NCHS Data Brief ■ No. 304 ■ February 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Prevalence of Herpes Simplex Virus Type 1 and Type 2 in 

Persons Aged 14–49: United States, 2015–2016

Geraldine McQuillan, Ph.D., Deanna Kruszon-Moran, M.S., Elaine W. Flagg, Ph.D., M.S., and 

Ryne Paulose-Ram, Ph.D., M.A.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey

● During 2015–2016,

prevalence of herpes simplex

virus type 1 (HSV-1) was

47.8%, and prevalence of

herpes simplex virus type 2

(HSV-2) was 11.9%.

● Prevalence of both HSV-1

and HSV-2 increased with age.

● Prevalence of both HSV-1

and HSV-2 was higher among

females than males.

● Prevalence of HSV-1 was

highest among MexicanAmerican persons and lowest

among non-Hispanic white

persons. HSV-2 prevalence was

highest among non-Hispanic

black persons and lowest

among non-Hispanic Asian

persons.

● Prevalence of both HSV-1

and HSV-2 decreased from 

1999–2000 to 2015–2016 (from 

59.4% to 48.1%, and from 

18.0% to 12.1%, respectively).

Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common, lifelong 

infections, which often have no symptoms (1). People with symptoms may 

have painful blisters or sores at the site of infection (2,3). The viruses are 

transmitted through contact with an infected person’s lesion, mucosal surface, 

or genital or oral secretions. This report provides recent national estimates of 

HSV-1 and HSV-2 antibody prevalence from the 2015–2016 National Health 

and Nutrition Examination Survey (NHANES) among persons aged 14–49 by 

age, sex, and race and Hispanic origin, and examines trends in prevalence by 

race and Hispanic origin from 1999–2000 to 2015–2016.

Keywords: HSV-1 • HSV-2 • NHANES

Prevalence of HSV-1 during 2015–2016 was highest among 

Mexican-American persons and lowest among non-Hispanic 

white persons.

Figure 1. Age-adjusted prevalence of herpes simplex virus type 1 among persons aged 14–49, by age group, 

sex, and race and Hispanic origin: United States, 2015–2016

 

1

Linear increase with age group. 2Significantly lower than females. 3

Significantly lower than Mexican-American persons. 4Significantly higher than non-Hispanic white persons.

NOTES: Age adjusted by the direct method to the 2000 U.S. Census population, using age groups 14–19, 20–29, 30–39, and 

40–49 years. Total population includes all race and Hispanic-origin groups including those not shown separately. Access data table 

for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db304_table.pdf#1.

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2015–2016.
NCHS Data Brief ■ No. 304 ■ February 2018

■  2  ■

● The prevalence of HSV-1 among persons aged 14–49 was 47.8% (48.1% when adjusted for 

age) (Figure 1).

● Prevalence increased linearly with age, from 27.0% among those aged 14–19, to 41.3%, 

54.1%, and 59.7% among those aged 20–29, 30–39, and 40–49, respectively.

● Age-adjusted prevalence was higher among females (50.9%) than males (45.2%).

● Age-adjusted prevalence was highest among Mexican-American persons (71.7%) and 

lowest among non-Hispanic white persons (36.9%). There was no significant difference in 

prevalence between non-Hispanic black (58.8%) and non-Hispanic Asian (55.7%) persons.

Prevalence of HSV-1 decreased over time from 1999–2000 to 2015–2016.

● Age-adjusted prevalence of HSV-1 decreased linearly over time by 11.3 percentage points, 

from 59.4 % in 1999–2000 to 48.1% in 2015–2016 (Figure 2).

● Age-adjusted prevalence of HSV-1 decreased linearly from 1999–2000 to 2015–2016 for all 

race and Hispanic-origin subgroups: from 52.4% to 36.9% for non-Hispanic white, 68.4% to 

58.8% for non-Hispanic black, and 82.0% to 71.7% for Mexican-American persons.

Figure 2. Trends in age-adjusted prevalence of herpes simplex virus type 1 among persons aged 14–49, for the total 

population and by race and Hispanic origin: United States, 1999–2000 through 2015–2016 

1

Significant decreasing linear trend over time, p < 0.05.

NOTES: Age adjusted by the direct method to the 2000 U.S. Census population, using age groups 14–19, 20–29, 30–39, and 40–49 years. Total population 

includes all race and Hispanic-origin groups including those not shown separately. Data for the Asian subpopulation are only available since 2011, so this 

subpopulation is not shown separately, but included in the total population. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db304_table.pdf#2. 

