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Trends in Herpes Simples Virus Type 2 infection in the United States

Trends in Herpes Simples Virus Type 2 infection in the United States. Fujie Xu, Geraldine McQuillan, Benny Kottiri, Maya Sternberg, Francis Lee, Andr é Nahmias, Lauri Markowitz Centers for Disease Control and Prevention (CDC) Emory University. Background.

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Trends in Herpes Simples Virus Type 2 infection in the United States

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  1. Trends in Herpes Simples Virus Type 2 infection in the United States Fujie Xu, Geraldine McQuillan, Benny Kottiri, Maya Sternberg, Francis Lee, André Nahmias, Lauri Markowitz Centers for Disease Control and Prevention (CDC) Emory University

  2. Background • HSV-2 is the cause of most genital herpes • HSV-2 increases the risk for HIV acquisition and transmission • HSV-2 seroprevalence is a marker of sexual risk behaviors • In adolescents and young adults, HSV-2 seroprevalence is a measure of morerecent risky sexual behaviors

  3. Data Source • NHANES—National Health And Nutrition Examination Survey • A series of nationally representative surveys of non-institutionalized US population • Survey staff travel across the nation to conduct interviews and health examinations

  4. Study Objectives • Describe trends of HSV-2 seroprevalence in the US between two NHANES surveys: • NHANES III: 1988-1994 • NHANES 1999-2000 • The mid-point interval between this two surveys was 8.5 years

  5. Statistical Methods • Age-adjustment • 2000 US Census as the standard population • Weights • Accounting for oversampling and non-response • SUDAAN software • Accounting for multi-stage sampling design

  6. HSV-2 Serology • Type-specific immunodot assay • Glycoprotein of gG2 as antigen • The same assay and the same laboratory was used for both surveys

  7. Results

  8. Changes in HSV-2 SeroprevalenceBy Age Group CI, confidence interval. † p<0.05; ‡p<0.001

  9. Changes in HSV-2 SeroprevalenceBy Age Group

  10. Changes in HSV-2 Seroprevalence CI, confidence interval. † p<0.05; ‡p<0.001

  11. Changes in HSV-2 Seroprevalence in 14-29 year-olds CI, confidence interval. † p<0.05; ‡p<0.001

  12. Conclusions • HSV-2 seroprevalence decreased significantly between NHANES III and NHANES ‘99-00 • The largest decrease occurred in adolescents • In adolescents and young adults (14-29 year-olds), significant decreases occurred in all sex and race/ethnicity groups except non-Hispanic blacks

  13. Limitations • Limited behavioral data in NHANES • The number of lifetime sex partners • Changes in methods and wordings • Changes in US population • Mexican Americans • Small sample size of NHANES’99-00

  14. Discussion • Is the decrease in HSV-2 infection real? • NHANES 2001-2002 to be released in May 2004 • HSV-2 included in NHANES 2003-2004

  15. Changes in HSV-2 Seroprevalence between NHANES II and NHANES III Fleming DT et al. N Engl J Med 1997; 337: 1105-11.

  16. HSV-2 Seroprevalence in NHANES By Age Group

  17. Discussion (cont) • Youth Risk Behavior Surveys (1991-2001)* Ever had sex Had four or more partners Used condoms • Between 1990 and 2000, teen pregnancy rates in women aged 15-19 in the US decreased 28%**. * CDC. MMWR 2002; 51:856-859. **Data from the Alan Guttmacher Institute

  18. Teenage Pregnancy Rate in the US, 1972-2000 Rate per 1,000 women aged 15-19

  19. Changes in HSV-1 Seroprevalence between the two NHANES Surveys CI, confidence interval. † p<0.05

  20. Discussion (cont) • An analysis found that about 25% of the decline in teenage pregnancy between 1988 and 1995 was due to decreased sexual activity. * Data from the Alan Guttmacher Institute

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