On Herpes

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Genital herpes is one of the most common sexually transmitted infections (STIs) in the United States. It is caused by either herpes simplex virus (HSV) type 2 (HSV-2), a virus that almost exclusively causes genital infections, or HSV type 1 (HSV-1) which causes oral and lip infections (cold sores) and genital herpes. HSV-2 is estimated to infect more than 45 million US residents aged 14 to 49 years. HSV-1 now causes 10 to 20 percent of all new cases of genital herpes. Congential herpes (newborns infected during birth by an infected mother) is more than twice as common as congenital syphilis, and can be devastating to newborns. In addition there is a strong association between genital herpes infection and HIV type 1.

There is no cure and no vaccine for HSV infections. There is also no coordinated national effort to control genital herpes. Efforts to reduce HSV transmission can be challenging because most infected people (estimated to be 8 out of 10) are unaware they are infected, yet they remain at risk to transmit the virus to others. The first step in confronting a widespread, largely underrecognized public health problem is to identify those who are infected. One would think that given such a large problem, screening the population with a blood test or genital swab would readily identify infected individuals, but sadly such is not the case. Recently, the US Preventative Services Task Force (USPSTF) again (they last made a recommendation in 2005), recommended against, routine screening for HSV. This is based on the high rate of false positives (estimated to be about the same rate as true positives or 50 percent), potential harms from screening (telling and treating someone as positive when they are not), and limited evidence that medical treatment reduces transmission to uninfected persons and newborns. In addition, screening for HSV-1 cannot determine the infection site, so a positive HSV-1 screen could be from an oral infection, genital infection, or both. HSV screening should still be performed, however, in selected cases.

Treatment with antiviral medications can shorten the length of an attack and lessen the likelihood of transmission. Long-term suppressive treatment can do the same, plus reduce the number of outbreaks with their pain and discomfort, but treatment does nothing to reduce the social stigma that HSV infection can bring. Obstetricians and hospitals will recommend a C-section to a symptomatic infected woman about to deliver, to avoid having the baby become infected. Because HSV is transmitted by physical contact with an infected person, the only way to prevent transmission is physical protection (condom). Oral contraceptives, IUDs and other pregnancy protection methods will not prevent HSV infection. Also an infected but asymptomatic person may still transmit the virus.

It is clear then that the medical community, perhaps with the assistance of lawmakers and the public, needs to goad the federal agencies like the NIH, CDC, and others into action to develop better screening tests and methods. In this age of technology it should be relatively easy to reliably identify, warn, and treat infected individuals in order to stop the transmission of this nasty virus.

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