International Journal of Epidemiology, Vol 26, 698-709, Copyright © 1997 by International Epidemiological Association
R Brugha, K Keersmaekers, A Renton and A Meheus
Genital herpes infection is life-long and may result in painful and
recurrent genital lesions, systemic complications, serious psychosocial
morbidity, and rare but serious outcomes in neonates born to infected
women, including permanent neurological handicap and death. Herpes simplex
virus (HSV)-2 is the principal cause, with an increasing proportion of
first-episode disease caused by HSV-1. Genital HSV transmission is usually
due to asymptomatic viral shedding by people who are unaware that they are
infected and clinical screening fails to detect most infections.
Type-specific serological assays can distinguish the two viral subtypes,
but these are expensive and currently restricted to a few research
settings. Most infections are asymptomatic, or cause a mild illness which
does not lead to health service attendance; but the limited evidence
suggests a rise in disease incidence, perhaps related to a fall in HSV-1
age-specific prevalences. The prevalences of HSV genital infections
increase with age and numbers of sexual partners, with higher rates in
specific ethnic and low socioeconomic groups. However, infection is not
restricted to high-risk populations. Antiviral agents, such as acyclovir,
can reduce disease severity, prevent recurrences and shorten periods of
viral shedding, but currently there are no effective population control
measures. This may change with the advent of HSV vaccines, if their safety
and long- term efficacy are confirmed. Possible applications for vaccines
may include the suppression of disease and recurrences in patients with
genital infections (immunotherapy), the prevention of viral transmission to
their seronegative partners, and immunoprevention through vaccinating the
latter. Economic evaluations of existing and potential control strategies,
age-specific population HSV-1 and 2 seroprevalence studies for targeting
future interventions, and cohort studies to elucidate the natural history
of HSV-2 infections are needed.
ARTICLES
Genital herpes infection: a review
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
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