We’ve mentioned the statistics many times before in The Helper: while nearly 1 in 5 adults in the U.S. have genital herpes, nearly 90% are unaware of their infection. Genital herpes symptoms, if noticed at all, are often attributed to other causes (such as friction burn or pimples, for example) and testing for herpes simplex virus (HSV) is far from commonplace.
But given the fact that genital herpes is often transmitted when a person has no visible or noticeable symptoms (and often when a person is unaware of the infection), should testing be more widespread? Certainly if individuals were aware of their HSV status, they could then take steps to prevent transmission to a partner. Is broader HSV testing the answer?
For its part, the U.S. Preventive Services Task Force (USPSTF) recommends against routine blood testing for HSV. As they note, there is “no evidence that screening asymptomatic adolescents and adults with serological tests for HSV antibody improve health outcomes or symptoms or reduces transmission of disease.” Yet some in the public health community, among them Dr. Edward W. Hook III of the University of Alabama at Birmingham, think it may be time to change our approach to HSV diagnosis and management.
In an editorial in the Journal of Infectious Diseases in early 2010, Hook commented on research presented in the issue by Sunitha Tata, et al. In Tatas’ study, researchers looked at herpes reactivation in women with genital HSV. The results from the study challenged current understandings involving genital herpes when researchers found that viral shedding occurred bilaterally (on both sides of the body) on areas associated with different nerve ganglia. While acknowledging the limitations of this small study, Hook noted that the results “encourage conceptualization of genital herpes as a chronic, nearly continuously active infection rather than an infection characterized by periodic recurrences interspersed with periods of disease inactivity.”
For Hook, this data also encourages a new approach to herpes diagnosis and management, to put the tools we have in place (reliable type-specific serologic tests and effective antiviral suppressive therapy) to more effective use to stop the spread of herpes. As Hook states, “The data presented by Tata et al add to the argument, from a patient and public health perspective, that a national campaign for serological testing of those at risk would provide the foundation for more effective efforts to control HSV transmission to others, and that suppressive therapy should be the preferred approach for most sexually active persons with HSV-2 whose sex partners are not known to be infected.”
While Hook makes the case for broader testing and treatment, others are not convinced. In a response to Hook’s editorial, Dr Giorgio Tarchini of the Cleveland Clinic Florida offered his own views of the potential pitfalls of this approach in the Journal of Infectious Diseases this past fall. Among his concerns are the costs associated with more widespread use of suppressive antiviral therapy, as well as the possibility of adverse events among those being treated. Additionally, Tarchini questions the benefit of providing more widespread therapy to prevent transmission. As he notes, “The number of persons it would be necessary to treat to avoid a single genital transmission of HSV-2 would probably be very high. In addition, even if transmission were to occur there is no guarantee that the newly infected partner will ever experience an HSV-2 genital outbreak.”
Tachini also supports of the recommendation of the USPSTF regarding testing, noting the “potential harm” of HSV screening. He notes that this harm includes “false-positive test results, labeling, and anxiety. Diagnosis of HSV-2 infection could lead to substantial anguish in young people who may, nonetheless, never experience an outbreak during their entire life.”
But in his editorial, Hook suggests that the new approach to managing HSV could help address the anxiety and anguish, by reconceptualizing the approach to this all too common infection. As he states, “[T]here would be a need to portray genital herpes not as a ‘scarlet letter’ but rather as a widespread untoward consequence of human sexuality.”
So now you have heard both sides of the argument, we now want to hear from you. Do you agree with Hook or Tarchini (or neither)? As always The Helper staff are very interested in what readers have to say—let us know what you think!