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Herpesvirus Clinician FAQ
- The Impact of Genital Herpes in the United States - How Big Is the Problem and How Much Does It Cost?
- Clinical Spectrum of Genital Herpes in Primary Care Practice - Disease Recognition and Risks of Unrecognized Infection
- How Do I Diagnose Genital Herpes?
- Herpes Patients Are Dissatisfied with Their Healthcare Providers - Why and What Can Be Done?
The Impact of Genital Herpes in the United States-How Big Is the Problem and How Much Does It Cost?
Genital herpes, most often caused by HSV-2, is the most common ulcerative sexually transmitted disease in North America, with a seroprevalence of approximately 22% in Americans over 12 years of age. It is estimated that there are 1 million new cases of herpes infection each year; however, many of these cases are either unrecognized or misdiagnosed, allowing infected individuals to unwittingly transmit virus to their sexual partners, propagating the genital herpes epidemic.
The impact of genital herpes in terms of both human suffering and dollar values is staggering. It is estimated that the direct medical costs (physician visits and pharmacy claims) of known cases of genital herpes in the United States are as high as $208 million per year—which is considered by most to be a gross underestimate of the actual cost. In addition to the dollar value, the psychosocial impact of genital herpes can be serious and long-lasting, causing problems such as depression, isolation, and self-hate, among others.
Clinical Spectrum of Genital Herpes in Primary Care Practice—Disease Recognition and Risks of Unrecognized Infection
A diagnosis of genital herpes infection is often met with a benign attitude by healthcare providers. This attitude is reinforced by the extensive, and often unrecognized, clinical spectrum of symptoms. Classic signs and symptoms of genital herpes occur only in a minority of infected individuals, making recognition and accurate diagnosis extremely difficult. Many people are unaware of the potential morbidity and even mortality resulting from genital herpes infections. While pregnant women and immunocompromised individuals are most at risk for severe sequelae, all infected individuals, aware or unaware of their infected state, are sources of infection. The correct diagnosis is paramount in reducing the spread of this prolific disease, and goes hand in hand with patient education
on transmission, recognition, treatment, and protection. Patients must be made fully aware of their infection and the risks and consequences of transmission if the genital herpes epidemic is to be halted.
How Do I Diagnose Genital Herpes?
The key tool for diagnosis is laboratory testing. If the patient presents with signs or symptoms suggestive of a genital infection, take a sample from the sores, if present, and test it for the presence of herpesvirus. Although a positive culture indicates herpes, a negative culture does not rule out herpes.
Recently, two new serologic diagnostic tests have become available for use by the primary care clinician to test for the HSV antibody in blood. One is a point-of-care test that can be used in the office; the other is a test to be performed by a central lab. It is critical that clinicians realize that unless the serologic test specifies that it is measuring glycoprotein G, it is not a type-specific test. Only type-specific serologic tests will be able to distinguish between HSV-1 (the most common cause of fever blisters) and HSV-2 (the most common cause of genital herpes).
Glycoprotein G is specific for HSV-1 or HSV-2. Previous testing methods could not distinguish between HSV-1 and HSV-2. Therefore, if the serology was positive, you could not determine if the test was picking up antibodies formed from a fever blister infection or a genital herpes infection. The new tests can tell the difference. As mentioned earlier, HSV-1 is most commonly associated with cold sores. However, HSV-1 can also cause genital herpes.
About 30% of primary cases in the United States are actually caused by type 1. Because of the frequency of reactivation, 95% of recurrent cases are caused by type 2. It is important to know the difference because the long-term prognosis of genital herpes due to type 1 versus type 2 is different. Genital HSV-1 usually recurs less frequently and there is less asymptomatic shedding.
For more detailed information on genital herpes, herpes in the pregnant woman, or new diagnostic tests, click here to link directly to The Herpes Monitor. This publication of the American Herpes Foundation (AHF), directed toward healthcare professionals, is available free of charge to all practicing clinicians, and is available on our web site after every mailing.
Herpes Patients Are Dissatisfied With Their Healthcare Providers—Why and What Can Be Done?
According to recent surveys, healthcare providers have been failing their patients most of the time in terms of psychological management of genital herpes. Management of the disease needs to progress beyond prescribing drugs and into providing emotional support and education for patients with genital herpes. The American Social Health Association (ASHA) has developed the ASHA STD Counseling Model to help healthcare providers overcome barriers to counseling their patients in a clinical setting. If the model is followed, providers will be better able to view the disease from the patient's perspective and include emotional counseling and referrals to additional information sources in their arsenal of disease management tools.
Please note that this site is designed primarily as an information service on herpesvirus infections and AHF activities. We regret that we cannot give medical advice or referrals via this web site and we are not able to offer a medical question-and-answer service. If you would like more detailed information, please click here to review the topics covered in depth by The Herpes Monitor. This AHF publication is made available free of charge to practicing clinicians through our mailing list or by accessing our web site. If you are interested in receiving our publication, please leave your name and address on our response page (click here). Other good sources of information can be found by following the links on our Herpes-Related Web Sites for Clinicians page.
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American Herpes Foundation - Hackensack, New Jersey
Telephone (201) 342-4441 | Fax (201) 342-7555