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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. 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. 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). Since 1976, CDC has monitored HSV-2 seroprevalence in the United States through the National Health and Nutrition Examination Survey (NHANES). 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). 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). 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, research into development of an HSV-2 vaccine should continue and might result in a more effective preventive measure in the future. 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). All seroprevalence estimates were weighted using medical examination weights of the survey to represent the U.S.

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