Current Thinking on Genital Herpes

Annika M. Hofstetter; Susan L. Rosenthal; Lawrence R. Stanberry


Curr Opin Infect Dis. 2014;27(1):75-83. 

In This Article


Genital ulcer disease is highly prevalent worldwide, and HSV has been isolated in 50–80% of cases.[14–19] HSV-1 seroprevalence is over 80–90% in many countries,[20] and HSV-2 is estimated to affect over 16% of the global population aged 15–49 years.[21] In the United States, seroprevalence is approximately 58% for HSV-1 and 16% for HSV-2.[22,23] Seroprevalence has been shown to vary widely depending on certain characteristics, including age, sex, race/ethnicity, educational status, socioeconomic background, risk behaviour profile and country/region.[20,21,23,24]

The epidemiologyof HSV infection has changed over time. In the United States, overall HSV-1 seroprevalence decreased between the late 1980s and early 2000s, particularly among children.[22,25] Although HSV-2 seroprevalence increased between the 1970s and 1990s,[24] it subsequently declined in the early 2000s[22] and has since remained stable.[26] This temporal variability in seroprevalence over the past few decades has been accompanied by a rising proportion of genital herpes infections caused by HSV-1,[22,27–29] particularly among college students, young heterosexual women and MSM.[30–32] A recent large prospective study[33] demonstrated that the rate of primary HSV-1 infection was over twice that of HSV-2 and presented most commonly as genital rather than oral disease. This changing landscape marks a major shift in traditional thinking about HSV infection, that is HSV-1 principally causes oro-labial disease and HSV-2 causes most primary genital herpes disease. It poses new challenges to determining global estimates of disease burden, interpreting serologic screening results and developing new HSV vaccines.[21,34,35]