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Signs herpes outbreak is coming

That is because improved hygiene in rich countries is lowering HSV-1 infection rates in childhood, leaving young people more at risk of catching it via oral sex when they become sexually active.
Two-thirds of the world’s population under 50 have the highly infectious herpes virus that causes cold sores around the mouth, the World Health Organization said on Wednesday, in its first estimate of global prevalence of the disease. More than 3.7 billion people under the age of 50 suffer from the herpes simplex virus type 1 (HSV-1), usually after catching it in childhood, according to a the WHO study. That is in addition to 417 million people in the 15-49 age range who have the other form of the disease, HSV-2, which causes genital herpes.
HSV-1 normally causes mouth ulcers rather than genital infection, but it is becoming an increasing cause of genital infection too, mainly in rich countries. Gottlieb said GSK had previously abandoned a vaccine trial after finding the product was not effective against HSV-2, although it did show some efficacy against HSV-1. The New Age covers news from all nine provinces, along with national events, Op-Ed columns, politics, Africa and International news, sports, business, entertainment, lifestyle, science and technology.
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. This is likely because of the differing methods of transmission between the two viruses, says Anna Wald, a professor at the University of Washington’s School of Medicine whose research specialties include the herpes simplex virus. 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. The authors conclude that genital HSV-1 infections are becoming a public health concern in certain parts of the developed world.
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.
Domeika M, Savicheva A, Sokolovskiy E, Ballard R, Unemo M; Eastern European Network for Sexual and Reproductive Health (EE SRH Network).
A Sexually Transmissible Infection (STI) is an infection that can be passed on through vaginal, anal or oral sex.A  Most STIs are transmitted through the exchange of sexual fluids, but some can be passed on through skin to skin genital contact. STIs can cause a wide range of health problems, from mild irritations to more serious illness. Between 50%-70% of people with a STI do not know they have the infection, because they have no symptoms. If you notice any of these symptoms or have had sex without a condom it is important to go to Clinic 34, a Doctor, Family Planning or your local clinic to get a sexual health check. Chlamydia and gonorrhoea are transmitted through an exchange of body fluids (semen, blood and vaginal fluids) during unprotected vaginal, anal or oral sexual activity. While many people with genital herpes experience no symptoms, the first sign of an infection is often an itching or tingling sensation in the genital area, followed by tiny blisters appearing. HIV (Human Immunodeficiency Virus) is a virus, which attacks the body's immune system and can lead to AIDS (Acquired Immune Deficiency Syndrome).

Pregnant women with HIV can pass the virus to their unborn child, however there are now some good medications that can lower the risk of this happening.A  Women with HIV are advised not to breastfeed their baby as breast milk can transmit HIV. There is no cure for HIV, however, treatments for HIV have improved in the past 12 years and many people with HIV feel and look healthy. Many people with hepatitis have no symptoms, but some experience yellowing of the skin and eyes, loss of appetite, nausea, stomach pain, extreme tiredness and pains in their joints. Hepatitis A is transmitted through contact with faeces (poo) from contaminated water or food, or by anal sex or oral-anal contact. Hepatitis B is transmitted through blood, semen and vaginal fluids and can be passed on through unprotected sexual activity, sharing needles and other drug injecting equipment, and use of non-sterilised tattooing and body piercing equipment and sharing personal items such as razors and toothbrushes. Hepatitis C is transmitted through contact with infected blood and can be passed on through sharing (re-using) needles and other drug injecting equipment, use of non-sterilised tattoo and body piercing equipment and sharing personal items such as razors and toothbrushes. 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. National Institutes of Health and companies including GlaxoSmithKline Plc were involved in trials to determine whether a therapeutic or preventative vaccine was preferable.
Genocea Biosciences Inc recently dropped work on a pneumonia vaccine in favour of its more promising work on genital herpes. 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. Once infected with the virus in one part of the body, the immune system generally protects against infection in another area. 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. Back when i was doing herpes vaccine research in college there was a lot of data out there that at some point in their life 70 to 90% percent of people will be infected. Quality enhancements and quality assurance of laboratory diagnosis of sexually transmitted infections in Eastern Europe. Genital herpes simplex virus infections: current concepts in diagnosis, therapy, and prevention.
Diagnosing genital ulcer disease in a clinic for sexually transmitted diseases in Amsterdam, The Netherlands. Association between HIV-1 infection, the etiology of genital ulcer disease, and response to syndromic management. The aetiology of genital ulcer disease by multiplex polymerase chain reaction and relationship to HIV infection among patients attending sexually transmitted disease clinics in Pune, India.
Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. Early HIV symptoms can include having a flu-like illness, swollen glands in the neck, armpits and groin, headaches, fever and a rash.
It is not often sexually transmitted but there is still a risk involved, particularly if a woman has her period or if the skin is broken. Thirty-eight percent had at least 6 recurrences during the first year and 20% had more than 10 recurrences. 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. Only 43% of the countries could provide the number of genital HSV cases recorded at national level.
Some STIs are easily cured with antibiotics if detected early, but can cause long-term problems if left untreated. In women untreated Chlamydia and Gonorrhoea can lead to Pelvic Inflammatory Disease (PID).A  This is when the fallopian tubes are infected and become blocked and damaged and this stops a woman from being able to become pregnant or because the tubes are blocked the egg grows in the tubes and not in the uterus and this can cause an ectopic pregnancy which is a serious health issue. However, warts can be removed either by freezing, with chemical paint or cream.A  Even if this is carried out you will still have the HPV virus in your body and the warts may come back. Eighty-six percent of countries employed syndromic management in cases of genital ulcer disease.
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. Direct detection methods for HSV, such as PCR, antigen detection and culture, are available in the region, but their usage was extremely low.

