National Health and Nutrition Examination Survey

HSV-2 infection is one of the best markers of sexual risk factors leading to sexually transmitted infections, because: (a) HSV-2 infections are common and, thus, HSV-2 rates are a measure of sexual risk in the broader population beyond high risk groups; (b) HSV-2 infection is almost always a result of sexual transmission and, thus, a specific measure of sexually transmitted infection; (c) HSV-2 infections are not curable and, thus, HSV-2 risk is not influenced by health care-seeking factors; and (d) sensitive, specific, and relatively inexpensive tests for HSV-2 antibody are available. HSV-2 is a very important marker for monitoring the impact of large national efforts, motivated by the HIV epidemic, to reduce risky sexual behaviors.

The NHANES laboratory data can be linked to NHANES sexual behavior questions to assist in the understanding of national trends in HIV and sexually transmitted diseases. The availability of sexually transmitted infection and risk factors data in a national sample over time is a unique and invaluable resource for evaluation of national HIV/STD risk-reduction efforts and for risk-based modeling of the burden and trends of sexually transmitted infections.

Herpes Simplex Virus Type 1 (HSV-1)

Sera from NHANES examinees aged 14–49 were tested for antibody to herpes simplex virus type 1 (HSV-1). HSV-1 is a common chronic infection that is the cause of most oral herpes or cold sores.

Herpes Simplex Virus Type 2 (HSV-2)

Sera from NHANES examinees aged 14–49 were tested for antibody to herpes simplex virus type 2 (HSV-2). HSV-2 is a sexually transmitted infection and can be used as a marker for sexual transmission of other infectious agents. HSV-2 infections are rarely life threatening, but morbidity due to painful genital ulcerations is significant.

Participants 14–49 years of age who did not meet any of the exclusion criteria were tested for HSV-1 and HSV-2. The public release data file includes HSV-1 data for persons 14–49 years, and HSV-2 data for persons 18–49 years of age. Please see Analytic Notes about availability of HSV-2 data for persons 14–17 years of age.

Serum specimens were processed, stored, and shipped to Emory University, Atlanta, GA for analysis.

Although extensive antigenic cross-reactivity exists between the two viral types of herpes, a viral glycoprotein specific for herpes simplex virus type 2 (HSV-2) (designated gG-2) and a glycoprotein specific for herpes simplex virus type 1 (HSV-1) (designated gG-1) have been identified. Monoclonal antibodies and affinity chromatography have been used to purify these glycoproteins and thus provide antigens for type-specific herpes serologic assays. Solid-phase enzymatic immunodot assays are used to detect antibodies reactive to these antigens. The purified glycoprotein, gG-1 or gG-2, is adsorbed to the center of a nitrocellulose disk. The rest of the disk surface is coated with bovine serum albumin to prevent further nonspecific protein adsorption. Incubation of test serum with the disk allows specific antibodies, if present, to bind to the immobilized antigen. After extensive washing to remove non-reactive antibodies, the bound antibodies are detected by sequential treatment with peroxidase-conjugated goat-anti-human IgG and the enzyme substrate (H2O2 with chromogen 4-chloro-1-naphthol). A positive reaction is demonstrated by the appearance of a blue dot at the center of the disk. Serum reactive to an immunodot charged with gG-1 indicates the person being tested has HSV-1 infection. Serum reactive to an immunodot charged with gG-2 indicates the person being tested has HSV-2 infection.

There were no changes (from the previous 2 years of NHANES) to equipment, lab methods or lab site.

Detailed instructions on specimen collection and processing can be found in the NHANES Laboratory/Medical Technologists Procedures Manual (LPM).

Read the General Documentation on Laboratory Data file for detailed data processing and editing protocols.The analytical methods are described in the Description of Laboratory Methodology section above.

The NHANES quality assurance and quality control (QA/QC) protocols meet the 1988 Clinical Laboratory Improvement Act mandates. Detailed QA/QC instructions are discussed in the NHANES Laboratory/Medical Technologists Procedures Manual (LPM).

Read the General Documentation on Laboratory Data file for detailed QA/QC protocols.

NHANES Survey Design:

The analysis of NHANES laboratory data must be conducted with the key survey design and basic demographic variables. The Household Questionnaire Data Files contain demographic data, health indicators, and other related information collected during household interviews. The Household Questionnaire Data Files also contain all survey design variables and sample weights required to analyze these data. The Phlebotomy Examination file includes auxiliary information on duration of fasting, the time of day of the venipuncture, and the conditions precluding venipuncture. The Household Questionnaire and Phlebotomy Examination files may be linked to the laboratory data file using the unique survey participant identifier SEQN.

Laboratory Results

The items LBXHE1 and LBXHE2 represent type-specific enzymatic immunodot assay results.
The type-specific immunodot assays used to detect antibodies reactive to HSV-1 & HSV-2 antigens in NHANES 2009–2010 are the same assays as those used in NHANES 1999–2008 and NHANES III. Therefore, HSV-1 and HSV-2 results from these surveys are identical and comparable for trend analyses.

Data Access

The public release data file includes HSV-1 data for participants aged 14–49 and HSV-2 data for participants aged 18–49. HSV-2 data for youth aged 14–17 years are available through the NCHS Research Data Center (RDC).

Exam sample weights should be used for analyses. Please refer to the NHANES Analytic Guidelines and the on-line NHANES Tutorial for further details on the use of sample weights and other analytic issues. The Analytic Guidelines are available on the NHANES website.