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Trends in herpes simplex virus type 1 and type 2 seroprevalence in
the United States.
JAMA 2006; 296(8):964-973.
Xu F, Sternberb MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, Berman
SM, Markowitz LE.
Abstract
CONTEXT: Herpes simplex virus type 1 (HSV-1) and type 2 are common infections
worldwide. Herpes simplex virus type 2 (HSV-2) is the cause of most genital
herpes and is almost always sexually transmitted. In contrast, HSV-1 is usually
transmitted during childhood via nonsexual contacts. Preexisting HSV-1 antibodies
can alleviate clinical manifestations of subsequently acquired HSV-2. Furthermore,
HSV-1 has become an important cause of genital herpes in some developed countries.
OBJECTIVE: To examine trends in HSV-1 and HSV-2 seroprevalence in the United
States in 1999-2004 compared with 1988-1994. DESIGN, SETTINGS, AND PARTICIPANTS:
Cross-sectional, nationally representative surveys (US National Health and
Nutrition Examination Surveys [NHANES]), were used to compare national seroprevalence
estimates from 1999-2004 with those from 1988-1994, and changes in HSV-1
and HSV-2 seroprevalence since 1976-1980 were reviewed. Persons aged 14 to
49 years were included in these analyses. MAIN OUTCOME MEASURES: Seroprevalence
of HSV-1 and HSV-2 antibodies based on results from type-specific immunodot
assays; diagnosis of genital herpes. RESULTS: The overall age-adjusted HSV-2
seroprevalence was 17.0% (95% confidence interval [CI], 15.8%-18.3%) in 1999-2004
and 21.0% (95% CI, 19.1%-23.1%) in 1988-1994, a relative decrease of 19.0%
between the 2 surveys (95% CI, -28.6% to -9.5%; P<.001). Decreases in
HSV-2 seroprevalence were especially concentrated in persons aged 14 to 19
years between 1988 and 2004. In adolescents aged 17 to 19 years and young
adults, the decreases in HSV-2 seroprevalence were significant even after
adjusting for changes in sexual behaviors. 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% (95% CI, 59.6%-64.6%) in 1988-1994
to 57.7% (95% CI, 55.9%-59.5%) 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). CONCLUSIONS: These data show declines
in HSV-2 seroprevalence, suggesting that the trajectory of increasing HSV-2
seroprevalence in the United States has been reversed. Seroprevalence of
HSV-1 decreased but the incidence of genital herpes caused by HSV-1 may be
increasing.