Herpes Simplex Virus Type 2 in the United States, 1976 to 1994

doi:10.1056/NEJM199710163371601

Volume 337:1105-1111		October 16, 1997		Number 16

Herpes Simplex Virus Type 2 in the United States, 1976 to 1994

Douglas T. Fleming, M.D., Geraldine M. McQuillan, Ph.D., Robert E. Johnson, M.D., M.P.H., André J. Nahmias, M.D., M.P.H., Sevgi O. Aral, Ph.D., Francis K. Lee, Ph.D., and Michael E. St. Louis, M.D.

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ABSTRACT

Background Herpes simplex virus type 2 (HSV-2) infection isusually transmitted sexually and can cause recurrent, painfulgenital ulcers. In neonates the infection is potentially lethal.We investigated the seroprevalence and correlates of HSV-2 infectionin the United States and identified changes in HSV-2 seroprevalencesince the late 1970s.

Methods Serum samples and questionnaire data were collectedduring the National Health and Nutrition Examination Surveys(NHANES) II (1976 to 1980) and III (1988 to 1994). HSV-2 antibodywas assessed with an immunodot assay specific for glycoproteingG-2 of HSV-2.

Results From 1988 to 1994, the seroprevalence of HSV-2 in persons12 years of age or older in the United States was 21.9 percent(95 percent confidence interval, 20.2 to 23.6 percent), correspondingto 45 million infected people in the noninstitutionalized civilianpopulation. The seroprevalence was higher among women (25.6percent) than men (17.8 percent) and higher among blacks (45.9percent) than whites (17.6 percent). Less than 10 percent ofall those who were seropositive reported a history of genitalherpes infection. In a multivariate model, the independent predictorsof HSV-2 seropositivity were female sex, black race or Mexican-Americanethnic background, older age, less education, poverty, cocaineuse, and a greater lifetime number of sexual partners. As comparedwith the period from 1976 to 1980, the age-adjusted seroprevalenceof HSV-2 rose 30 percent (95 percent confidence interval, 15.8to 45.8 percent). The seroprevalence quintupled among whiteteenagers and doubled among whites in their twenties. Amongblacks and older whites, the increases were smaller.

Conclusions Since the late 1970s, the prevalence of HSV-2 infectionhas increased by 30 percent, and HSV-2 is now detectable inroughly one of five persons 12 years of age or older nationwide.Improvements in the prevention of HSV-2 infection are needed,particularly since genital ulcers may facilitate the transmissionof the human immunodeficiency virus.

Source Information

From the Division of STD Prevention, National Center for HIV, STD and TB Prevention (D.T.F., R.E.J., S.O.A., M.E.S.L.), the National Center for Health Statistics (G.M.M.), and the Epidemic Intelligence Service, Epidemiology Program Office (D.T.F.), Centers for Disease Control and Prevention, Atlanta; and from the Emory University School of Medicine, Atlanta (A.J.N., F.K.L.).

Address reprint requests to Dr. St. Louis at the Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Mailstop E-02, 1600 Clifton Rd., Atlanta, GA 30333.

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