SOURCE: NCHS, National Health and Nutrition Examination Survey, 1999–2016.
NCHS Data Brief ■ No. 304 ■ February 2018

■  3  ■

Prevalence of HSV-2 during 2015–2016 was highest among non-Hispanic 

black persons and lowest among non-Hispanic Asian persons.

● The prevalence of HSV-2 among persons aged 14–49 was 11.9% (12.1% when adjusted for 

age) (Figure 3). 

● Prevalence increased linearly with age, from 0.8% among persons aged 14–19, to 7.6%, 

13.3%, and 21.2% among those aged 20–29, 30–39, and 40–49, respectively. 

● Age-adjusted prevalence was higher among females (15.9%) than males (8.2%). 

● Age-adjusted prevalence was highest among non-Hispanic black persons (34.6%) and 

lowest among non-Hispanic Asian persons (3.8%). There was no significant difference in 

prevalence between non-Hispanic white (8.1%) and Mexican-American (9.4%) persons.

Figure 3. Age-adjusted prevalence of herpes simplex virus type 2 among persons aged 14–49, by age group, sex, and 

race and Hispanic origin: United States, 2015–2016

 

1

Linear increase with age group. 

2

Significantly lower than females.

3

Significantly lower than non-Hispanic black persons.

4

Significantly higher than non-Hispanic Asian persons.

NOTES: Age adjusted by the direct method to the 2000 U.S. Census population, using age groups 14–19, 20–29, 30–39, and 40–49 years. Total population 

includes all race and Hispanic-origin groups including those not shown separately. Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db304_table.pdf#3. 

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2015–2016.
NCHS Data Brief ■ No. 304 ■ February 2018

■  4  ■

Prevalence of HSV-2 decreased over time from 1999–2000 to 2015–2016.

● Age-adjusted prevalence of HSV-2 decreased linearly over time by 5.9 percentage points, 

from 18.0% in 1999–2000 to 12.1% in 2015–2016 (Figure 4).

● Age-adjusted prevalence of HSV-2 decreased linearly from 1999–2000 to 2015–2016 for 

all race and Hispanic-origin subgroups: 14.1% to 8.1% for non-Hispanic white, 41.5% to 

34.6% for non-Hispanic black, and 12.8% to 9.4% for Mexican-American persons.

Figure 4. Trends in age-adjusted prevalence of herpes simplex virus type 2 among persons aged 14–49, for the total 

population and by race and Hispanic origin: United States, 1999–2000 through 2015–2016 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Significant decreasing linear trend over time, p < 0.05.

NOTES: Age adjusted by the direct method to the 2000 U.S. Census population, using age groups 14–19, 20–29, 30–39, and 40–49 years. Total population 

includes all race and Hispanic-origin groups including those not shown separately. Data for the Asian subpopulation are only available since 2011, so this 

subpopulation is not shown separately, but included in the total population. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db304_table.pdf#4. 

SOURCE: NCHS, National Health and Nutrition Examination Survey, 1999–2016.
NCHS Data Brief ■ No. 304 ■ February 2018

■  5  ■

Summary

During 2015–2016, the prevalence of HSV-1 was 47.8% and of HSV-2 was 11.9% among those 

aged 14–49. Prevalence of both viruses was higher among females than males and increased 

linearly with age. Differences by race and Hispanic origin were different for the two viruses, with 

Mexican-American persons having the highest prevalence of HSV-1 (71.7%) and non-Hispanic 

black persons having the highest prevalence of HSV-2 (34.6%). Differences by race and Hispanic 

origin, and the increasing prevalence with increasing age for both HSV-1 and HSV-2, have been 

reported previously (4,5). The higher prevalence of HSV-2 among females has also been reported 

(6). 

From 1999 through 2016, there was a significant decline in the age-standardized prevalence of 

HSV-1 and HSV-2. For both virus types, a decrease in prevalence over time was seen in all race 

and Hispanic-origin subpopulations. Decreasing HSV-1 prevalence has been reported previously 

(4–7). A nonsignificant decline in overall prevalence of HSV-2 from 1999 through 2010 was 

reported in a previous study (5). 

This report provides the latest estimates of HSV-1 and HSV-2 prevalence in the United States. 

NHANES does not include populations that may be at higher risk for acquiring HSV-2 (e.g., those 

incarcerated and the homeless). Therefore, these data may provide conservative estimates of both 

HSV-1 and HSV-2 in the U.S. population aged 14–49.

