Herpes Simplex Virus Type 1 as a Cause of Genital Herpes: Impact on Surveillance and Prevention

Lafferty, William E.; Downey, Lois; Celum, Connie; Wald, Anna

doi:10.1086/315395

Cited by 221 publications

(123 citation statements)

References 12 publications

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“…[14][15][16] Epidemiological studies suggest that oral genital contact is the major risk factor for the acquisition of genital HSV-1. 17 Similar findings have been reported worldwide. In Scandinavia, the seroprevalance of HSV-2 among pregnant women was 33%, 18 and in Canada this rate was 17%.…”

Section: Epidemiology Of Genital Herpessupporting

confidence: 79%

Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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Neonatal herpes can occur when the neonate is exposed to herpes simplex virus in the maternal genital tract during labour. Attack rates are highest when the mother has a newly acquired infection and, therefore, does not have antibodies to protect the neonate. Even with early therapy, there is significant morbidity and mortality associated with neonatal herpes, suggesting that preventing neonatal herpes simplex virus exposure or early recognition of exposure is important. The incidence of neonatal herpes has not declined despite national guidelines for prevention. This suggests that the prevention guidelines need to be re-addressed.Keywords Herpes, neonate, prevention.Please cite this paper as: Gardella C, Brown Z. Prevention of neonatal herpes. BJOG 2011;118:187-192. Epidemiology of genital herpesBased on serological data from a large National Health and Nutrition Examination Survey (NHANES), 22% of pregnant women in the USA are infected with herpes simplex virus 2 (HSV-2), 63% are HSV-1 seropositive, 13% have both HSV-1 and HSV-2, and 28% are seronegative. 1 In the general population, for the first time since the 1976 inception of NHANES, the seroprevalence of HSV-2 has decreased; overall, the age-adjusted HSV-2 seroprevalence was 17% in 1999-2004, compared with 21% in 1988-94, a relative decrease of 19% between the two study periods. Among those infected with HSV-2, the percentage who reported being diagnosed was 14.3% in 1999-2004 and 9.9% in 1988-94, suggesting that more providers are aware of genital herpes, and able to make appropriate diagnoses. 2 However, the vast majority of people infected with HSV-2 remain undiagnosed and, therefore, untreated and able to spread the infection. Between 75% and 90% of HSV-2-infected people are not aware of having the infection. [3][4][5][6] This is important because most sexual transmission of HSV occurs during episodes of subclinical reactivation among persons with unrecognized infection. 4,7-10 Virtually all HSV-2 seropositive people have intermittent shedding from the genital mucosa, and most have mild (and hence unrecognized and undiagnosed) disease. 5 In the absence of symptoms, HSV-2 can be detected in the genital tract, by viral culture, on 3% of days for the first year after initial infection, then on 1% of days for the next 2 years. HSV-2 DNA can be detected by polymerase chain reaction testing 15-20% of days. 11,12 Recent data suggest that HSV reactivation may occur much more frequently than previously understood, and may be characterised by frequent short bursts of viral shedding that do not correlate with symptoms. 13 As HSV-2 seroprevalence decreased, HSV-1 seroprevalence in the USA increased to 62% in 1988-94 from 57.7% in 1999-2004. 2 Among persons infected with HSV-1 but not HSV-2, a higher percentage reported a diagnosis of genital herpes in 1999-2004 compared with 1988-94 (1.8% versus 0.4%). 2 HSV-1 has emerged as a major cause of genital herpes among college-age populations, in which up to 80% of new cases of genital HSV were caused by HSV-1. [14][1...

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Section: Epidemiology Of Genital Herpessupporting

confidence: 79%

Prevention of neonatal herpes

Gardella

Brown

2010

BJOG

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“…18 Receptive oral sex within the previous 2 months has been associated with an increased likelihood that the initial infection was HSV-1. 19 Despite the apparent increase in orogenital sex seen in many communities, an increased proportion of HSV-2 in orolabial lesions has not been detected in our study (results not shown) or studies undertaken by others. 20 At this time in Melbourne, HSV-1 is more common than HSV-2 in patients under 20 years of age and the likelihood that females will have an HSV-1 genital infection is now similar to that for HSV-2.…”

Section: Discussioncontrasting

confidence: 81%

Changing epidemiology of genital herpes simplex virus infection in Melbourne, Australia, between 1980 and 2003

Tran¹

2004

Sexually Transmitted Infections

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Objective: To investigate changes in the proportions of patients infected with genital herpes simplex virus (HSV) types 1 and 2 from 1980 to 2003 in Melbourne, Australia. Methods: A total of 25 372 patients were studied retrospectively. The proportions of HSV-1 and HSV-2 detected in these individuals were analysed by age, sex, and genital site. Results: In 1980 only 15.8% of HSV positive genital specimens were HSV-1 compared to 34.9% in 2003. In 2003 HSV-1 was detected in 77% of patients aged less than 20 years. Females were more likely to be infected with HSV-1, although the rate of increased detection was more pronounced in males. Except for females over the age of 40, the trend for the increase in HSV-1 was detected in all age groups. No specific genital site in either sex was associated with the increase. Conclusions: The proportion of genital HSV-1 has increased in Australian patients, although HSV-2 is still the most common cause of genital infection. Confirmation of HSV type is necessary for optimal patient management.

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“…1,2 In addition, HSV type 1 (HSV-1) now accounts for at least 20% and, in some locales, more than 50% of cases of genital herpes in the United States. 3,4 Therefore, managing infants potentially exposed to HSV at the time of delivery is not uncommon, and prevention of the devastating outcomes of neonatal HSV disease is paramount.…”

Section: Introductionmentioning

confidence: 99%

Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

Kimberlin¹,

Baley²,

Newborn³

2013

Pediatrics

116

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Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV. Women with primary genital HSV infections who are shedding HSV at delivery are 10 to 30 times more likely to transmit the virus to their newborn infants than are women with recurrent HSV infection who are shedding virus at delivery. With the availability of commercial serological tests that reliably can distinguish type-specific HSV antibodies, it is now possible to determine the type of maternal infection and, thus, further refine management of infants delivered to women who have active genital HSV lesions. The management algorithm presented herein uses both serological and virological studies to determine the risk of HSV transmission to the neonate who is delivered to a mother with active herpetic genital lesions and tailors management accordingly. The algorithm does not address the approach to asymptomatic neonates delivered to women with a history of genital herpes but no active lesions at delivery. Pediatrics 2013;131:e635-e646

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Herpes Simplex Virus Type 1 as a Cause of Genital Herpes: Impact on Surveillance and Prevention

Cited by 221 publications

References 12 publications

Prevention of neonatal herpes

Prevention of neonatal herpes

Changing epidemiology of genital herpes simplex virus infection in Melbourne, Australia, between 1980 and 2003

Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

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