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. The availability of laboratory services must be improved, and countries in the region should implement consensus recommendations for the laboratory diagnosis of genital HSV infections in order to improve clinical practice. We have previously reported the establishment of the international collaboration group, the Eastern European Network of Sexual and Reproductive Health (EE SRH) (1), a project supported by the Swedish International Development Cooperation Agency (SIDA).
The main objective of this network is to facilitate improvement in reproductive healthcare in Eastern Europe, firstly via the improvement, harmonization and assurance of quality of diagnostic testing and management of STIs and other reproductive tract infections (RTIs). Genital herpes simplex virus (HSV) infection is one of the most prevalent life-long incurable STIs. Data on the laboratory methods used by both public and private section services in the region have not been available previously.The aim of this study was to collect data regarding the availability of diagnostic services and diagnostic tests used, as well as the relative importance of genital HSV infection in 14 EE SRH countries, in order better to understand the diagnostic needs of Eastern Europe.
Where further clarification was needed, telephone interviews and personal interviews during the annual meeting of the EE SRH were held subsequently.ResultsRepresentatives from 14 of the 15 EE SRH Network countries completed the questionnaire. Only six countries (43%) recorded the number of new cases of genital HSV infection each year.
However, the rates of infection do not distinguish between primary and recurrent genital herpes.
However, all countries, with the exception of Armenia, used some laboratory testing in order to establish a definitive diagnosis in at least some clinics (Table II). Antigen detection of HSV by enzyme-linked immunosorbent assay (ELISA) was used only in Estonia and was available at all laboratories performing any test for HSV. However, in-house, non-commercial reagents were often used, particularly for the direct detection of HSV. Non-EU countries mainly used tests (both for the detection of virus and antibodies) manufactured in Russia.
In a small number of cases laboratories in non-EU countries used ELISA kits produced in the West.DiscussionThis study was designed to investigate the availability of diagnostic services and diagnostic tests used, as well as the relative importance of genital HSV infection in 14 of the EE SRH countries, of which four are part of the EU. The results clearly showed that genital HSV infection is a presumed major cause of GUD and that, in the vast majority of cases, a definitive diagnosis is not established using laboratory testing, even if facilities exist. It should be remembered that both Treponema pallidum and HSV might coexist in the same lesion (2).
Because of the diversity of the signs and symptoms of genital HSV infections, a laboratory confirmed diagnosis should be made whenever possible (3). The reported incidence figures varied considerably between the different countries surveyed. Accordingly, completely reliable incidence figures and figures of relative percentage of HSV and syphilis in GUD may not be available due to the inadequacy of the diagnostic services available (use of inappropriate diagnostic tests and reagents), uneven access to the point-of-care sites (where tests for HSV are performed), and suboptimal systems for case reporting and epidemiological surveillance.
Viral isolation, HSV DNA detection by PCR and HSV antigen detection by enzyme immunoassay or DIF, all could be used for direct virus detection.
However, PCR techniques have higher sensitivity and are less dependent on transport time and some other variables (4). Viral isolation was available only for routine diagnostics in one of the 14 EE SRH countries surveyed, while direct detection of viral DNA was available in a further nine countries. In Tajikistan viral detection is achieved solely using DIF, while in Bulgaria, Azerbaijan and Armenia no direct detection of HSV in lesions was available. Clearly, there is a need to reinforce the regional capacity for the direct detection of HSV, preferably using validated PCR techniques.
Furthermore, HSV typing to distinguish HSV-1 and HSV-2 has important prognostic consequences, since the recurrence rate is significantly lower in HSV-1 compared with HSV-2 genital infection, and typing also needs to be encouraged in the region. Although type-specific HSV serology may be a useful tool for the diagnosis and management of genital HSV infection in selected cases, generally it is not of high diagnostic value.
Serology is necessary for staging of genital herpes as either primary or recurrent disease (in combination with culture or PCR). In addition, type-specific serology can identify discordant couples, which might reduce transmission risk and the risk of congenital disease (5). Unfortunately, nine (64%) of the 14 countries surveyed indicated that they used HSV antibody tests that cannot differentiate between infections caused by HSV-1 and HSV-2.
These tests are of little diagnostic value for genital HSV infection, especially in impoverished communities, where oral-labial HSV-1 infections are commonly acquired during childhood. In general, many of the surveyed countries had modern diagnostic tools necessary to provide a definitive diagnosis of this infection. Although bacterial STIs remain a significant public health problem and are a main focus in many East European countries, the relative importance of HSV in GUD has increased globally (6a€“8). It is unlikely that Eastern Europe is any different, bearing in mind the recent reduction in cases of primary and secondary syphilis (9).
Furthermore, the differentiation between genital HSV infection and other infectious or non-infectious aetiologies of genital ulceration is difficult, and laboratory confirmation of the infection should always be sought.
Diagnosis based only on clinical symptoms has been shown to have a low sensitivity, even in carefully monitored populations. False-positive clinical diagnoses also occur frequently (10).The recent important advances in the laboratory diagnosis of genital HSV infection, the decrease in cost of acyclovir and the emerging importance of genital herpes as a cofactor in transmission of HIV (11) indicate that more attention should be paid to HSV as a cause of genital ulceration.

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