Scientific Article: Genital Herpes

Genital herpes is a lifelong, recurring, incurable infection that can cause painful genital ulcerations, painful urination and flu-like symptoms such as malaise and muscle aches.  The initial break out usually lasts longer and is more wide-spread than recurring break-outs. At this time, there is no cure and no effective vaccine for the prevention of genital herpes.

Genital herpes infections are caused by Herpes Simplex Virus -1 and 2 (HSV-1, HSV-2). Historically, HSV-2 was associated with genital herpes infections, while HSV-1 was more closely associated with “cold sores” and break-outs around the area of the mouth. However, genital infections caused by HSV-1 are being diagnosed much more frequently in recent years, especially among adolescents and young adults in industrialized countries, such as the U.S.

It is difficult to ascertain the number of cases of genital herpes already existing (prevalence), as well as the number of new cases each year (incidence) for several reasons. First, it is approximated that up to 90% of genital herpes is undiagnosed. Further, the Center for Disease Control uses only data from HSV-2 in calculating statistics for genital herpes.1

However, even considering only cases caused by HSV-2, a press release from the Centers for Disease Control and Prevention on March 9, 2010, states that one in six Americans is infected with HSV-2; with the highest prevalence being among women and African-Americans.2

Both HSV-1 and HSV-2 can be transmitted to a newborn infant at the time of delivery by an infected mother. If it is the mother’s first break-out, the infant has a 60% chance of being infected. Because newborns lack a mature immune system, the infection can be devastating. Up to 30% of infants so infected die from the most severe form of the disease. If the infection affects the central nervous system of the newborn, the baby may be left with lifelong neurological consequences. Testing pregnant women in late pregnancy for HSV can prove to be lifesaving for newborns.3

Some valuable data regarding genital herpes infections in women was gathered during a vaccine testing study.4  During this study, women were tested over a 20 month period of time for the Herpes Simplex Virus, both HSV-1 and HSV -2.  A total of 3,438 women between the ages of 18 – 30 years of age all initially tested negative for the virus.  Over the next twenty months, 3.7% of the women became infected with HSV-1 and 1.6% with HSV-2.

Several important facts emerged from the vaccine study, adding to the overall knowledge of genital herpes:

  • Most infections occurred without recognized signs or symptoms of herpes disease.
  • Younger participants (18 – 22 years) were more likely to acquire HSV-1 infections and less likely to develop recognized symptoms than older participants.
  • Irrespective of virus type, most recognized disease was genital (84%).
  • No differences were observed in the clinical manifestations of genital herpes from HSV-1 and HSV-2.

Anna Wald, M.D., discusses two potential explanations for the increase of HSV-1 induced genital infections among young people. First, it seems that there has been a decrease in children naturally acquiring HSV-1 in the U.S. and other industrialized countries. Thus, many adolescents and young adults are vulnerable to HSV-1 at sexual debut. Second, the increase in oral-genital contact among young people is likely to be a factor, as there is a trend to decrease the risk of pregnancy by replacing vaginal sex with oral sex.5

Young people need to understand that trading one risk factor (pregnancy) for another (genital herpes or other STIs) is not the best choice. There are consequences to having sex, whether it be oral, genital, or anal in nature. Herpes can be spread from person to person even when there are no visible signs of infection. Condoms, vaginal or penile, offer limited protection against a virus that is widely spread over the genital and mouth areas.  The best protection is to have sex only with an uninfected person who shares a long-term monogamous relationship.

References:

  1. Centers for Disease Control and Prevention, “Sexually Transmitted Disease Surveillance 2013”, Division of STD Prevention, December 2014.
  2. Centers for Disease Control and Prevention, “CDC Study Finds U.S. Herpes Rates Remain High”, Press Release, March 9, 2010.
  3. Kimberlin, David W., “The Scarlet H”, Journal of Infectious Diseases (2014)209(3):315-317.
  4. Bernstein DI, et al, “Epidemiology, Clinical Presentation, and Antibody Response to Primary Infection With Herpes Simplex Virus Type 1 and Type 2 in Young Women,” Clinical Infectious Diseases 2013;56(3)344-51.
  5. Wald, Anna MD, “Genital HSV-1 Infections” an editorial, Sexual Transmitted Infections 2006;82:189-90