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Trends in Seroprevalence of Herpes Simplex Virus Type 2 Among Non-Hispanic Blacks and Non-Hispanic Whites Aged 14 to 49 Years—United States, 1988 to 2010

Fanfair, Robyn Neblett MD, MPH; Zaidi, Akbar PhD; Taylor, LaShan D. DrPH, MPH, MS; Xu, Fujie MD, PhD; Gottlieb, Sami MD, MSPH; Markowitz, Lauri MD

doi: 10.1097/OLQ.0000000000000043
Original Study

Objectives Genital herpes simplex virus type 2 (HSV-2) is one of the most prevalent sexually transmitted infections in the United States. We sought to assess differences in HSV-2 seroprevalence among non-Hispanic blacks and non-Hispanic whites and describe trends over time from 1988 to 2010.

Methods Data from National Health and Nutrition Examination Surveys (NHANES) were used to determine national HSV-2 seroprevalence estimates from National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2002, 2003 to 2006, and 2007 to 2010. Persons aged 14 to 49 years were included in the analyses. Race/Ethnicity was defined by self-report as non-Hispanic white or non-Hispanic black. Purified glycoprotein specific for HSV-2 was used to detect type-specific antibodies using an immunodot assay. The same assay was used in all surveys. History of diagnosed genital herpes was self-reported.

Results Overall, HSV-2 seroprevalence decreased in the United States between 1988 to 1994 and 2007 to 2010, from 21.2% to 15.5%. Among non-Hispanic white females, HSV-2 seroprevalence decreased from 19.5% (1988–1994) to 15.3% (2007–2010; P < 0.001); HSV-2 seroprevalence remained stable among non-Hispanic black females, 52.5% (1988–1994) to 49.9% (2007–2010; P = 0.1). The female black/white prevalence ratio was 2.7 (95% confidence interval [CI], 2.4–3.0) in 1988 to 1994 increasing to 3.3 (95% CI, 2.9–3.7) in 2007 to 2010 (P = 0.01). Among males, the black/white prevalence ratio was 2.4 (95% CI, 1.9–2.9) in 1988 to 1994 increasing to 4.4 (95% CI, 3.3–5.8) in 2007 to 2010 (P = 0.001). The overall percentage of HSV-2–seropositive survey participants who reported never being told by a doctor or health care professional that they had genital herpes did not change significantly between 1988 to 1994 and 2007 to 2010 and remained high (90.7% and 87.4%, respectively).

Conclusions Although HSV-2 seroprevalence decreased overall, the decrease was most marked among non-Hispanic whites, and racial disparities significantly increased over time. These persistent disparities demonstrate the need for innovative prevention strategies among this at-risk population.

A retrospective analysis of National Health and Nutrition Examination Survey participants found that herpes simplex virus 2 seroprevalence disparities among non-Hispanic blacks and non-Hispanic whites have increased over time.

From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA

Acknowledgments: The authors gratefully acknowledge and thank Dr Heather Bradley for assistance with statistical support.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control. This study was conducted while under employment by the US government; no external funds were used for this study.

Conflict of interest: None declared.

Correspondence: Robyn Neblett Fanfair, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E02, Atlanta, GA 30333. E-mail:

Received for publication June 5, 2013, and accepted August 29, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association