This supplemental issue of Public Health Reports (PHR) presents a variety of articles addressing the science and practical applications of sexual health, an important health promotion concept with the potential for improving population health in a broad range of areas related to sexual behavior, including human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), sexually transmitted diseases (STDs), viral hepatitis, teen and unintended pregnancy, and sexual violence. The focus of these articles is especially timely given the population burden of these conditions in the United States and other nations, and the growing recognition that, despite the sensitive nature of the topic, addressing the broad construct of sexual health can enhance the national dialogue in this area and increase the effectiveness of public health programs.1–4 | The concept of sexual health has evolved since its initial articulation by the World Health Organization (WHO) in 1975,5 but it has generally emphasized well-being across a range of life domains (e.g., physical, mental, and emotional) rather than simply the absence of disease or other adverse outcomes.6 The definition of sexual health currently in most widespread use is that developed by WHO in 2002: | Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.7 | More recently, the Centers for Disease Control and Prevention(CDC)/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment (CHAC) has developed the following revised definition of sexual health recommended for use in the U.S.: | Sexual health is a state of well-being in relation to sexuality across the life span that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an intrinsic element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence. It includes: the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. Sexual health is impacted by socioeconomic and cultural contexts—including policies, practices, and services—that support healthy outcomes for individuals, families, and their communities.8 | Similar to the WHO definition, this newer definition is health-focused, emphasizing well-being related to sexuality that is beyond the absence of specific health problems, in multiple dimensions of life, as well as positive and respectful approaches to sexuality and relationships. Moving beyond the WHO definition, the CHAC definition also specifically emphasizes attributes of sexual health at both the individual level (e.g., individual understanding of benefits, risks and responsibilities, and prevention and care of health outcomes) and the social level (e.g., impact by socioeconomic and cultural contexts and healthy outcomes for families and communities as well as individuals).

OBJECTIVES: To identify opportunities within nationally representative surveys and surveillance systems to measure indicators of sexual health, we reviewed and inventoried existing data systems that include variables relevant to sexual health. METHODS: We searched for U.S. nationally representative surveys and surveillance systems that provided individual-level sexual health data. We assessed the methods of each data system and catalogued them by their measurement of the following domains of sexual health: knowledge, communication, attitudes, service access and utilization, sexual behaviors, relationships, and adverse health outcomes. RESULTS: We identified 18 U.S.-focused, nationally representative data systems: six assessing the general population, seven focused on special populations, and five addressing health outcomes. While these data systems provide a rich repository of information from which to assess national measures of sexual health, they present several limitations. Most importantly, apart from data on service utilization, routinely gathered, national data are currently focused primarily on negative aspects of sexual health (e.g., risk behaviors and adverse health outcomes) rather than more positive attributes (e.g., healthy communication and attitudes, and relationship quality). CONCLUSION: Nationally representative data systems provide opportunities to measure a broad array of domains of sexual health. However, current measurement gaps indicate the need to modify existing surveys, where feasible and appropriate, and develop new tools to include additional indicators that address positive domains of sexual health of the U.S. population across the life span. Such data can inform the development of effective policy actions, services, prevention programs, and resource allocation to advance sexual health.

Nations across the globe face significant public heath challenges in optimizing sexual health, including reducing human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), sexually transmitted infections (STIs), unintended pregnancies, and sexual violence, and mitigating the associated adverse social and economic impacts. In response, some countries have implemented national strategies and other efforts focused on promoting more holistic and integrated approaches for addressing these syndemics. This article describes opportunities for national leadership to use a more holistic approach to improve the sexual health of individuals and communities.

Genital herpes simplex virus [HSV]-2 is considered the highest prevalence sexually transmitted infection in the United States, with an estimated 17% of all adolescents and adults infected.1 Although asymptomatic in most persons, HSV-2 causes a range of important problems, including recurrent genital ulcerations, devastating neonatal infection, and enhanced HIV transmission, with estimates that HSV-2 may account for 25% to 35% of HIV infections in sub-Saharan Africa.2 Conventional tools for prevention and control (e.g., curative therapy, vaccines) do not exist for HSV-2. However, strategies that do exist—serologic tests for diagnosis, disclosure to partners, the use of condoms,3,4 and antiviral therapy that suppresses symptoms and reduces transmission5—are analogous to those in use for HIV prevention, and, over the past decade, the magnitude of the population burden associated with HSV-2 has stimulated discussion about the value of initiating broad prevention programs.6–10 | The appropriate use and likely effect of these approaches, particularly the role of widespread serologic testing, has generated controversy. Since over 80% of infected persons are unaware of their diagnosis1 and most transmission is from individuals with unrecognized infection,11 identifying those who are infected is a logical starting point for prevention. Type-specific serologic tests for herpes, available over the past decade, represent a major improvement over the earlier, nonspecific, whole antigen tests.12 However, based on concerns over test performance in low-prevalence populations and lack of data about benefit of testing, screening has not been recommended in general populations, although there continues to be debate about its role in targeted populations such as those attending sexually transmitted disease [STD] clinics.