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A systematic review of the epidemiology and interaction of herpes simplex virus types 1 and 2
  1. K J Looker,
  2. G P Garnett
  1. Department of Infectious Disease Epidemiology, Imperial College London, UK
  1. Correspondence to:
 K J Looker
 Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, St Mary’s Campus, Norfolk Place, London W2 1PG, UK;


Objectives: To explore epidemiological evidence about the interaction of herpes simplex virus (HSV) 1 and HSV-2 infections.

Methods: A systematic review was undertaken of published epidemiological studies describing the pattern of HSV-1 or HSV-2 by age, and the coincidence of the two viral infections.

Results: In cross sectional studies the unadjusted odds of HSV-2 are greater in those with HSV-1 infection in study populations categorised as “low risk” (p = 0.06) and across European populations (p = 0.001). This was not evident in “high risk” populations or in the United States. This increased risk of HSV-2 in those with HSV-1 infection does not agree with the results of prospective studies where there is a non-significant trend towards a lower risk of HSV-2 infection associated with previous HSV-1 infection.

Conclusions: “Low risk” and European populations have a relatively low HSV-2 seroprevalence and infection is more concentrated in those with characteristics putting them at high risk for both HSV-1 and HSV-2. This confounding could mask any protective effect of HSV-1, which is hinted at, but not demonstrated, in prospective and adjusted studies.

  • herpes simplex virus
  • prevalence
  • epidemiology

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  • Conflicts of interest: GPG is a consultant for GlaxoSmithKline. GPG and KJL both receive funding from GSK.