September 12, 2022:
We are writing to express our views on the USPSTF updates to its recommendations regarding asymptomatic serum screening for genital herpes (HSV-2).
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
Although we agree with the USPSTF in terms of the general population, we are concerned that the Task Force has not taken into account the disproportionate burden of HSV-2 on non-Hispanic Blacks in the U.S. The infection is most prevalent in non-Hispanic Blacks, and yet this group is also most likely to be undiagnosed with HSV-2 even when they have a positive blood test1. An analysis of data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004 found that 86% of patients who had a positive blood test for HSV-2 reported never having been told they had the infection1. Non-Hispanic Blacks who tested positive for HSV-2 were twice as likely to be undiagnosed as non-Hispanic Whites1. Specifically, 85% of non-Hispanic Black females and 95% of non-Hispanic Black males who tested positive with HSV-2 were not told about their infection2.
The cause of these racial differences is not clear, but these results suggest that research is needed to determine if the rate of false positives varies by race/ethnicity and/or sex and therefore whether the ratio of benefit to harm of screening varies according race/ethnicity and/or sex. USPSTF should examine whether the benefits of asymptomatic screening outweigh the risks in the most affected racial and ethnic groups. Answering these questions has the potential to help revise screening guidelines and prevent HSV-2 transmission and help reduce the disparate impact of this infection among various racial and ethnic groups.
- Pouget ER, Kershaw TS, Blankenship KM, Ickovics JR, Niccolai LM. Racial/Ethnic Disparities in Undiagnosed Infection With Herpes Simplex Virus Type 2. Sex Transm Dis. 2010;37(9):538-543. doi:10.1097/OLQ.0b013e3181d9042e
- Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in Seroprevalence of Herpes Simplex Virus Type 2 Among Non-Hispanic Blacks and Non-Hispanic Whites Aged 14 to 49 Years—United States, 1988 to 2010. Sex Transm Dis. 2013;40(11):860-864. doi:10.1097/OLQ.0000000000000043