Herpes Termed Common, but Not Serious, Disease
BOSTON — In the early 1980s, fear of herpes approached hysteria. Then that fear seemed to evaporate, replaced in the headlines by a sexually transmitted disease that kills--acquired immune deficiency syndrome.
But even though AIDS is immeasurably worse, genital herpes is still very much with us--more so than health officials even recently imagined. The news, though, is actually good. General agreement has emerged among the experts that genital herpes is a common disease, but not a very serious one.
How common? Consider these facts, which coalesce from recent surveys:
- Probably one-quarter to one-third of all adult Americans are infected with the genital herpes virus.
- Most of them caught their herpes from a sexual partner who showed no obvious signs of the disease.
- Most people who have it don’t know it.
- Those with sores that come back regularly are a small, unlucky minority of all the people with herpes.
“The important thing to realize is that these viruses have evolved with the human species over many thousands of years,†says Dr. Stephen Straus of the National Institute of Allergy and Infectious Diseases.
“Clever infectious agents are not ones that kill their hosts,†he continues. “They’re ones that find mechanisms for spreading and persisting without causing much damage. As with most infections, the damage that we recognize is the tip of the iceberg. Most of it goes on below levels of detection. Therefore we really have very little to fear.â€
The herpes simplex viruses are among the most ubiquitous of all the parasites that find a home inside the human body. An estimated 170 million Americans have them. Once the herpes virus gets established, it stays for life.
The virus actually stitches its genetic material into the genes of nerve cells. It may lie there dormant forever. Or it may snap to life from time to time, making new copies of itself and perhaps causing some herpes sores on the skin.
The virus comes in two varieties--herpes simplex virus Type 1, which causes cold sores, and Type 2, which causes genital herpes. They are about 50% alike.
Perhaps the greatest concern a few years ago was that mothers with herpes would pass it to their babies at birth. Dr. Charles G. Prober of Stanford University said many still worry about this.
“We see a lot of women who are paralyzed because they know they’ve got herpes, and they think it means the baby is going to die,†he said. “And it’s just not the case.â€
Generally, doctors deliver babies through Caesarean section if the mother has obvious herpes sores during labor. Babies can become seriously ill or even die if they catch herpes during birth. A Caesarean is not an absolute guarantee that the virus won’t be transmitted, but infants rarely catch it from their mothers.
Studies show that when an infected mother shows no signs of an obvious herpes flare-up, there is still a 1% chance that she is shedding the virus in her birth canal. But even when the virus is present, there is only a 5% chance that she will give it to her baby.
Experts once estimated that perhaps 5% to 10% of Americans had genital herpes.
Recently, however, a test has become available that can distinguish between the two forms of the herpes simplex virus. Dr. Robert Johnson of the U.S. Centers for Disease Control said researchers used it to analyze blood drawn in a nationwide survey in 1978. It showed that between 20% and 25% of adult Americans then had genital herpes.
Experts believe that the infection rate now is somewhere around 25% or 30%. For instance, tests showed that 35% of women who attended a gynecology clinic at a health maintenance organization in Atlanta were infected.
Such figures were a surprise because the infection is not obvious in most people.
“It appears that at least two-thirds of the people do not know that they have genital herpes,†said Dr. Lawrence Corey of the University of Washington. “That’s not to say that they never have a symptomatic episode, but the episodes may be so mild that they are never recognized.â€
In these people, herpes may show up--if at all--as nothing more than a minor itch or pimple that quickly goes away. However, seemingly herpes-free people can still spread the virus to others. Doctors believe that most herpes transmission is by such symptomless people.
“If one were an optimist,†Straus said, “one would say that means that most of this infection is of no real physical consequence, and if a person had it, their sexual partner would likely not even know if he ever got it.â€
Something else that has quite literally taken the sting out of herpes is acyclovir. This prescription drug became available in ointment form in 1982 and as a pill in 1985, and it has proven to be highly effective and safe. The medicine can prevent new outbreaks if taken regularly by those who have recurrent herpes. And it can make the sores heal up quickly if used after they appear.
Although experts agree that herpes fear was overblown, some think that attitudes about the disease have swung too far the other way.
“Both the tremendous attention and the absence of attention were inappropriate,†said the CDC’s Robert Rolfs. “It was never as important as the attention it got, and it’s not as unimportant as the lack of attention it’s now getting.â€
