Original Article

HSV-1 and HSV-2 Seroprevalence in the United States among Asymptomatic Women Unaware of Any Herpes Simplex Virus Infection (Herpevac Trial for Women)

Authors: Joann M. Schulte, DO, MPH, Abbie R. Bellamy, PhD, Edward W. Hook, MD, David I. Bernstein, MD, Myron J. Levin, MD, Peter A. Leone, MD, Marcia L. Sokol-Anderson, MD, Marian G. Ewel,l ScD, Peter A. Wolff, MS, Thomas C. Heineman, MD, PhD, Robert B. Belshe, MD

Abstract

Objectives: Recent evidence suggests that the epidemiology of herpes simplex viruses (HSVs) is changing because fewer HSV-1 infections are acquired in childhood and increased sexual transmission of HSV-1 is reported. The objective of the study was to assess the seroprevalence of type-specific antibodies to HSV-1 and HSV-2 in the United States.

Methods: We used the Western blot antibody screening data from a large phase III vaccine efficacy trial (Herpevac Trial for Women) to assess the seroprevalence of type-specific antibodies to HSV-1 and HSV-2 in the United States.

Results: The antibody status of 29,022 women (>31,000 women interviewed and then had their blood drawn for the HSV testing [29,022 women]) between the ages of 18 and 30 years in the United States revealed that increasing age was associated with increasing seroprevalence to HSV. Overall, in asymptomatic women unaware of any HSV infection, HSV-1/-2 status was positive/negative in 45%, negative/positive in 5%, positive/positive in 7%, negative/negative in 38%, and indeterminate in 5%. HSV-1 infections were more common in Hispanic and non-Hispanic black women and in the US northeast and in individuals living in urban areas. HSV-2 was more common in non-Hispanic black women, the US south, and in urban areas.

Conclusions: Seronegative status for both HSV-1 and HSV-2 was the second most common finding after positive antibody to HSV-1 but negative antibody to HSV-2. Despite recent changes in genital herpes epidemiology, most women acquired HSV-1 but not HSV-2 infections before 18 years of age. Among participants screened for study participation and who were unaware of any HSV infection, progressively higher prevalence of the HSV-1 or HSV-2 antibody was observed in older subjects. Many women who test positive for HSV-1 and/or HSV-2 are unaware of their status.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006;296:964-973.
 
2. Lafferty WE, Downey L, Celum C, et al. Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis 2000;181:1454-1457.
 
3. Pena KC, Adelson ME, Mordechai E, et al. Genital herpes simplex virus type 1 in women: detection in cervicovaginal specimens from gynecological practices in the United States. J Clin Microbiol 2010;48:150-153.
 
4. Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 2003;30:797-800.
 
5. Ribes JA, Steele AD, Seabolt JP, et al. Six-year study of the incidence of herpes and genital in nongenital cultures in a central Kentucky medical center patient population. J Clin Microbiol 2001;39:3321-3325.
 
6. Lowhagen GB, Tunback P, Andersson K, et al. First episodes of genital herpes in a Swedish STD population: a study of epidemiology and transmission by the use of herpes simplex virus (HSV) typing in specific serology. Sex Transm Infect 2000;76:179-182.
 
7. Vyse AJ, Gay NJ, Slomka J, et al. The burden of infection with HSV-1 and HSV-2 in England andWales: implications for the changing epidemiology of genital herpes. Sex Transm Infect 2000;76:183-187.
 
8. Pebody RG, Andrews N, Brown D, et al. The seroepidemiology of herpes simplex virus type 1 and 2 in Europe. Sex Transm Infect 2004;80:185-191.
 
9. Forward KR, Lee SH. Predominance of herpes simplex virus type 1 from patients with genital herpes in Nova Scotia. Can J Infect Dis 2003;14:94-96.
 
10. Howard M, Sellors JW, Jang D, et al. Regional distribution of antibodies to herpes simplex virus type 1 (HSV-1) and HSV-2 in men and women in Ontario, Canada. J Clin Microbiol 2003;41:84-89.
 
11. Tran T, Druce JD, Catton MC, et al. Changing epidemiology of genital herpes simplex virus infection Melbourne, Australia, between 1980 and 2003. Sex Transm Infect 2004;80:277-279.
 
12. Ryder N, Jin F, McNulty AM, et al. Increasing role of herpes simplex virus type 1 in first-episode anogenital herpes in heterosexual women and younger men who have sex with men, 1992Y2006. Sex Transm Infect 2009;85:416-419.
 
13. Centers for Disease Control and Prevention. Seroprevalence of herpes simplex virus type 2 among persons aged 14Y49 yearsVUnited States, 2005-2008. MMWR Morb Mortal Wkly Rep 2010;59:456-459.
 
14. Xu F, Lee FK, Morrow RA, et al. Seroprevalence of herpes simplex virus type 1 in children in the United States. J Pediatr 2007;151:374-377.
 
15. Belshe RB, Leone PA, Bernstein DI, et al. Efficacy results of a trial of a herpes simplex vaccine. N Engl J Med 2012;366:34-43.
 
16. Ashley RL, Militoni J, Lee F, et al. Comparison of Western blot (immunoblot) and glycoprotein G-specific immunodot enzyme assay for detecting antibodies to herpes simplex virus types 1 and 2 in human sera. J Clin Microbiol 1988;26:662-667.
 
17. Centers for Disease Control and Prevention. Sexually transmitted diseases surveillance 2009. www.cdc.gov/StD/stats09/default.htm. Accessed December 20, 2013.
 
18. Census Bureau Regions and Divisions with State FIPS Codes. Department of Commerce, US Census Bureau. www.census.gov/popest/about/geo/state_geocodes_v2011.xls. Accessed December 20, 2013.
 
19. Kroop RY, Wong T, Cormier L, et al. Neonatal herpes simplex virus infections in Canada: results of a 3-year national prospective study. Pediatrics 2006;117:1955-1962.
 
20. Brown ZA, Wald A, Morrow RA, et al. Effect of serological status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003;289:203-209.
 
21. Tookey P, Peckham CS. Neonatal herpes simplex virus infection in the British Isles. Paediatr Perinat Epidemiol 1995;10:432-442.
 
22. Celum C,Wald A, Lingappa JR, et al. Acyclovir and transmission of HIV- 1 from persons infected with HIV-1 and HSV-2. N Engl J Med 2010; 362:427-439.
 
23. Schacker T, Zeh J,Hu H, et al. Changes in plasma human immunodeficiency virus type 1 RNA associated with herpes simplex virus reactivation and suppression. J Infect Dis 2002;186:1718-1725.
 
24. Corey L, Wald A, Patel R, et al. Once-daily valcyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 2004;350:11-20.
 
25. Fife KH, Williams JA, Thomas AL, et al. Herpes simplex virus type 2 infection in young adult women: risk factors for infection and frequency of viral shedding. Sex Transm Dis 2010;37:248-252.
 
26. Wald A, Zeh J, Selke S, et al. Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med 1995;333:770-775.
 
27. Sanders SA, Reinisch JM. Would you say you ‘‘had sex’’ if I? JAMA 1999;281:275-277.
 
28. Sanders SA, Hill BJ, Yarber WL, et al. Misclassification bias: diversity in conceptualizations about having ‘‘had sex.’’ Sex Health 2010;7:31-34.