Sex Transm Infect 79:456-459 doi:10.1136/sti.79.6.456
  • Herpes

Epidemiology of recurrent genital herpes simplex virus types 1 and 2

  1. L Solomon1,
  2. M J Cannon1,
  3. M Reyes1,
  4. J M Graber1,
  5. N T Wetherall2,
  6. W C Reeves1,
  7. for the Task Force on Herpes Simplex Virus Resistance*
  1. 1Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
  2. 2ViroMed Laboratories, Inc, Minneapolis, MI, USA
  1. Correspondence to:
 William C Reeves
 MD, Centers for Disease Control and Prevention, Mail Stop A-15, 1600 Clifton Road, Atlanta, GA 30333, USA;
  • Accepted 19 June 2003


Objectives: To describe the epidemiology of type specific recurrent genital herpes, and to compare the duration of recurrent genital lesions caused by herpes simplex virus (HSV) types 1 and 2.

Methods: Participants were enrolled at clinics across the United States. Adults suspected of having active genital herpes were eligible. Lesions were cultured for HSV and typed. Data from 940 participants with recurrent culture positive HSV lesions were analysed. Pearson’s χ2 and Fisher’s exact tests, multivariate logistic regression models, and a stratified Cox proportional hazards model were used to compare epidemiological characteristics and lesion duration of HSV-1 and HSV-2.

Results: HSV-1 was present in 4.2% of the recurrent HSV culture positive lesions. HSV-1 was most prevalent among whites (6.5%) and individuals with 0–2 recurrences in the previous year (9.1%) and, among men, in those with rectal/perirectal lesions (13.2%). Longer lesion duration was not significantly associated with virus type (hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.65 to 1.38, p = 0.79), but was associated with male sex (HR 0.85, 95% CI 0.74 to 0.99, p = 0.04), and HIV seropositivity (HR 0.62, 95% CI 0.48 to 0.81, p<0.01).

Conclusions: The authors found that, in the United States, recurrent genital HSV-1 is relatively rare in the STD and HIV clinic setting, especially among black people. Among men, rectal/perirectal recurrent lesions are more likely to be caused by HSV-1 than are penile lesions. In addition, lesion duration depends on sex and HIV status but not virus type. These findings shed new light on the type specific epidemiology of recurrent genital HSV, and suggest that type specific testing can inform the prognosis and management of genital herpes.


  • * Task Force on Herpes Simplex Virus Resistance E R Kern, L Corey, C Crumpacker, G Darby, G Davis, P E Pellett, S Sacks, S E Straus.

  • Current affiliations and addresses for authors who have moved since completion of the study: M Reyes, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mail Stop K-26, Koger Office Park, Chamblee, GA 30341, USA; J M Graber: Maine Bureau of Health, Key Plaza, 11 State House Station, Augusta, ME 04333, USA; N T Wetherall: Cambridge Biomedical Research Group, 1256 Soldiers Field Road, Brighton, MA 02135, USA; L Solomon, Department of Epidemiology and Surveillance Research, American Cancer Society, 1599 Clifton Road, Atlanta, GA 30329, USA.