Herpes Simplex Type 2 Virus Revisited

Since the 1970's the incidence of Herpes Simplex Virus Type 2 has increased by 30% in the United States. This finding is surprising considering the amount of publicity that has gone into promoting "safe sex" in the past ten years, and the availability of Acyclovir and its' derivatives. It is estimated that approximately 1 in 5 Americans above the age of 12 years carries this virus. Moreover the largest increase is seen in the younger cohorts, especially among white teens where the prevalence has quintupled. This increase in the incidence of HSV-2 has implications for the spread of HIV because sexual partners with active HSV-2 lesions, and who are infected with HIV, can more easily spread the virus. The increase in incidence also means that more mothers will be infected with the virus, increasing the potential for neonatal infection.

A study of the biology of HSV-2 can explain this phenomenon. It is now apparent that the virus is spread by infected partners who are asymptomatic. Once a patient is infected, the virus may remain present at the genital site for days to weeks before migrating to the lumbosacral sensory gangliae. The primary infection is asymptomatic. When it is reactivated, the virus migrates back down the neural pathways to the skin where it rarely causes any symptoms, although it may erupt with the classic ulcerations. In this reactivated state the virus can be transmitted to an unsuspecting partner by an unsuspecting host. Since there are about 45 million people infected in the US, it is obvious that the more sexual partners a person has, the higher is the risk of being infected.

Anti-viral agents are useful for those reactivations with lesions. A vaccine, if one was developed, might produce antibodies which could help the host mitigate the effect of the disease, even if the virus cannot be eradicated. However at present the best protection available is to limit the number of one's sexual partners, and to use a condom.

-John Hickey

This page last updated December 20, 1997