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Persons using assistive technology might not be able to fully access information in this file. Herpes simplex virus type 2 (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 (1).
NHANES surveys are cross-sectional surveys designed to compile nationally representative statistics on the health of the U.S. HSV-2 infection is an important public health concern because of the morbidity associated with symptomatic infection, the potential for high rates of clinical and subclinical recurrences, and the strong association between HSV-2 and HIV infections; genital HSV-2 infection in pregnant women can lead to serious infection in neonates through vertical transmission.
Persons infected with HSV-2 are at greater risk for HIV acquisition, even in the absence of HSV-2 symptoms (2). CDC recommends that persons with genital herpes avoid sexual activity with uninfected partners when lesions or prodromal symptoms are present because the greater viral shedding that accompanies these symptoms likely increases risk for HSV-2 transmission (5). Persons with known HSV-2 infection should be tested for HIV and adopt HIV risk-reduction strategies, such as limiting the number of sex partners and using condoms consistently and correctly.
Routine serologic testing might identify numerous unrecognized HSV-2 infections; however, the role of routine serologic screening in population-based prevention efforts has been controversial (10). Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted infection in the United States and is associated with an increased risk for human immunodeficiency virus (HIV) infection.
Health-care providers should consider HSV-2 infection in the differential diagnosis of genital complaints consistent with HSV-2 infection; patients with known HSV-2 infection should be tested for HIV. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S.
This conversion might result in character translation or format errors in the HTML version. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Both type-specific and nonspecific antibodies to HSV develop during the first several weeks following infection and persist indefinitely. The sensitivities of these tests for detection of HSV-2 antibody vary from 80% to 98%, and false-negative results may occur, especially in the early stages of infection. Roughly 3.7 billion people a€” 67% of the world's population a€” are infected with type-1 herpes-simplex virus (HSV-1), according to a World Health Organization study published October 28. The researchers behind the study write that this is the first time the global burden of this virus has been measured. And the numbers are a real cause for concern, they say, because the most common way the virus is transmitted is changing in many parts of the world.
HSV-1 is the virus behind what we normally think of as oral herpes, responsible for cold sores. Most people with a herpes infection have the virus their whole lives, since there's no known cure, although they don't always show symptoms. The growing problem, however, comes from the factA that HSV-1 can be sexually transmitted and cause genital herpes too. One of the biggest issues is that public-health efforts have focused primarily on preventing HSV-2 infections, the researchers write, not HSV-1 infections. What's more, according to the new report, is that sexually transmitted HSV-1 is on the rise, especially in the Americas, Europe, and the Western Pacific. Aside from those cold sores, HSV-1 is the most common cause of sporadic encephalitis (inflammation of the brain). The growing prevalence of genital HSV-1 is more worrisome in cases associated with pregnancy. It's worth stressing that neither of those serious conditions are common, and in the case of a pregnancy, medication and a C-section can prevent the virus from being passed on. There's also a chance that a genital (as opposed to oral) HSV-1 infection could increase the risk of an HIV infection, though that has yet to be convincingly shown. Paradoxically, the reason that genital herpes from type 1 of the virus is on the rise is that HSV-1 infection rates in the Americas and Europe are declining. In Asia and Africa, most people who get HSV-1 get an oral infection as children a€” well before they become sexually active a€” and the first site of infection seems to prevent infections at different sites, the researchers write.


