Analytic Characterization of the Herpes Simplex Virus Type 2 Epidemic in the United States, 1950–2050

Abstract

Background We analytically characterized the past, present, and future levels and trends of the national herpes simplex virus type 2 (HSV-2) epidemic in the United States. Methods A population-level mathematical model was constructed to describe HSV-2 transmission dynamics and was fitted to the data series of the National Health and Nutrition Examination Surveys. Results Over 1950-2050, antibody prevalence (seroprevalence) increased rapidly from 1960, peaking at 19.9% in 1983 in those aged 15-49, before reversing course to decline to 13.2% by 2020 and 8.5% by 2050. Incidence rate peaked in 1971 at 11.9 per 1,000 person-years, before declining by 59% by 2020 and 70% by 2050. Annual number of new infections peaked at 1,033,000 in 1978, before declining to 667,000 by 2020 and 600,000 by 2050. Women were disproportionately affected, averaging 75% higher seroprevalence, 95% higher incidence rate, and 71% higher annual number of infections. In 2020, 78% of infections were acquired by those 15-34 year-olds. Conclusions The epidemic has undergone a major transition over a century, with the greatest impact in those 15-34 year-olds. In addition to 47 million prevalent infections in 2020, high incidence will persist over the next three decades, adding >600,000 new infections every year.

Epidemiology of herpes simplex virus type 2 in Europe: systematic review, meta-analyses, and meta-regressions

“…These results demonstrated generic patterns in HSV-2 epidemiology that are also observed in other world regions. [17][18][19][83][84][85][86] There was strong hierarchy in seroprevalence based on sexual risk behaviour classification, with the highest seroprevalence observed in FSWs and MSM and the lowest in the general populations, similar to what is observed for other STIs. 96,97 Men had 35% lower seroprevalence than women, attesting to a higher bio-anatomical susceptibility to this infection among women.…”

“…HSV-2 seroprevalence in the adult general population of Europe averaged at about 12% over the last three decades, similar to that found in Asia, 17 but lower than that in Africa at 37%, 18 in Latin America and the Caribbean (LAC) at 21%, 19 and in the United States of America (USA), at about 15%. 83 , 84 , 85 , 86 HSV-2 seroprevalence has been declining in Europe at a rate of 1% per calendar year over the last three decades. Similar declines were observed, but at a higher rate of 2% per calendar year in Africa, 18 Asia, 17 LAC, 19 and the USA.…”

“…Similar declines were observed, but at a higher rate of 2% per calendar year in Africa, 18 Asia, 17 LAC, 19 and the USA. 83 , 84 , 85 , 86 Since HSV-2 seroprevalence is a proxy for population sexual risk behaviour, 20 , 41 , 42 , 87 , 88 , 89 these declines may be explained by less risky sex following recognition of the HIV epidemic, 90 , 91 , 92 , 93 improved STI awareness, 94 increasing access to HIV/STI services, 12 , 95 and/or changes in the structure of sexual networks following changes in socio-economic conditions. 17 Use of antiviral suppressive therapy is unlikely to be substantial in Europe and such therapy, if used, is not likely to be used in the long-term.…”

“…Building on these compiled data, a future direction of this work is to conduct mathematical modelling studies to quantitatively characterize the transitioning epidemiology of HSV-2 in Europe and to estimate its epidemiologic indicators such as incidence, past, present, and future, similar to that done recently for the USA. 83 …”

Estimated economic burden of genital herpes and HIV attributable to herpes simplex virus type 2 infections in 90 low- and middle-income countries: A modeling study

“…The model adapted and extended a recent model characterizing the HSV-2 epidemic in the United States from 1950 to 2050 [ 22 ]. The model was parameterized for HSV-2 natural history and epidemiology [ 22 , 23 ] and then calibrated by fitting to HSV-2 seroprevalence data by sex, and an overall seroprevalence decline by 2% [ 24 ] ( S1 Appendix , section 3.A).…”