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admin 16.09.2014

Approximately two-thirds of all people under age 50 across the globe are infected with herpes simplex virus type 1 (HSV-1), the virus most commonly associated with cold sores, according to a World Health Organization (WHO) report released today in the journal PLOS One.
The burden of infection varies in different parts of the world and between men and women, according to the report.
HSV-1 is the same virus most commonly responsible for causing skin lesions, or “cold sores,” around the mouth, a disease than can be transmitted via skin-to-skin contact, such as kissing. The research suggests that HSV-1 may be increasingly responsible for genital herpes as well, and it’s also been known to cause infections leading to blindness and, albeit rarely, encephalitis. In 2012, the WHO released a report on HSV-2 estimating that its global prevalence in people between the ages of 15 and 49 is around 11.3% — low in comparison to the HSV-1 estimates released in the new paper. Since HSV-2 most commonly affects the genitals, it typically isn’t transmitted until people become sexually active. However, in recent years research has increasingly shown that both HSV types can be responsible for either oral or genital infections, and either type may be transmitted via oral sex. It’s thought that genital HSV-1 infections are becoming particularly prevalent in developed nations.
So if fewer people are infected with the virus as children, they’re susceptible to genital infection as they become sexually active later in life, the WHO paper says.
In other parts of the world, such as in Africa and Southeast Asia, the authors note that oral transmission in childhood is still high and has a tendency to protect people from genital infection later on.
In addition to better tracking of a sexually-transmitted infection, such data collection can help scientists gain a better understanding of the ways the virus could influence other serious health conditions, Wald says. It’s unclear whether infection with HSV-1 has a similar effect as HSV-2 in raising the risk of HIV, according to Wald. And HSV-1 is a leading cause of a condition known as HSV keratitis, which is an infection of the cornea that can lead to blindness. Both types of HSV can also cause encephalitis, which is rare but can lead to severe brain damage or death.
Both types of HSV are usually responsible for skin lesions only, which can be painful but are not typically seen as a serious health risk. This behavior is part of what makes the virus so difficult to track, as many people are unaware that they are infected.


In the absence of symptoms, many medical providers also typically do not test for either type of the virus during routine sexually transmitted diseases (STD) screenings for a variety of reasons, some of them practical and others ethical. The Centers for Disease Control and Prevention (CDC) does not recommend testing for people who do not present with symptoms, stating, “STD screening tests are usually done for infections that can have serious outcomes if they are left untreated.
That said, as HSV infection can be the cause of serious complications in some cases, it’s worth tracking on both a regional and global scale, Wald says.
Cullen said it is perplexing that there's not more of an effort to cure both types of the Herpes virus.
While there are medications that can help prevent outbreaks, there is currently neither a cure nor a vaccine for either HSV-1 or HSV-2. In the new paper, the WHO concludes that continued global monitoring of the virus might help make a difference on that front. Chelsea Harvey is a freelance journalist specializing in science, health and environmental reporting.
Requests for Reprints: Lawrence Corey, MD, University of Washington, Virology Division, Room 9301, 1200 12th Avenue South, Seattle, WA 98144. Acknowledgments: The authors thank Michael Remington, PA, Carol Winter, RN, Cathy Critchlow, PhD, Stacy Selke, MA, Joan Dragavon, Colleen Olson, Michele Crist, Judy Zeh, PhD, Paul Van Veldheisen, MS, Carolyn Lapinsky, WHCS, Anita Fahnlander, RN, and others whose collaborative efforts over a 14-year period made possible the establishment of our genital herpes database. Anyone can submit a comment any time after publication, but only those submitted within 4 weeks of an article’s publication will be considered for print publication.
Above this age, the burden of infection would probably “trend toward 100%” in many places, says Bryan Cullen, director of the Duke University Center for Virology, although the WHO study doesn’t include these statistics. But while cold sores are a mostly cosmetic issue, there’s good reason to collect data on the virus, argue some experts. The other, HSV-2, has historically been associated with genital herpes and is almost exclusively sexually transmitted.
HSV-1, on the other hand, has historically been commonly transmitted in early childhood, for instance if an infected adult kisses an uninfected child. The new paper notes that, worldwide, about half a billion people between the ages of 15 and 49 have a genital herpes infection caused by either HSV-1 or HSV-2. In fact, it’s the “biggest cause of infectious blindness in the United States,” says Cullen.


And infection of either HSV type in newborns can sometimes cause severe reactions, including high fever, seizures or even death.
And while the lesions may recur repeatedly in some infected people, others become asymptomatic after the first outbreak — or they may never have an outbreak at all. And while it’s possible to perform a blood test that will show whether the virus is present, “those kinds of studies are expensive and take up a lot of resources,” Wald says. Powered by its own proprietary technology, Mashable is the go-to source for tech, digital culture and entertainment content for its dedicated and influential audience around the globe. Thirty-eight percent had at least 6 recurrences during the first year and 20% had more than 10 recurrences.
One month after publication, editors review all posted comments and select some for publication in the Letters section of the print version of Annals. In the Eastern Mediterranean, 75% of both men and women are infected and 87% of both men and women are infected in Africa.
Infection with HSV-2 can have more serious consequences, too, since it has been shown to increase a person’s risk of becoming infected with HIV. Once infected with the virus in one part of the body, the immune system generally protects against infection in another area.
Twenty-six percent of women and 8% of men had no or 1 recurrence in year 1 of follow-up, whereas 14% of women and 26% of men had more than 10 recurrences.
Recurrence rates are especially high in persons with an extended first episode of infection, regardless of whether they receive antiviral chemotherapy with acyclovir.
Men with genital HSV-2 infection have about 20% more recurrences than do women, a factor that may contribute to the higher rate of HSV-2 transmission from men to women than from women to men and to the continuing epidemic of genital herpes in the United States.



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