Prevalence of Genital Herpes in the General Adult Population
Approximately 22% of adults in the United States have genital herpes (HSV-2 infection), though the vast majority—over 90%—are unaware they are infected. 1
Current Epidemiological Data
Seroprevalence Rates
The HSV-2 seroprevalence rate in U.S. adults was 22% in the early 1990s, representing a 32% increase from the previous decade. 1
More recent U.S. data (2015-2016) shows 12.1% of the population aged 14-49 years is seropositive for HSV-2, while 47.8% is seropositive for HSV-1 (which can cause both oral and genital infections). 2
An earlier national survey (1976-1980) found 16.4% of the U.S. population aged 15-74 years was infected with HSV-2 (approximately 25 million persons). 3
The Recognition Gap
Only 9% of HSV-2-seropositive persons actually recognize or report that they have genital herpes, meaning approximately 91% of infected individuals are unaware of their infection. 1
This massive discrepancy exists because 80-90% of genital herpes infections progress subclinically after initial acquisition, with no visible symptoms at the time of transmission. 4
These subclinically infected individuals can remain asymptomatic for months, years, or their entire lifetime, yet still transmit the virus to sexual partners. 4
Clinical Prevalence vs. Serological Prevalence
Diagnosed Cases
Recent claims data (2019-2021) shows a standardized prevalence of diagnosed genital herpes ranging from 236 to 280 cases per 100,000 person-years. 5
This represents only a small fraction of the true burden, as most infections remain undiagnosed due to subclinical presentation. 5
High-Risk Populations
Prevalence is highest among those aged 25-29 years (497-582 cases per 100,000), female patients (348-404 cases per 100,000), and those with HIV infection (1608-2080 cases per 100,000). 5
Among blacks in the oldest age group (60-74 years), the prevalence reaches 64.7%, compared to 19.7% in whites of the same age. 3
Women have higher rates than men among black populations across all age groups. 3
Critical Clinical Pitfalls
Transmission Dynamics
Most genital herpes infections are transmitted by persons who are unaware they have the infection or are asymptomatic when transmission occurs. 1
Even individuals with only one lifetime sexual partner can have the infection, as the virus can remain dormant for years before causing the first visible outbreak. 4
The appearance of a first clinical episode does not prove recent sexual contact or acquisition—it could represent reactivation of virus acquired years earlier. 4
Diagnostic Challenges
More than half of patients present with atypical manifestations, including extragenital sites (buttocks 19%, thighs 6%, anal region 5%, fingers 5%) or morphologically atypical lesions (single ulcer 9%, isolated erosion 4%). 6
Only 49% of patients present with the classic cluster of genital vesicles, leading to widespread underdiagnosis. 6
Type-specific serologic testing is essential because it can distinguish HSV-1 from HSV-2 antibodies and help diagnose unrecognized infections, though it cannot determine timing of acquisition. 1, 2
Treatment Patterns
- Among diagnosed patients, approximately two-thirds (65-68%) receive antiviral medications annually, with the majority (80%) receiving episodic therapy rather than suppressive therapy (20%). 5