Herpes on the Rise

by Brian A. Boyle, MD and Adam Stracher, MD

The number of people with herpes simplex virus type 2 (HSV-2), which causes most cases of genital herpes, has increased thirty percent in the last twenty years. According to the Centers for Disease Control and Prevention, more than one in five American adolescents and adults are now infected-an estimated forty-five million people-and eighty to ninety percent of those infected do not know they have it. Below, Dr. Adam Stracher and Dr. Brian Boyle of the New York Presbyterian Hospital, Weill Cornell Medical Center discuss the symptoms and prevalence of HSV-2.

Q: What are the symptoms of genital herpes?
BRIAN BOYLE, MD: Genital herpes generally start with a blister-type rash that is itchy or painful, which then may progress, when the blisters break, into an ulcerative type of rash. If the rash is not treated, it may continue for a week or two.

Q: How prevalent is HSV-2?
BRIAN BOYLE, MD: Thirty to fifty percent of college-age kids these days have herpes. It is thought that approximately forty-five million people in the United States carry the virus.

Q: How many of those forty-five million people are symptomatic?
BRIAN BOYLE, MD: Probably twenty-five percent of those infected with herpes will never have any symptoms, and seventy-five percent have intermittent symptoms. That is, they may have a lesion that lasts a week or two but then goes away. Some people have a lesion every few weeks or so, and these episodes can be brought on by things such as stress or menstruation. Other people may go a year or two, or longer, without having a repeat of their lesions. So, it is variable.

Q: Why are some people symptomatic and others not?
ADAM STRACHER, MD: We do not completely understand why some people never develop symptoms. In this case, the concern is the risk of spread. The majority of the spread of herpes comes when people are not symptomatic. Also, those who do develop intermittent symptoms continue to shed virus even when they don't have any sores or lesions.

Q: When is herpes most contagious?
ADAM STRACHER, MD: It is definitely more contagious and infectious when people have lesions, but it is still contagious when people do not have lesions. It has been proven very recently that the majority of these infections are spread during the time when there are no symptoms or lesions.

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Q: Why is the spread of herpes more common when people are not symptomatic?
ADAM STRACHER, MD: There is a misperception that you cannot spread herpes when you do not have lesions. Also, there may be months or years between symptomatic episodes, so the asymptomatic periods are far longer than the symptomatic times. Therefore, statistically, more people are infected in those periods simply because they are far longer periods of time.
BRIAN BOYLE, MD: Another reason why more people are infected during asymptomatic periods is that sex can be very painful with a lesion. For women, it not only affects the vulva, but it may also may affect the vagina. So people who have herpes lesions are less likely to be having sex..

Conclusion

Herpes has become one of the most common viral infections in the United States today, with half a million new cases diagnosed each year. The good news is that even though there is still no cure, treatment for herpes has improved significantly, and for many, herpes is a manageable nuisance. The wisest advice for the sexually active is this: use a condom. Laboratory studies have shown that the herpes virus does not pass through latex condoms. When properly used, latex condoms will reduce your risk of spreading or getting herpes.

Written in: 5/01. Last Updated 10/05.

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