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Background  Herpes simplex virus type-2 (HSV-2) infection is the main cause of genital ulcer disease and increases the risk of HIV acquisition. Little information is available regards the epidemiological characteristics of HSV-2 among general population in China. The aim of this study was to explore seroprevalence and associated factors of HSV-2 and provide information for design of HSV-2 control strategy in Shandong, China.    Methods  In this cross-sectional study, a total of 8074 persons, 18–49 years of age, were selected using multi-stage probability sampling to represent the general population of Shandong in 2016. Demographic data were collected through face-to-face interviews. Other variables were obtained by self-administered questionnaire surveys. Blood was collected for HSV-2 IgG detection with ELISA.    Results  A total of 7256 sexually-active participants were included in the analysis. The weighted seroprevalence of HSV-2 infection was 4.2% (95% confidence interval [CI], 3.2–5.3) in females, which was significant higher than that in males (2.7%; 95% CI, 1.1–4.2) ( P  = 0.04). The seroprevalence of HSV-2 was higher in individuals from eastern region (6.4%; 95% CI, 5.9–6.9) and urban areas (4.3%; 95% CI, 2.6–6.0) of Shandong than those from other regions ( P  < 0.01). Associated factors for HSV-2 infection among men were being urban residents (adjusted odds ratio [AOR], 2.36; 95% CI, 1.14–4.88), having two or more sex partners in the past year (AOR, 3.22; 95% CI, 1.90–5.43) and having commercial sex (AOR, 1.51; 95% CI, 1.00–2.26). Among females, being divorced or widowed (AOR, 1.79; 95% CI, 1.08–2.97), having a tattoo (AOR, 2.89; 95% CI, 1.07–7.84), and being dissatisfied with the sex activity quality (AOR, 2.12; 95% CI, 1.24–3.63) was associated with HSV-2 infection.    Conclusions  This study showed a relatively low burden of HSV-2 in Shandong province, China compared with the seroprevalence reported in many other provinces and countries. HSV-2 control programs in Shandong should focus on eastern, urban and female residents, and pay more attention to individuals with identified associated factors.

Seroprevalence and associated factors of HSV-2 infection among general population in Shandong Province, China