Prevalence of HSV2 in the MSM community

[herps2005]

Doctor,

Thanks very much for this service.  I've reviewed the archives for questions from gay men about HSV.  I currently have one type genitally but the HerpeSelect tests, even in the 8th month, have come back equivocal for both types.  

My question addresses the prevalence statistics you've cited to other posters, namely that in the MSM (or gay male) community, 50-70% test positive for HSV2.  I believe it may turn on whether or not they had a previous STD, and, of course, whether or not they conform to the character of the gay community by having many sexual partners.  Where did you get this statistic?

I've read that a recent study of gay men in SF, who attended a free STD clinic tested positive for HSV2 27% of the time, which was lower than the 40% estimate.  Elsewhere, in scientific papers, the range they give for MSM HSV2 prevalence is between 26-40%.  However, my doctor, when I was first diagnosed, told me that half of all gay men have HSV2, but was unable to cite a source.  I think he said it was a reasonable epidemiological conclusion from the facts that we do know.

Just curious to get my head around which numbers to use when educating people.  I don't want to underestimate or exaggerate the prevalence.  I'm still not sure whether gay men don't talk about herpes because they don't care so much about it, or whether they don't talk about it because they don't know anything about it and otherwise would care.  Given the safe sex changes that have to occur to avoid HSV, I would be surprised if being more informed would change community behavior significantly, or at all.  

Thanks very much for your time.  I hope this question isn't too frivolous.

[herpeslad]

A related discussion, percentage of gay men with HSV-2 in large urban cities was started.

[H. Hunter Handsfield, M.D.]

Frivolous?  I wish more questions on this forum were as insightful as this one!

You are right to question the validity of statistics cited about HSV-2 in MSM.  The studies are few in number and not nearly as broad-based as for the general population.  You also are correct in the implication that the prevalence isn't the same in all MSM, and undoubtedly there is a correlation with all the standard measures of STD risk:  past STD, number of partners, age (which correlates with no. of partners).  Finally, the available data are generally limited to MSM in special settings that might selectively attract people at higher risk than average, such as STD clinics and HIV testing centers.

Having said all that, there is no doubt that, on average, the proportion of MSM infected with HSV-2 is much higher than in the general population. For example, in every study in which straights and MSM were recruited in the same setting (e.g., STD clinics), MSM have had at least double the prevalence of HSV-2 compared with women and straight men.  Since the HSV-2 population prevalence in the US is around 25%, it is a pretty solid bet that it exceeds 50% in MSM as a whole.  In other words, your doc has it right:  "...a reasonable..conclusion from the [incomplete} facts...."

I can't comment on the specific figures or "scientific papers" you are referring to, without knowing the specific sources.  My guess is that the figures are referring to virologic diagnosis, not blood test results.

I hope this helps.  Best wishes--  HHH, MD