HERPES RESEARCH EXERPTS

1. The Current Trend in Genital Herpes. Progress in Prevention.

          Corey, L.

          Department of Laboratory Medicine, University of Washington,

          Seattle 98144. 1994, Mar-Apr; 21(2 Suppl): S38-44.

Recent serosurveys indicate that the prevalence of genital herpes hascontinued to increase even during the decade of HIV. Much of this continued transmission is due to the difficulty of identifying the subclinical carrier of HSV-2. The development of serologic assays that accurately distinguishHSV-1 from HSV-2 infection now allow such persons to be identified, and recent studies indicate almost all HSV-2 seropositives have symptoms and signs of reactivation HSV-2. Moreover, over 50% will shed virus subclinically in the genital tract. This underestimation of this reactivationrate appears to be another factor in the continued spread of the virus throughout the population. The development of an HSV vaccine is imperative if we are to control this rapidly increasing infection.

WHAT DOES THIS RESEARCH EXERPT MEAN TO YOU?

   Medical researchers in the 1990’s report that you can be accurately tested for genital herpes infection (HSV-2) because a large proportion of North Americans carry titers to the common cold sore virus (HSV-1) and technology was not available earlier to distinguish between HSV-1 and HSV-2.

   There was and still is today (2007) a continuing, expanding epidemic of sexually transmitted diseases among our population and genital herpes is riding the crest of the tidal wave due to various factors among which are subclinical carriers of genital herpes. This means that these HSV-2 virus carrying, sexually active persons may not know they have genital herpes and their sex partners and the carriers will not observe tell tale genital herpes sores of this carrier person, below the waist.

    Anyone infected with genital herpes which includes those who know by seeing manifestions of the infection or those who don’t (carriers) may shed the virus when they appear symptom free of herpes sores.

2.   Asypmtomatic reactivation of herpes simplex virus in women after the first episode of genital herpes.

Koelle DM, Beneditte J, Langenberg, A, Corey L.

University of Washington, Seattle. 1992 Mar 15; 116(6): 433-7

OBJECTIVE: To determine frequency, anatomic site, and host factors associated with asymptomatic shedding of herpes simplex virus after initial episodes of genital herpes. DESIGN: Cohort study with follow-up for a median of 63 weeks. SETTING: Referral clinic. PATIENTS: Women (306) with first episode of herpes; 43 had primary herpes simplex type 1, and 227 and 36 had primary and nonprimary herpes simplex virus type 2, respectively.

MEASUREMENTS: Asymptomatic shedding was detected among 11.9, 18.3%, and 22.9% of women with primary herpes simplex virus type 1, primary HSV type 2, and nonprimary HSV type 2, respectively. Among patients with type 2 infection, previous type 1 antibody was associated with a lower rate of asymptomatic vulvar shedding. Asymptomatic cervical shedding was 3 times more frequent during the first three months after resolution of primary type 2 disease than during later time periods. In contrast, the rate of symptomatic recurrent herpes did not change over time. CONCLUSIONS: Asymptomatic genital herpes simplex type 2 is more common than type 1. Asymptomatic genital shedding occurs more often during the first 3 months after acquisition of primary type 2 disease than during later periods. Patients with HSV type 2 should be advised of this high early rate of asymptomatic shedding and of potential transmission to sexual partners.

WHAT DOES THIS RESEARCH EXERPT MEAN TO YOU?

   Women who were already infected with the cold sore virus (HSV-1) that usually causes sores in the head range, and then contracted genital herpes (HSV-2), had lower shedding of this virus after their first clinical signs (sores), showing that they had contracted genital herpes. This is called a primary event.

   Women who contracted genital herpes for the first time (primary) had the highest shedding of this virus (HSV-2) from their genitals but no expressions of sores during this virus shedding time to indicate to themselves and their sexual partners that they were infective for genital herpes.

   Asymptomatic (subclinical) means no visible signs that a disease state is present or no symptoms (clinical) seen.