That means that in places where HSV-1 infections are becoming less common, adults have a greater risk of getting sexually infected, the researchers write.
Around the world, more than 500 million people have genital herpes from one of the two virus types. Still, the changing type of transmission and the overall prevalence of HSV-1 means that prevention and control efforts, which have traditionally focused on HSV-2, should address HSV-1 as well in the future. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site.
Multiple studies have shown that HSV-2 infection increases the risk for human immunodeficiency virus (HIV) infection by at least twofold (2). Increased susceptibility to HIV infection likely occurs because even HSV-2 ulcerations that are microscopic can provide a portal of entry for HIV, and HSV-2 reactivation recruits potential target cells for HIV to the genital skin and mucosa. Viral shedding and transmission to sex partners can occur in the absence of symptoms or a noticeable lesion (5). Infected persons also should be counseled regarding the HSV-2 transmission risk associated with viral shedding in the absence of symptoms. 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 (10). Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. Effect of acyclovir on HIV-1 acquisition in herpes simplex virus type 2 seropositive women and men who have sex with men: a randomized, double blind, placebo-controlled trial. Seroprevalence of human immunodeficiency virus in the US household population aged 18--49 years: the National Health and Nutrition Examination Surveys, 1999--2006. Development of clinically recognizable genital lesions among women previously identified as having "asymptomatic" herpes simplex virus type 2 infection.
Clinicians, health departments, health-care organizations, and community groups should promote measures that prevent HSV-2 transmission, including minimizing the number of sex partners, avoiding concurrent sexual partnerships, and using condoms consistently and correctly.
This recurrent, incurable disease remains undiagnosed in most infected persons; they often have mild or asymptomatic infections and shed virus intermittently in the genital tract.
However, many patients with herpes simplex virus type 2 infections have no signs or symptoms of the disease. Isolation of HSV in cell culture is the preferred virologic test in patients who have genital ulcers or other mucocutaneous lesions. Because false-negative HSV cultures are common, especially in patients with recurrent infection or healing lesions, these tests are useful in confirming a clinical diagnosis of genital herpes. Accurate type-specific assays for HSV antibodies must be based on the HSV-specific glycoprotein G2 for the diagnosis of HSV-2 infection and glycoprotein G1 for HSV-1 infection. Type-2 herpes simplex virus (HSV-2), meanwhile, is the one we normally consider a sexually transmitted infection. And while this brain infection is very rare, it kills more than 50% of those infected if left untreated, according to the National Institutes of Health. So if you get oral herpes as a kid, you're less likely to get an HSV-1 genital infection as an adult.
In the US, more than 15% of people have a sexually transmitted herpes infection, according to the CDC.
The same goes for the development of treatment or vaccines; as of today, there are no cures, only drugs to suppress an infection. Sami Gottlieb, one of the WHO researchers and study coauthors, told Stat's Megan Thielking. HSV-2 infection is lifelong, and serologic testing provides the best method to estimate HSV-2 prevalence.
Two large randomized controlled trials among persons who were HSV-2-infected and HIV negative found that daily antiviral (acyclovir) therapy to suppress HSV-2 infection did not decrease the risk for HIV acquisition (4).
Multiple prevention strategies used alone or in combination are potentially useful in limiting acquisition and transmission of HSV-2. 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 (5).


Although systemic antiviral drugs can partially control the signs and symptoms of herpes, they do not eradicate latent virus and have no effect on recurrence after therapy is discontinued.
Many infected persons do not have the typical painful multiple vesicular or ulcerative lesions (Figure 1).
The sensitivity of culture declines rapidly as lesions begin to heal, usually within a few days of onset. They can also be used to diagnose asymptomatic infection and to test sex partners of infected patients. These assays became available in 1999; older assays do not accurately distinguish HSV-1 from HSV-2 antibody. False-positives can occur, especially in patients with a low likelihood of HSV infection, and a second test may be required. Since 1976, CDC has monitored HSV-2 seroprevalence in the United States through the National Health and Nutrition Examination Survey (NHANES). Most notably, HSV-2 seroprevalence among non-Hispanic blacks was approximately three times that of non-Hispanic whites and nearly four times that of Mexican Americans. Thus, primary prevention of HSV-2 infection might be the only available strategy to reduce the increased risk for HIV infection associated with HSV-2. For persons with symptomatic HSV-2 infection, daily antiviral therapy has been shown to reduce clinical and subclinical reactivation rates of HSV-2 and to reduce the risk for HSV-2 transmission to uninfected partners by 50% (6).
A recent meta-analysis found that persons who reported always using condoms had a 30% decreased risk for acquiring HSV-2 infection compared with persons who reported no condom use (7). Second, no information was collected regarding genital symptoms to assess the extent of symptomatic but undiagnosed HSV-2 infection. Therefore, health-care providers should consider testing for HSV-2 infection in those patients with either typical or atypical genital complaints, especially when the symptoms are recurrent (5).
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 (10).
Thus, laboratory testing is necessary to confirm the diagnosis and to determine the HSV serotype.
Polymerase chain reaction assay for HSV DNA is the test of choice for detecting HSV in the spinal fluid of patients with suspected CNS involvement. Routine screening for HSV infection in the general population, however, is not recommended. Increasing awareness of the high HSV-2 prevalence in the United States and the link between HSV-2 and HIV infections are important first steps in addressing the increased risk for HIV infection, especially among persons at greatest risk for HSV-2 and HIV infections. Additionally, persons with HSV-2 infection should be encouraged to inform partners of their infection status before initiating a sexual relationship. Finally, because of insufficient sample size, coinfection with HSV-2 and HIV could not be assessed. Finally, research into development of an HSV-2 vaccine should continue and might result in a more effective preventive measure in the future.
Participants also were asked, "Has a doctor or other health-care professional ever told you that you had genital herpes?" Statistical software was used to generate seroprevalence estimates and 95% confidence intervals. However, a previous report using data from multiyear NHANES found a strong association between HSV-2 seropositivity and HIV infection in the general population (8).
Although HSV-1 causes up to 30% of the first episodes of genital herpes, recurrences are much less common with HSV-1 infection than with HSV-2 infection. All seroprevalence estimates were weighted using medical examination weights of the survey to represent the U.S.



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