Genital HerpesAuthor: Rachel MacDonald
Date: 5-18-2010

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Abstract:
Herpes Simplex Virus- 2 is the most common sexually transmitted disease infecting at about 50 million people in the United States. Herpes Simplex Virus is much more common in women then it is in men. Of the women that it infects African Americans are at the most infected. While all of these people are infected, most people do not experience any symptoms. The most basic symptom is having sores in the genital area, which form blisters and break open. In order to see if you are infected two types of testing can be done, virologic and type specific testing. The more accurate tests are those that look for the antibodies of the virus in your blood. Since women are more commonly affected, complications in pregnancy are something to be educated about. While it is not a high risk issue, certain precautions need to be taken. Herpes Simplex virus has no cure. The only treatment options for those who are infected are to take antiviral medications. This STD is something that stays with you for the rest of your life.

Introduction:
The reason that I choose this sexually transmitted disease is mainly that it is extremely common infecting almost 50 million in the US population. However despite its impact on society I did not know that much about it. I was hoping to discover in my research who genital herpes infects the most, what tests in the lab are done to determine if someone is infected, and what are the treatments for it? With my research I discovered that women affected dramatically more than men, especially African Americans. I found that there are a variety of tests to determine if a person is infected included both virologic and type-specific serologic tests. There is no cure for herpes, but there are treatments including Acyclovir, Valacyclovir, Famciclovir, episodic therapy, and suppressive therapy.

Figure 47. Genital herpes—Initial visits to physicians’ offices: United States, 1966–2008
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Discussion:
Genital herpes is a viral disease also called herpes simplex virus type 2 (HSV-2). Oral Herpes is type 1 (HSV-1). Most people have minimal or no signs or symptoms (asymptomatic) from HSV-1 or 2. However when the first signs occur they are typically around the genital and or rectal area varying from one or more blisters. These blisters break and form ulcers that take many weeks to heal. A second outbreak is typically a few months or weeks afterwards. But overtime the occurrences of viral shedding decreases. The infection however stays in the body indefinitely.
Approximately 16.2% according to CDC’s Morbidity and Mortality Weekly Report or one out of six people between the ages of 14-19 years old have genital HSV-2 in the US. However women are dramatically more affected than men, approximately 20% or women are infected. Throughout my research I also found that African Americans are severely more impacted than other races at 39.2%. African American women are at the most risk of all with 48% being infected.


FIGURE 1. Herpes simplex virus type 2 seroprevalence* among persons aged 14--49 years, by age group and race/ethnicity† --- National Health and Nutrition Examination Survey, United States, 2005--2008
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Symptoms:

Most people who are infected with Herpes Simplex Virus-2 are not aware of it. Most people do not experience any symptoms of it. When they do it is typically in the first episode. Despite having sores other common symptoms include, flu-like symptoms such as a fever and swollen glands. With the first episode it is also possible to be experiencing headaches and pain upon urination. One of the most common mistakes, is that people mistake their sores (lesions) for other things according to the Center for Disease Control. These can include, insect bites, abrasions, yeast infections, ingrown hair, pimples, razor burn, and “jock itch”. Many people just assume it is a bite or a pimple and do not take the necessary precautions to insure they are not infected.

Testing:
If symptoms of genital herpes do appear the first test that may be done it a culture test, in which a sample needs to be taken from the lesion within the first 48 hours. They difficulty with this test is that there is a very high possibility of getting a false negative. This happens because an active virus needs to be sampled and it is hard to obtain that. Virologic testing such as PCR testing is the most specific test that can be done without there being an outbreak. This is because it is testing for HSV DNA. Type Specific Serologic Tests include blood tests are common way of diagnosing genital herpes by using the ELSIA method. It is based on testing the type specific glycoprotein G2. This is done by testing for the antibodies IgM and IgG that fight against HSV-2. In order for there to be enough antibodies to be able to test it is recommended to get a blood test at least 12-16 weeks from the last possible exposure.

Herpes and Pregnancy:
Herpes simplex virus can be spread to an infant upon birth if the virus is present in the birth canal upon delivery. If it indeed spreads to the infant the baby will then be infected with neonatal herpes. It is not very common with only .1% of infants being infected with it in the United States each year. But with 25-30% of pregnant mothers having genital herpes it is not common for it to spread to the infant. The possibility of it being transmitted to the baby is based on when the mother was infected. If the mother obtained it late in the pregnancy then most likely their body has not made enough antibodies yet, but if the mother has been infected for a while then they have enough antibodies in the system to most likely protect the baby. If there is an outbreak when the mother is in labor then the infant is delivered through a c-section.

Treatment:
Treatment can be given in both episodic therapy and suppressive therapy. Many trials have indicated that Acyclovir, Valacyclovir, and Famciclovir have been the most beneficial antiviral medications for controlling Herpes Simplex Virus (Corey). These are the only options for treatment. There is no cure for this sexually transmitted disease. So in theory the best type of treatment is prevention.

Literature Cited:


1) "Seroprevalence of Herpes Simplex Virus Type 2 Among Persons Aged 14--49 Years --- United States, 2005--2008." Centers for Disease Control and Prevention. 23 Apr. 2010. Web. 10 May 2010. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5915a3.htm>.

2) Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2006. MMWR 2006; 55(no.

3) Corey L, Wald A, Patel R, et al; Valacyclovir HSV Transmission Study Group. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 2004;350:11--20.

4) Seppa, Nathan. "One-Two Punch." Science News 167.1 (2005): 5-6. EBSCOhost. Web. 10 May 2010.

5) Tortora, Gerard J., Berdell R. Funke, and Christine L. Case. Microbiology an Introduction. San Francisco: Benjamin Cummings, 2010. Print.

6) Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health 2004; 36:6-10.

7) Xu F, Sternberg M, Kottiri B, McQuillan G, Lee F, Nahmias A, Berman S, Markowitz L. National trends in herpes simplex virus type 1 and type 2 in the United States: Data from the National Health and Nutrition Examination Survey (NHANES). JAMA 2006; Vol 296: 964-973.

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