Genital Herpes Affects Approximately 16% of Americans Aged 14 to 49 Years

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Genital Herpes Affects Approximately 16% of Americans Aged 14 to 49 Years

April 23, 2010 — Genital herpes affects approximately 16% of Americans aged 14 to 49 years, according to a report of seroprevalence of herpes simplex virus type 2 (HSV-2) from 2005 to 2008, published in the April 23 issue of the Morbidity and Mortality Weekly Report.

"[HSV-2] is one of the most common sexually transmitted infections worldwide and the primary cause of genital and neonatal herpes and genital ulcer disease," write F. Xu, MD, PhD, from the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and colleagues. "Multiple studies have shown that HSV-2 infection increases the risk for human immunodeficiency virus (HIV) infection by at least twofold. HSV-2 infection is lifelong, and serologic testing provides the best method to estimate HSV-2 prevalence."

The US Centers for Disease Control has monitored HSV-2 seroprevalence in the United States since 1976, using the National Health and Nutrition Examination Survey (NHANES). HSV-2 seroprevalence increased from 1976 - 1980 (NHANES II) to 1988 - 1994 (NHANES III) and then decreased, going from 21.0% in 1988 - 1994 to 17.0% in NHANES 1999 - 2004. In NHANES 2005 - 2008, overall HSV-2 seroprevalence was 16.2% among persons aged 14 to 49 years, which is not statistically different from the 1999 - 2004 seroprevalence.

Among those infected with HSV-2, 81.1% had not been diagnosed. Women and non-Hispanic blacks had the highest seroprevalence (20.9% and 39.2%, respectively), with prevalence among women almost twice that of men and prevalence 3 times higher among blacks than whites. Prevalence was lowest among Mexican-Americans.

These data reinforce findings from previous research indicating that racial disparities are likely perpetuated because of the higher prevalence of infection within black communities, the authors note in a statement. As a result, they add, blacks are at greater risk of exposure to genital herpes with any given sexual encounter.

The study findings, the authors say, warrant greater promotion of measures to prevent HSV-2 transmission, including limiting the number of sexual partners and consistent condom use.

An accompanying editorial note points out several limitations of this report, including the lack of sampling of military or institutionalized populations, limiting generalizability; lack of data regarding genital symptoms to determine the extent of symptomatic but undiagnosed HSV-2 infection; and an inability to determine coinfection with HSV-2 and HIV.

"Serologic HSV-2 testing is not recommended currently for the general population because of concerns related to test performance in low-prevalence settings and a lack of data regarding the benefits of screening," the editorial note concludes.

"Nonetheless, HSV serologic screening might be useful in selected populations at high risk, such as persons with multiple sex partners or HIV infection, and men who have sex with men. Additional research is needed to determine the benefits, feasibility, and cost effectiveness of serologic testing, alone or in combination with antiviral treatment, to prevent HSV-2 acquisition and transmission. Finally, research into development of an HSV-2 vaccine should continue and might result in a more effective preventive measure in the future."

Morb Mortal Wkly Rep. 2010;59:456-460.

http://www.medscape.com/viewarticle/720764