Prevalence has Increased 30 Percent in Past 20 Years; Greatest Increase in White Teens, Says CDC/Emory Team in NEJM

October 19, 1997

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An estimated 45 million Americans are infected with herpes simplex virus 2 (HSV-2), reports a research team from the U.S. Centers for Disease Control and Prevention (CDC) and Emory University in this week's New England Journal of Medicine. Fewer than 10 percent of those infected are aware they have a virus which can be transmitted to sexual partners as well as newborns at delivery.

Also known as genital herpes, HSV-2 is characterized by recurring, active phases of painful, genital blisters. When ulcers are present, one is at higher risk for contracting and transmitting human immunodeficiency virus (HIV). Neonates exposed during birth are at high risk for serious illness or death.

"Since the late 1970s, the prevalence of HSV-2 infection has increased by 30 percent, and HSV-2 is now detectable in roughly one of five persons 12 years of age or older nationwide," conclude team members, including lead author Michael E. St. Louis, M.D., of the CDC's Division of STD Prevention at the National Center for HIV, STD and TB Prevention, and Andre J. Nahmias, M.D., professor of Pediatrics (Infectious Diseases) at the Emory University School of Medicine and professor of Epidemiology at Emory's Rollins School of Public Health. "Improvements, in the prevention of HSV-2 infection are needed, particularly since genital ulcers may facilitate the transmission of the human immunodeficiency virus."

Current study data came from information and serum samples gathered from two National Health and Nutrition Examination Surveys (NHANES). Data from NHANES II were gathered from a nationally representative sample of 28,000 Americans between 1976-80 and NHANES III information was collected from 40,000 Americans between 1988-94.

"The age adjusted overall prevalence of HSV-2 antibody rose from 16 percent in NHANES II to 20.8 percent in NHANES III, a relative increase of 30 percent," the authors report... "The increases in HSV-2 seroprevalence between NHANES II and NHANES III were concentrated in the younger age groups."

The team reports that HSV-2 prevalence among white teenagers has quintupled (from .96 to 4.5 percent) and among whites in their 20s has doubled (from 7.7 to 14.7 percent).

Several factors were identified by the researchers to be independent predictors of HSV-2, including the following: female sex, black race or Mexican-American ethnic background, older age, less education, poverty, cocaine use and a greater lifetime number of sexual partners.

"This objective type of study confirms other reports that young, white Americans are not heeding public health messages related to the prevention of sexually transmitted diseases -- a grave problem the Institute of Medicine calls 'the hidden epidemic,'" Dr. Nahmias says.

Dr. Nahmias led the Emory team in the 1980s largely responsible for differentiating between herpes types 1 and 2 and for showing that type 2 is venereally transmitted and can cause serious newborn disease. His colleague Francis K. Lee, Ph.D., associate professor of Pediatrics (Infectious Diseases) at Emory and a co-author of the current study, led the team that developed the immunoassay for differentiating HSV-2 antibodies from those associated with herpes simplex virus 1 (HSV-1) -- the nongenital form of the disease. The test has been used in more than 200,000 sera in more than 20 countries and made possible evaluation of the NHANES serum samples.

Also credited with adding the "H" to the TORCH (toxoplasma, rubella, cytomegalovirus, herpes) complex of perinatal infections through his research on neonatal herpes simplex, Dr. Nahmias received in September The Bristol Award from the Infectious Diseases Society of America. The award recognizes the career contributions he has made over the past 35 years which have shaped current knowledge of herpes and other viruses including the human immunodeficiency virus.

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Copyright ©Emory University, 1997. All Rights Reserved.
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