Genital Herpes Epidemic Grows
Even in the sexually permissive ‘70s, the afflicted often kept quiet. Having genital herpes, after all, was akin to being a social leper.
Then along came HIV, which can lead to AIDS, making herpes pale in comparison and pushing it out of our collective consciousness.
But the herpes epidemic, far from being over, is getting worse.
Today, roughly one in five Americans over age 12--or about 45 million people--is thought to have genital herpes, although most are unaware they have it. Since the ‘70s, diagnoses of genital herpes have increased 30%.
That rise was the impetus for “Stopping the Genital Herpes Epidemic: How Close is a Cure?” a teleconference hosted Thursday by the American Social Health Assn. The North Carolina organization is devoted to eradicating sexually transmitted diseases.
According to recent research, the greatest increase in the incidence of genital herpes is in white teens and white young adults. The estimates are based on an analysis of the National Health and Nutrition Examination Surveys conducted by researchers at the federal Centers for Disease Control and Prevention and published Oct. 16 in the New England Journal of Medicine.
For some, herpes is an occasional annoyance. But having genital herpes can put people at greater risk for human immunodeficiency virus, or HIV, since the presence of the herpes lesions can facilitate transmission of HIV. Pregnant women with active herpes at delivery must usually have a caesarean section to protect the newborn.
Grim as the statistics are, there’s reason for hope.
Long-term therapy with antiviral drugs is proving effective for those plagued with recurrent outbreaks. Now, investigators are trying to find out whether early treatment with these antivirals during the initial outbreak might dramatically reduce or even eliminate recurrences, according to experts speaking at the teleconference.
Attempts to develop a vaccine are continuing, although availability is probably years away.
And making the diagnosis, which can be elusive, might soon be simpler. A new blood test developed by a Salt Lake City company and already used in Europe is under review by the Food and Drug Administration and might be available in the United States within a month.
How is it that someone can have genital herpes and not know it?
The severity of the first outbreak can vary. Some people will have blisters on their genitals, feel tired and have horrible headaches, says Dr. Virginia Sulica, chairwoman of dermatology at George Washington University Medical Center, Washington, D.C., and a speaker at the teleconference.
“After seven to 14 days, the patients are usually OK,” she says. “The virus migrates from the skin to the nerves and remains in the body for the rest of their lives. The virus can migrate back from the nerves to the skin, and the patient can get a recurrent episode.”
In others, the first episode can go practically unnoticed, says Dr. Carol Otis, staff physician at the UCLA Student Health Service. The denial factor can come into play.
“Some may discount it, think it’s something else,” she says. “Women may think it is a yeast infection.”
Adds Dr. Dennis Kelly, physician specialist at the UCLA Student Health Service: “Many times men will describe an abrasion on the genitals [that’s actually herpes].”
One blood test currently available cannot differentiate whether the patient has been exposed to genital herpes or to oral herpes. Another test, the herpes Western blot, can differentiate, but it’s expensive, time-consuming and rarely ordered. (Most genital herpes cases are caused by the herpes simplex virus Type 2, or HSV-2, although some genital herpes can be caused by herpes simplex virus Type 1, or HSV-1, which is transmitted by oral sex. Most oral herpes or cold sores are caused by HSV-1.)
So physicians mostly rely, instead, on medical history, visual exam and tissue culture. Taking a sample of the lesion, they culture it in the lab, trying to grow the virus and confirm the diagnosis.
But by the time some check in with their doctor, the virus may already have migrated to nerve cells and the tissue culture is negative. The new blood test developed by Gull Laboratories requires a small blood sample and is expected to cost a fraction of the fee charged for the herpes Western blot, says Peter Van Duser, spokesman for Gull Laboratories. It works by detecting two different types of antibodies produced in response to the herpes virus; one is specific to HSV-1 and another is specific to HSV-2.
If the diagnosis is positive for genital herpes, there are more medication options than ever. Antiviral drugs prescribed include acyclovir, which is off patent and available generically, valacyclovir (Valtrex) and famciclovir (Famvir).
“Those with more than six outbreaks a year are candidates for long-term therapy,” says Dr. Robert Alan Winters, an internist and infectious disease specialist at St. John’s Hospital & Health Center in Santa Monica. He says he has seen long-term therapy dramatically reduce recurrences.
He often prescribes six months of therapy, then often takes the patient off it to see whether outbreaks continue. Some patients have been on suppressant therapy for years.
Now, investigators are studying whether very early treatment with an antiviral drug--administered within 72 hours of the initial outbreak--may prevent the virus from attacking the nerve cells, thus reducing recurrences and the likelihood of further transmission. The study involves 400 subjects at 67 study sites worldwide, according to George Washington University’s Sulica, who is one of the investigators. Subjects receive either Valtrex or Famvir for 10 days and then will be followed for 10 months to determine whether outbreaks recur. The study is supported by a grant from SmithKline Beecham, the manufacturer of Famvir.
“I would be doubtful if this study shows the virus can be eradicated,” Winters says.
Besides being given medications, patients who have recently been diagnosed as having herpes are cautioned to alert their sexual partners and to practice safe sex.
Winters tells patients: “It’s possible to spread the virus without any observable lesions. And when you are obviously symptomatic, you need to abstain.”
Between outbreaks, patients are also cautioned to use condoms to help prevent spread of the virus.
“The female condom probably works better because it covers more of the genital surface,” says UCLA’s Otis.
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* William Holmes of the editorial library contributed research to this story.
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Where to Call for Information
For more information about herpes:
* National STD Hotline, (800) 227-8922.
* National Herpes Hotline, (919) 361-8488.
* Herpes Resource Center, (800) 230-6039.
