Introduction
Herpes simplex virus type 2 (HSV-2) is an incurable and recurring sexually transmitted infection.1 Often asymptomatic, people with HSV-2 can transmit the virus to their sexual partners without awareness of their infection.2 It also increases the risk of acquiring and transmitting the Human immunodeficiency virus (HIV).3,4 Given its contingency and impact on life quality and well-being,5understanding the epidemiology of HSV-2 is essential for informing future prevention. Also, considering its synergy with HIV, reducing HSV-2 infection is beneficial to the goal of ending STI epidemics as major public health concerns by 2030.6
The latest estimate of HSV-2 global prevalence in 2016 was 13.2% (491 million) among people aged 15-49 worldwide.7 Recent meta-reviews have reported a wide range of prevalence estimates from different geographical regions, including 37.3% in sub-Saharan Africa,8 20.6% in Latin America,915.4% in Canada, Australia, and New Zealand,10 12.4% in Europe,11 12.1% in Asia,12 and 5.1% in the Middle East and North Africa among the general population.13 Seroprevalences of HSV-2 among key populations such as male sex workers(MSW), men who have sex with men (MSM), and female sex workers (FSW) are substantially higher across regions, ranging from 20.6% to 74.8% for FSW and from 18.3% to 54.6% for MSM and MSW.8-13
Despite the existing literature, a comprehensive overview of HSV-2 epidemiology and trends among different populations in China is limited, calling for a systematic review and meta-analysis. A meta-analysis in Asia reported a pooled HSV-2 seroprevalence of 9.3% among the general population.12 However, it only included literature identified from English bibliographic databases, which may incur language bias.14 We also identified two additional meta-analyses that focused on specific populations in China, such as the MSM population with a pooled prevalence of 9.4%, 15and the FSW population with a 15.8% HSV-2 prevalence.16 These reviews included a small portion of the existing studies, which is quite limited. Our study aims to fill this gap and provide a more comprehensive and up-to-date estimate of the HSV-2-related outcomes (e.g., prevalence and incidence) among various populations in China by synthesizing literature published in Chinese and English and generating estimates by different groups and subpopulations.