More than 15 years ago, herpes was widely recognized as a “silent epidemic” in the major media.
“Then HIV-AIDS came along and everyone forgot about herpes,” said Dr. Harold Kessler, associate director of infectious diseases at Rush-Presbyterian-St. Luke’s Medical Center.
But the herpes simplex virus, Type 2, which is more commonly known as genital herpes, didn’t just go away. Incidence of the sexually transmitted disease is up 30 percent since the late 1970s, according to recent data from the federal Centers for Disease Control and Prevention. One in five Americans age 12 and older carries the virus.
The Type 2 herpes virus differs from the more common Type 1 variety, which invades the body of roughly 95 percent of all Americans by age 5. The most common symptoms of Type 1 are cold sores on the lips and mouth.
“We teach medical students that Type 1 is generally above the waist and Type 2 is below the waist,” said Dr. Virginia Sulica, chair of the dermatology department at George Washington University Medical Center in Washington, D.C. “They are separate illnesses. Having Type 1 doesn’t predispose you to genital herpes.”
In any case, you can expect to hear more about herpes in the next few months. Large pharmaceutical firms, notably Glaxo Wellcome with its television commercials, have rolled out national marketing campaigns for specific drug treatments. The CDC is also part of a renewed interest in increasing public awareness.
Young people are targeted as the group at highest risk for Type 2. Research shows nearly 70 percent of high school seniors and 40 percent of ninth-graders have had sex. Like most others among the 500,000 Americans who contract herpes Type 2 each year, most of these adolescents don’t know they have it. The CDC reports that less than 10 percent of people who tested positive for Type 2 were previously aware of the condition.
One problem is a good number of people do not experience noticeable symptoms during an initial exposure, though they frequently feel as if they have a mild case of flu and fever. The primary evidence of genital herpes is a series of fever blisters or cold sores that can be uncomfortable and even painful when they break into open sores that can last one to three weeks. Many people mistake such outbreaks for a rash, ingrown hair, insect bites, jock itch or yeast infections.
Sulica said there is often no less clarity at the professional level. Herpes is a disease frequently missed by doctors, she said, mostly because there often are no apparent lesions or sores. Plus, physicians have no regular screening process available.
If an outbreak occurs, cultures of the area can be evaluated for the Type 2 virus. When there are no symptoms, a blood test for specific antibodies of Type 1 and Type 2 is available, but only one version–at the University of Washington laboratory in Seattle–can reliably distinguish between the two, said Kessler.
Kessler and Sulica both advised anyone with concern about herpes to consult a physician. But Sulica acknowledged it can be confusing which type of specialist is best. Dermatologists, gynecologists, family practitioners and urologists are possible candidates.
“What you want to avoid is a doctor who thinks herpes is not in his or her patient population,” said Sulica.
The first outbreak of genital herpes usually occurs two weeks after infection. While the first year is usually the most difficult in terms of recurrences–four to five is typical–some people suffer little after the original episode. An unfortunate minority has regular and fairly severe outbreaks.
Women are more likely to develop a case of herpes Type 2. Statistics show it affects 25.6 percent of U.S. females, compared with 17.8 percent of males. African-Americans also are documented to be at higher risk than whites.
Despite such figures, some people might be tempted to dismiss the herpes epidemic.
“Patients with more regular symptoms wouldn’t feel that way,” said Kessler. “The physical outbreaks are one part. There can also be some significant psychosocial and sexual issues.”
Linda Alexander, president of the American Social Health Association, said it is common for people to feel stigmatized, betrayed or violated when diagnosed with herpes. Even mild outbreaks can lead to depression for some.
“People go through the typical stages with any medical condition: disbelief, anger, shame and acceptance,” Alexander explained. “We recommend communication as the key element between sexual partners.”
Kessler said there also is a larger issue: “We can’t look at genital herpes in isolation of all sexually transmitted diseases. It is part of a disturbing trend.”
Indeed, eight new sexually transmitted infections have been discovered since 1980. AIDS overshadows the rest because of its tragic consequences, but that doesn’t mean the other diseases should go unaddressed.
Chlamydia, for example, is a common sexually transmitted bacteria that is hard to detect. Like herpes, it shows no symptoms in many people–about 75 percent of infected women and about half of infected men. A simple course of antibiotics can eliminate the problem, but when it goes unchecked, as in the majority of cases, it is the most common cause of infertility in women of child-bearing age.
Herpes also carries related health risks. Research shows that people with Type 2 herpes are at significantly greater risk for HIV transmission, and a pregnant woman with Type 2 can pass the disease to her child, causing brain damage and even death, possibilities that are increased if untreated by her obstetrician.
Researchers are making progress in the treatment of genital herpes, despite the lack of a cure. New studies show that using certain medications during the first outbreak can discourage recurrences and severity. There is also good evidence that an ongoing regimen of drugs can suppress “asymptomatic” viral shedding–when the virus can be passed on even in the absence of observable blisters or sores–that scientists have now discovered is common.
“This raises the question of whether a person who is otherwise feeling healthy should go on chronic medication,” said Kessler. For partners of individuals with Type 2, a protective vaccine may be only a few years away, he added.
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The American Social Health Association toll-free information hotline is 800-230-6039. Its herpes counseling hotline is 919-361-8488.