   Nonprimary episodes of genital herpes means that this is your second, third, fourth, etc episodes of genital sore eruptions which can occur regularly (once per month) or irregularly (every few years).

3.   SERO-EPIDEMIOLOGICAL AND –SOCIOLOGICAL PATTERNS OF

     HERPES SIMPLEX VIRUS INFECTION IN THE WORLD.

     Nahmias AJ, Lee FK, Beckman-Nahmias S.

     Department of Pediatrics, Emory University School of Medicine, Atlanta, GA

     30303. Scand J Infect Dis Suppl. 1990; 69: 19-36

A newly developed Herpes simplex virus (HSV) type 1 and type 2 enzyme immunoassay has been applied to over 40,000 sera from different populations in the US and 17 other countries on all 5 continents. The HSV-1 antibody patterns found permit the current and past socioeconomic status, as well as the extent of oral-genital sexual contact, to be deduced for various populations. The HSV-2 antibody results provide an objective measure of various aspects of sexual behavior; extent of polypartnerism in the subjects tested (or their contacts), early age of sexual experience and acquisition rates of genital herpes. It has thus been possible to extend sero-epidemiology to sero-sociology which can provide objective markers fro sexual behavior and effects of intervention for monitoring other STDs, such as HIV infection, recent studies also support a possible role for HSV infections to increase the transmissibility, not only of HIV-1, but also of HTLV-1.

PIP: This is a review of the implications of epidemiology of herpes simplex virus types 1 and 2 accrued over 19 years of use of an enzyme immunoassay on over 40,000 sera from 18 countries from 1964 to 1983. HSV-1, which typically causes intraoral ulcers and fever blisters, is usually acquired in childhood and adolescence, and more often by socioeconomically less advantaged populations.

Genital HSV-2 when it occurs is usually a primary genital herpes, is more often acquired by sexual activity, and usually causes severe disease in neonates.

Prior HSV-1 confers moderate protection against getting HSV-2, and reduces its severity. There were 2 national settings with a typical infection patterns, Brazzaville, Congo and Wuhan, China. Here a high percentage of HSV-2 antibodies alone suggested that primary, probably neonatal, HSV-2 protected from subsequent HSV-1 infection. The prevalence of HSV-2 antibodies in 18 countries was correlated with number of sexual partners, form zero in nuns and 0.3% in U.S. children, to 50% in pregnant Blacks from Haiti.

Prevalence in African countries ranged from 6-97%. Studies showed that most HSV-2 infections were subclinical. 22-28% of pregnant women shed HSV-2 particles vaginally from micro-ulcers only detectable by colposcopy. An association between HSV-2 and HIV infections has been documented in several studies. HSV-2 infections increased in some populations in the 1960-1970s, notably in Western countries undergoing a sexual revolution. Many White Americans experience severe HSV-2 symptoms possibly because of lack of protection from prior HSV-1.

WHAT DOES THIS RESEARCH EXPERPT MEAN TO YOU?

 This may be an older study for herpes infections since the data was collected between 1964 to 1983 from 40,000 patients across the world, but its findings are still relevant today.

  Your immune system does mount a protective response to both cold sore herpes (HSV-1) and genital herpes (HSV-2) when first contracted from others BUT it can NOT completely eliminate the virus from the body, due to the unique nature of these viral infections.

  If you contracted cold sores (HSV-1) as a child, and then contract genital herpes later, your first genital herpes sore eruption should be less severe due to the fact that your HSV-1 antibodies help fight the genital herpes virus. This is also true if you contract cold sores after you already carry the genital herpes virus. Your first cold sore eruption should be less severe.

Studies showed years ago that most of the genital herpes (HSV-2) infections are subclinical. This means that you may NOT know and your sexual partner therefore also won’t know that you are a carrier and hence shedder of the genital herpes virus because visible genital sores are not seen readily by either of you. If you carry genital herpes, you are infective and a danger to others. Women who are carriers for genital herpes and are subclinical (no obvious herpes sores are observed by the naked eye), endanger their babies at birth to life threatening herpes infection

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