysis. BMC Infect Dis 2010;10:359.  Back to cited text no. 5
Beauclair R, Dushoff J, Delva W. Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi. BMC Public Health 2018;18:403.  Back to cited text no. 6


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