Prevalence of HSV-2 in U.S. is decreasing
Prevalence of HSV-2 in U.S. is decreasing
Good news! A new analysis indicates that the prevalence of herpes simplex virus Type 2 (HSV-2) is dropping in the United States.1
Researchers from the Centers for Disease Control and Prevention (CDC) and Emory University in Atlanta used information from the U.S. National Health and Nutrition Examination Surveys (NHANES), a series of cross-sectional, nationally representative surveys conducted by the National Center for Health Statistics, to perform their analysis. Survey results were examined to compare national seroprevalence estimates from 1999-2004 with those from 1988-1994.
The results indicate "significant progress" in reducing HSV-2, the primary cause of genital herpes, especially among youth, notes Fujie Xu, MD, PhD, a research scientist in CDC's Division of STD Prevention. The researchers found that the overall age-adjusted HSV-2 seroprevalence was 17% in 1999-2004 and 21% in 1988-1994, a relative decrease of 19% between the two surveys. The decrease was concentrated among adolescents 14-19 years of age — a 72% decline — with statistically significant declines documented among young people of both genders and all races, she states.
What factors have influenced the drop in numbers? Declines in sexual activity among young people may have played a part in the decrease, Xu points out. "Between the two surveys, the percentage of adolescents ages 15-19 reporting having had sex declined from 60% to 55%," she states. "Other factors that were not measured in this study may also have contributed to the decline, such as partner selection, condom use, or changes in sexual behaviors, [such as changing] from vaginal to oral sex."
The downward trend in prevalence does not signal that genital herpes infection is under control, notes Xu. Genital herpes remains a serious, often hidden threat, especially for women and minorities, she states. Data suggest that 17% of Americans ages 14-49 — one in six — have HSV-2, she says. Despite an increased proportion reporting having been diagnosed (from 10% to 14%), the vast majority of those infected remain unaware of their infection, Xu says. "While treatment is available for those with recurrent genital herpes, the disease remains incurable and has potentially serious health consequences."
Single-day therapy OK'd
While HSV-2 infection cannot be cured, antiviral drugs have been found helpful in reducing or suppressing symptoms.2 People with recurrent genital herpes can treat the infection by taking medication every day (suppressive therapy) or by taking medication when each outbreak occurs (episodic therapy).
Effective episodic treatment of recurrent herpes requires initiation of therapy within one day of lesion onset or during the prodrome that precedes some outbreaks, advises the most recent Sexually Transmitted Diseases Treatment Guidelines issued by the CDC.3 Patients should be provided with the drug or a prescription for the medication, with instructions to initiate treatment immediately when symptoms begin, the guidance advises.3
The recommended regimens for episodic therapy include:
- Acyclovir (Zovirax, GlaxoSmithKline, Research Triangle Park, NC) 400 mg orally three times a day for five days;
- or Acyclovir 800 mg orally twice a day for five days;
- or Acyclovir 800 mg orally three times a day for two days;
- or Famciclovir (Famvir, Novartis Pharmaceuti-cals Corp.; East Hanover, NJ) 125 mg orally twice daily for five days;
- or Famciclovir 1000 mg orally twice daily for one day;
- or Valacyclovir (Valtrex, GlaxoSmithKline) 500 mg orally twice a day for three days;
- or Valacyclovir 1 g orally once a day for five days.
The Food and Drug Administration has just approved single-day treatment for Famvir, which makes it the first antiviral medication approved to treat recurrent genital herpes in a single day. A multicenter, multinational, randomized, double-blind, parallel-group, placebo-controlled study compared single-day, patient-initiated oral famciclovir (1,000 mg given twice daily) with placebo.4 The study drug significantly reduced the time to healing of nonaborted lesions, as well as time to resolution of studied symptoms in patients with lesions by almost two days.
Convenience is perhaps the most significant advantage offered by the single-day therapy approach, notes Stephen Tyring, MD, PhD, professor in the Department of Dermatology at the University of Texas Health Science Center in Houston and a co-author of the famciclovir study. Single-day, patient-initiated treatment may improve patient compliance, he says.
When an HSV-2 outbreak is triggered in the body, there is a narrow window of opportunity for treatment, because the virus is replicating most actively in the first hours of an outbreak. With the one-day treatment approach, clinicians should stress that the first dose of famciclovir be taken as soon as possible — within six hours — of the first sign or symptom of an outbreak.
Scientists are now performing a comparison study of the single-day famciclovir therapy and the three-day valacyclovir approach in episodic treatment of HSV-2 infection, says Tyring. Patient enrollment has just begun, he reports.
References
1. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006; 296:964-973.
2. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.
3. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR 2006; 55(RR-11):40.
4. Aoki FY, Tyring S, Diaz-Mitoma F, et al. Single-day, patient-initiated famciclovir therapy for recurrent genital herpes: A randomized, double-blind, placebo-controlled trial. Clin Infect Dis 2006; 42:8-13.
A new analysis indicates that the prevalence of herpes simplex virus Type 2 (HSV-2) is dropping in the United States.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.