Definitions

HSV-1: Prevalence of antibody to herpes simplex virus type 1 from tested sera. 

HSV-2: Prevalence of antibody to herpes simplex virus type 2 from tested sera.
NCHS Data Brief ■ No. 304 ■ February 2018

■  6  ■

Data source and methods

Data for this report are from NHANES, a cross-sectional survey that uses a complex, multistage, 

probability design to select a sample of the civilian noninstitutionalized U.S. population. It 

consists of interviews in participants’ homes, followed by standardized physical examinations 

that include collection of various biological specimens. In 1999–2016, sera for HSV-1 and HSV-2 

antibody testing were available for persons aged 14–49 (see: https://wwwn.cdc.gov/nchs/data/

nhanes/2013-2014/labmethods/HSV_H_MET_HERPES_1_2.pdf). In 2011–2016, non-Hispanic 

black, non-Hispanic Asian, and Hispanic persons, including Mexican American-persons, were 

oversampled. Refer to the NHANES website for further details.

Estimates were calculated in SAS-callable SUDAAN software release 11.0 (RTI International, 

Research Triangle Park, N.C). Examination weights were used to account for differing 

probabilities of selection, nonresponse, and noncoverage. Taylor series linearization was used to 

calculate standard errors. Age adjustment was done by the direct method to the 2000 projected 

Census population using age groups 14–19, 20–29, 30–39, and 40–49. All reported estimates met 

statistical reliability criteria (relative standard error less than 30% and greater than 10 positive 

cases). Individual differences between sex and race and Hispanic subgroups, as well as a linear 

trend with age, were evaluated using orthogonal contrasts to calculate a Student’s t statistic. 

Linear regression modeling was used to determine significance of linear and quadratic trends with 

time controlling for age group. Differences were considered significant at p < 0.05.

About the authors

Geraldine McQuillan, Deanna Kruszon-Moran, and Ryne Paulose-Ram are with the National 

Center for Health Statistics, Division of Health and Nutrition Examination Surveys. Elaine W. 

Flagg is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 

Division of STD Prevention.
NCHS Data Brief ■ No. 304 ■ February 2018

■  7  ■

References

1. Tronstein E, Johnston C, Huang ML, Selke S, Magaret A, Warren T, et al. Genital shedding 

of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. 

JAMA 305(14):1441–9. 2011.

2. Ryder N, Jin F, McNulty AM, Grulich AE, Donovan B. Increasing role of herpes simplex 

virus type 1 in first-episode anogenital herpes in heterosexual women and younger men who have 

sex with men, 1992–2006. Sex Transm Infect 85(6):416–9. 2009.

3. Bernstein DI, Bellamy AR, Hook EW 3rd, Levin MJ, Wald A, Ewell MG, et al. 

Epidemiology, clinical presentation, and antibody response to primary infection with herpes 

simplex virus type 1 and type 2 in young women. Clin Infect Dis 56(3):344–51. 2013.

4. Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, et al. Trends in herpes 

simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 296(8):964–73. 2006.

5. Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of herpes simplex virus 

types 1 and 2—United States, 1999–2010. J Infect Dis 209(3):325–33. 2014.

6. Dickson N, Righarts A, van Roode T, Paul C, Taylor J, Cunningham AL. HSV-2 incidence by 

sex over four age periods to age 38 in a birth cohort. Sex Transm Infect 90(3):243–5. 2014.

7. Dukers NH, Bruisten SM, van den Hoek JA, de Wit JB, van Doornum GJ, Coutinho RA. 

Strong decline in herpes simplex virus antibodies over time among young homosexual men is 

associated with changing sexual behavior. Am J Epidemiol 152(7):666–73. 2000.
NCHS Data Brief ■ No. 304 ■ February 2018

Suggested citation

McQuillan G, Kruszon-Moran D, Flagg 

EW, Paulose-Ram R. Prevalence of herpes 

simplex virus type 1 and type 2 in persons 

aged 14–49: United States, 2015–2016. 

NCHS Data Brief, no 304. Hyattsville, MD: 

National Center for Health Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

Ryne Paulose-Ram, Ph.D., Associate 

Director for Science

For e-mail updates on NCHS publication 

releases, subscribe online at: 

https://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: https://www.cdc.gov/nchs

Online request form: https://www.cdc.gov/info

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2018–1209

CS289157

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit:

https://www.cdc.gov/nchs/products/databriefs.htm.

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284