|
|
|
|
|
Edward Hook, MD, Division of Infectious Disease, University of Alabama School of Medicine, ZRB 242, 1530 3rd Ave South, Birmingham, AL 35294-0007, 205-934-4204, ehook@idmail.dom.uab.edu
Although genital herpes (GH) is a familiar term to physicians and most of the general public, advances in understanding of GH now require re-conceptualization of the infection, its clinical manifestations, and strategies for control. GH is the most prevalent STD in the United States, and past prevention efforts have been diffuse and largely ineffective. In 1997, the third National Health and Nutrition Examination Survey (NHANES III) documented a 30% increase in type 2 herpes simplex virus infection (HSV-2) over the 1980s (overall prevalence 21.7%), equating to infection of 45 million Americans. Only one in ten infected persons was aware of their infection, however, and multiple studies show most herpes transmission is from persons unaware of their infections. Apart from clinical disease, rising HSV-2 prevalence has multiple public health implications. Chief among these, recent studies suggest that HSV-2 infection increases risk for HIV acquisition at least two-fold, and large-scale African studies are examining the potential impact on HIV rates of interventions to curtail HSV-2 transmission and reactivation. Rising HSV-2 rates may also result in increased neonatal herpes, a devastating illness with lifelong sequelae. Recent research findings, however, suggest strategies for curbing the GH epidemic. New diagnostic tests, for example, now provide tools for better case identification, and antiviral therapy has recently been demonstrated to significantly reduce transmission in discordant couples, providing new opportunities for control. For uninfected persons a prophylactic vaccine against HSV-2 is now in Phase III clinical trials and may be ready for market within 10 years.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.