Understanding High Levels of Sexually Transmitted Infections in the United States: Do Economic and Cultural Factors Predict Having an Undiagnosed Herpes Simplex Type 2 Infection?

Kirsten Smith, University of Pennsylvania

The United States has among the highest levels of sexually transmitted infections in the developed world. The primary explanations cited in the literature are differential access to healthcare and culture related to sex and sexual health. In this paper, I analyze within-country differentials to evaluate whether these factors could contribute to the higher STI rates in the US, working through the mechanism of delayed or reduced diagnosis and treatment of STIs. I use data from the National Health and Nutrition Examination Survey to assess whether healthcare access and culture, as well as demographic and behavioral factors shown to increase risk in the US, are related to having an undiagnosed herpes simplex type 2 infection. By providing insight into risk factors for having an undiagnosed herpes infection in the US, this study advances understanding of why the US has higher rates of herpes and other STIs than most other developed countries.