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U.S. research update: Herpes rates remain high
The test results are in: Your patient tests positive for herpes simplex virus type 2 (HSV-2). What is your next step?
If results of a new study are any indication, there is a good chance you will fail to educate your patient about the protective effects of condom use or the effectiveness of suppressive therapy.1
Although clinicians usually discuss condoms and suppressive therapy with patients diagnosed with genital herpes, only a minority discuss suppressive therapy to prevent transmission, and only a quarter of patients take suppressive therapy, researchers reported at the 2010 National STD Prevention Conference. Most patients in the study could not estimate the effectiveness of condoms or suppressive therapy in preventing transmission, and few were offered routine follow-up care.1
To conduct the study, Washington state researchers used surveillance data collected in King and Pierce counties, WA, to identify persons 18 years of age and above with newly diagnosed symptomatic genital herpes. They interviewed patients and reporting clinicians regarding treatment. Patients were eligible for interviews if they had newly diagnosed symptomatic genital herpes, spoke English, and their provider agreed. Scientists interviewed clinicians regarding 246 (92%) of 267 reported cases and interviewed 134 (63% of 212 eligible) patients.
Patients reported condom use was discussed in 78% of encounters, suppressive therapy in 68%, and suppressive therapy to decrease transmission in 40% of visits. About one-fourth (26%) reported taking suppressive therapy. A follow-up appointment was recommended for 34% of patients, and 21% reported attending a follow-up appointment.
About one-third (30%) of patients correctly responded that condoms provide a protective effect in preventing herpes transmission, and just 21% estimated that suppressive therapy is effective in preventing transmission. Most (60%) of the surveyed patients were unsure of the effect of suppressive therapy on disease transmission.1
Women are at risk
About one in six Americans (16.2%) between ages 14-49 is infected with HSV-2, according to new research from the Centers for Disease Control and Prevention (CDC).2 The new estimate, compiled for 2005-2008, comes from the CDC's National Health and Nutrition Examination Survey, a nationally representative survey of the U.S. household population that assesses a broad range of health issues.
Women and blacks were most likely to be infected with HSV-2, according to the new analysis. Prevalence was nearly twice as high among women (20.9%) than men (11.5%), and was more than three times higher among blacks (39.2%) than whites (12.3%). The most affected group was black women, with a prevalence rate of 48%, researchers report.2
"This study serves as a stark reminder that herpes remains a common and serious health threat in the United States," says Kevin Fenton, MD, director of CDC's National C enter for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Everyone should be aware of the symptoms, risk factors, and steps that can be taken to prevent the spread of this lifelong and incurable infection." Public health officials are particularly concerned about persistent high rates of herpes among African-Americans, which is likely contributing to disproportionate rates of HIV in the black community, he states.
As with other sexually transmitted diseases, biological factors might make women more susceptible to HSV-2 infection. Such susceptibility is of concern: Research indicates that people with herpes are two to three times more likely to acquire HIV and that herpes also can make HIV-infected individuals more likely to transmit HIV to others.
The CDC estimates that more than 80% of those with HSV-2 are unaware of their infection. Most patients have no or minimal signs or infection. When signs do occur, they typically present as one or more blisters on or around the genitals or rectum. When the blisters break, they leave small sores that might take 2-4 weeks to heal at the first time of occurrence. The initial outbreak typically is followed by subsequent outbreaks that can appear weeks or months after the first. Such reoccurrences almost always are less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over subsequent years.3
"Many individuals are transmitting herpes to others without even knowing it," says John Douglas Jr., MD, director of the CDC's Division of STD Prevention. "We can't afford to be complacent about this disease. It is important that persons with symptoms suggestive of herpes, especially recurrent sores in the genital area, seek clinical care to determine if these symptoms may be due to herpes and might benefit from treatment."
Although HSV-2 infection is not curable, there are effective medications available to treat symptoms and prevent outbreaks. Those with known herpes infection should avoid sex when herpes symptoms or sores are present and understand that HSV-2 still can be transmitted when sores are not present. Effective strategies to reduce the risk of HSV-2 infection include abstaining from sexual contact, using condoms consistently and correctly, and limiting the number of sex partners.
The CDC does not recommend HSV-2 screening for the general population. However, such testing may be useful for individuals who are unsure of their status and at high risk for the disease, including those with multiple sex partners, those who are HIV-positive, and gay and bisexual men.