Whatever Happened to Herpes? The Forgotten Epidemic

Trends

The recent National Health and Nutrition Examination Surveys (NHANES III) found that seroprevalence of herpes simplex virus type 2 (HSV-2) in the United States, increased from 16.4 to 21.9 percent in the decade of the 1980s. This represents an increase of over 30 percent for the virus which is the most common cause of genital herpes. While these numbers are disturbing, they show only part of the picture. Approximately 25 percent of new cases of genital herpes may actually be caused by herpes simplex virus type 1.

Scope of Problem

The United States is not unique in its high rates of seroprevalence. Virtually every country in the world presents similar numbers. Since recurrences are often very mild and few patients are aware that they are infected, the infection is likely to continue to rise at double-digit rates without an intervention.

Sequelae

Once infected with HSV-1 or -2, a person may experience recurrences throughout his/her lifetime. Until recently, health care providers thought that herpes was largely an asymptomatic disease, with only approximately 20 percent of those infected experiencing symptomatic recurrences. More recent data show that 80 to 90 percent of people will experience recurrences. While usually not life-threatening to adults, transmission of HSV from an infected mother to her newborn can be fatal.

Costs

It is difficult to estimate the cost of genital herpes since so much of the disease is either misdiagnosed, undiagnosed or left untreated. However, the Kaiser Family Foundation recently released a report that estimates the cost of treating genital herpes at $208 million per year. Excluded from this estimate is the transmission of genital herpes from an infected mother to her newborn during delivery which could cost hundreds of thousands of dollars in each case. Also excluded are the costs of unnecessary C-sections in women who are known to be infected, yet are denied suppressive antiviral therapy at delivery.

Challenges and Goals

Herpes infections will continue to rise unless an intervention strategy is developed. A 30 percent increase of seroprevalence of HSV in the first decade of HIV indicates that strategies targeted at HIV risk groups will not help with HSV. To decrease the transmission of herpes several things are needed. We must be able to accurately diagnose the disease. We need to know who to screen for the disease and what to tell them once they are diagnosed. Lastly, we need a strategy to prevent transmission.

Risk Groups

Herpes does not have a particular risk group. All sexually active people are at risk of infection. While the highest prevalence is in the lower socioeconomic group, the highest rise in seroprevalence in the last decade was among white teenagers. As with many other STDs, women regardless of race are at the highest risk of infection.

Research Priorities

• To develop a national policy regarding whom to screen for HSV infection and how to counsel those with infection.
• To develop a disease management strategy once a person or their partner is diagnosed.

April 1999