Article Text

Download PDFPDF

Herpes simplex virus type 1 in Europe: systematic review, meta-analyses and meta-regressions
  1. Wajiha Yousuf1,
  2. Hania Ibrahim1,
  3. Manale Harfouche1,
  4. Farah Abu Hijleh2,
  5. Laith Abu-Raddad1,3
  1. 1 Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
  2. 2 Department of Public Health, College of Health Sciences, Academic Quality Affairs Office, Qatar University, Doha, Ad Dawhah, Qatar
  3. 3 Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, Ithaca, New York, USA
  1. Correspondence to Dr Laith Abu-Raddad; lja2002{at}


Objective To describe the epidemiology of herpes simplex virus type 1 (HSV-1) in Europe.

Methods We systematically reviewed HSV-1 related publications, conducted various meta-analyses and meta-regressions, assessed pooled mean seroprevalence, and estimated pooled mean proportions of HSV-1 viral detection in clinically diagnosed genital ulcer disease (GUD) and in genital herpes.

Results We extracted, from 142 relevant records, 179 overall (622 stratified) seroprevalence measures, 4 overall proportions of HSV-1 in GUD and 64 overall (162 stratified) proportions of HSV-1 in genital herpes. Pooled mean seroprevalence was 67.4% (95% CI 65.5% to 69.3%) with 32.5% (95% CI 29.4% to 35.7%) of children and 74.4% (95% CI 72.8% to 76.0%) of adults infected. Pooled seroprevalence increased steadily with age, being lowest in those aged <20 years (39.3%, 95% CI 35.9% to 42.7%) and highest in those aged >50 years (82.9%, 95% CI 78.8% to 86.6%). Pooled seroprevalence decreased yearly by 0.99-fold (95% CI 0.99 to 1.00). Pooled mean proportion of HSV-1 detection was 13.6% (95% CI 4.1% to 27.1%) in GUD, 34.1% (95% CI 31.7% to 36.5%) in genital herpes and 49.3% (95% CI 42.2% to 56.4%) in first episode genital herpes. Pooled proportion of HSV-1 detection in genital herpes increased yearly by 1.01-fold (95% CI 1.00 to 1.02), with higher detection in women (42.0%, 95% CI 37.4% to 46.7%) than men (24.1%, 95% CI 19.8% to 28.6%).

Conclusions HSV-1 epidemiology is transitioning away from its historical pattern of oral acquisition in childhood. Every year, seroprevalence is declining by 1% and the proportion of HSV-1 in genital herpes is increasing by 1%. As many as two-thirds of children are reaching sexual debut unexposed, and at risk of HSV-1 genital acquisition in adulthood.

  • herpes
  • genital ulcer disease
  • seroprevalence
  • prevalence
  • meta-analysis
  • meta-regression
  • europe
  • region

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Handling editor Alberto L Garcia-Basteiro

  • WY, HI and MH contributed equally.

  • Contributors WY, HI, and MH conducted the systematic search, data extraction, data analysis and wrote the first draft of the paper. FAH conducted the double extraction. LA-R conceived the study and led the data analysis and interpretation of the results. All authors contributed to drafting and revision of the article, and read and approved the final manuscript.

  • Funding This work was supported by the Qatar National Research Fund (NPRP 9-040-3-008), and through pilot funding by the Biomedical Research Program at Weill Cornell Medicine, Qatar.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data are fully available without restriction.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.