Australian Herpes Management Forum

Research Update: Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States

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September 2006

What's known?

HSV type 1 and 2 can cause either anogenital or oropharyngeal infection.

HSV-1 has become an increasingly common cause of clinical anogenital herpes in developed countries.

Pre-existing HSV-1 antibodies can alleviate clinical manifestations of subsequently acquired HSV-2

What’s New?

Cross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys [NHANES], were used to compare national HSV seroprevalence estimates from 1999-2004 with those from 1988-1994.

The analyses included 9165 persons from 1988-1994 survey and 11508 persons from 1999-2004 survey who were aged 14 to 49 years.

The overall age-adjusted HSV-2 seroprevalence was 17.0% in 1999-2004 and 21.0% in 1988-1994, a relative decrease of 19.0% between the 2 surveys (95% CI, –28.6% to –9.5%; P<.001).

The decrease in HSV-2 seroprevalence was concentrated in younger age groups.

Overall decrease was greater in males (31.9%) than in females (19.4%)

Among those infected with HSV-2, the percentage who reported having been diagnosed with genital herpes was statistically different (14.3% in 1999-2004 and 9.9% in 1988-1994; P = .02).

Seroprevalence of HSV-1 decreased from 62.0 in 1988-1994 to 57.7% in 1999-2004, a relative decrease of 6.9% between the 2 surveys (95% CI, –11.6% to –2.3%; P = .006).

Among persons infected with HSV-1 but not with HSV-2, a higher percentage reported having been diagnosed with genital herpes in 1999-2004 compared with 1988-1994 (1.8% vs 0.4%, respectively; P<.001).

The authors have suggested that the reasons for significant decrease in HSV-2 seroprevalence even after accounting for changes in measured sexual behaviour may include factors such as careful partner selection, condom use and or choosing oral sex over vaginal sex.

The changing HSV-1 seroprevalence may also have an impact on genital herpes as declines in HSV acquisition before onset of sexual activity will leave more individuals susceptible to genitally acquired HSV-1 infection when they become sexually active. Also, more individuals will acquire HSV-2 without HSV-1 antibodies. Confirmation of HSV type may contribute to optimal management of patients with symptomatic genital herpes.

Reference

Fujie Xu, Maya R. Sternberg, Benny J. Kottiri, Geraldine M. McQuillan, Francis K. Lee, Andre J. Nahmias, Stuart M. Berman, Lauri E. Markowitz. Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States. JAMA; 296:964–973.

Link

The abstract of paper is available at http://jama.ama-assn.org/cgi/content/abstract/296/8/964

The full text is available at http://jama.ama-assn.org/cgi/content/full/296/8/964 (Subscription to JAMA or one-off payment required).

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