HERPES SIMPLEX VIRUS–2 INFECTION: An Emerging Disease?

https://doi.org/10.1016/S0891-5520(05)70408-6Get rights and content

Herpes simplex virus (HSV) infections, including genital herpes, have been described in the medical literature for centuries. Ancient Greek and Roman physicians coined the term herpes, which comes from the Greek word meaning “to creep or crawl.” In the eighteenth century, the king of France's physician, Astruc, made the association between herpetic lesions and genital ulcers.15 In the early part of the twentieth century, herpes simplex virus was isolated from herpetic lesions. The epidemiologic and clinical differences between herpes simplex virus type 1 (HSV–1) and herpes simplex virus type 2 (HSV–2), however, were not fully appreciated until the 1960s when antigenic differences between the viruses were elucidated.48 Despite the development of HSV–specific therapy and extensive media coverage in the 1980s, genital herpes infections continue to increase worldwide. This increase has been brought to light by the development of new serologic techniques that for the first time accurately detect HSV–2 antibodies in the presence of HSV–1 antibodies and vice versa. Concomitant with an increase in genital HSV–2, an increase in neonatal herpes cases21, 63 and an increasing recognition of the role HSV–2 plays in human immunodeficiency virus type 1 (HIV–1) acquisition has been noted in many areas of the world. This article reviews the current seroepidemiologic studies of HSV–2 as a pandemic infectious disease and discusses the concern that genital ulcer disease caused by HSV seems to be an important antecedent to the sexual acquisition of HIV infection.

Section snippets

Seroepidemiology

Studies from the 1960s revealed that HSV–1 was more frequently associated with oral disease, whereas HSV–2 was associated with genital disease.48 These observations led to the commonly held colloquialism that HSV–1 causes disease “above the belt” and HSV–2 causes disease “below the belt.” In fact, HSV–1 is a significant cause of genital herpes, and up to 30% to 40% of new cases of genital herpes are caused by HSV–1.57 Genital HSV–1, however, reactivates clinically and subclinically much less

FACTORS ASSOCIATED WITH INCREASING PREVALENCE OF HSV–2

As discussed previously, incidence rate data and serial seroprevalence studies indicate that in developed and developing countries, genital HSV infections, especially genital HSV–2 infections, are becoming more frequent. In some patient populations the increase is dramatic. What accounts for this? The next section of this article discusses some of the biological and health care practice aspects of this rise. Like all public health problems, the factors associated with the HSV–2 epidemic are

Herpes Simplex Virus as a Risk Factor for Human Immunodeficiency Virus Acquisition

The presence of genital ulcers has been recognized as a potential risk factor for HIV acquisition ever since the start of the HIV epidemic. Numerous epidemiologic studies have supported the association of genital ulcers in general, and genital herpes in particular, with acquisition of HIV infection. Herpes simplex viruses are the most common cause of genital ulcers worldwide. This has been well documented in developed countries and has recently been shown in studies in the developing world.

SUMMARY

Genital herpes infections continue to increase in the world. As outlined previously, several factors play a role in the continued transmission of genital herpes worldwide. Reducing the medical consequences of HSV–2 infection will not be easy. It is also sobering to realize that widespread penetration of HSV–2 into the population had preceded the spread of sexually acquired HIV in most countries. The biological rationale for a connection between HIV and HSV continues to be strengthened.

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    Address reprint requests to Lawrence Corey, MD, Program in Infectious Diseases, M–115, Fred Hutchinson Cancer Research Center, 1124 Columbia St., Seattle, WA 98104-2092

    This work is supported by NIH Grants AI-20381 and AI-07140

    *

    From the Department of Medicine, University of Washington School of Medicine, and Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington

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