Emory Report

 November 3, 1997

 Volume 50, No. 11

Study says 1 in 5 Americans
infected with genital herpes

An estimated 45 million Americans are infected with herpes simplex virus 2 (HSV-2), reports a research team from Emory and the CDC in The New England Journal of Medicine.

Fewer than 10 percent of those infected are aware they have the 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," wrote team members, including lead author Michael St. Louis of the CDC and Andre Nahmias professor of pediatric infectious diseases at the School of Medicine and of epidemiology at the School of Public Health. "Improvements in the prevention of HSV-2 infection are needed, particularly since genital ulcers may facilitate the transmission of [HIV]."

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 wrote. "The increases in HSV-2 seroprevalence between [the two groups] were concentrated in the younger age groups."

The team reports that HSV-2 prevalence among white teenagers has quintupled (from 0.96 to 4.5 percent), and among whites in their 20s it has almost doubled - from 7.7 to 14.7 percent.

Several factors were identified by the researchers to be independent predictors of HSV-2 including female sex, African-American or Mexican-American ethnic background, older age, inferior 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,'" Nahmias said.

Nahmias led the Emory team in the '80s 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 Emory colleague, Francis Lee, associate professor of pediatric infectious diseases and a co-author of the current study, led the team that developed the immunoassay for differentiating HSV-2 antibodies from those associated with HSV-1, the nongenital form of the disease. The test has been used in more than 20 countries and made possible the 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, in September Nahmias received 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 HIV.

-Lorri Preston

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