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HSV-1 the cause of most HSV infections in young women
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Herpes simplex virus type 1 is now the leading cause of herpes simplex virus infections among most young women, marking a change in the epidemiology of the virus, data reported in Clinical Infectious Diseases suggest.
“When HSV-1 caused disease, it was far more likely to cause genital disease than oral disease, although the majority of both HSV-1 and HSV-2 infections occurred without causing recognized symptoms,” David Bernstein, MD, of the division of infectious diseases at Cincinnati Children’s Hospital Medical Center, told Infectious Disease News.
David Bernstein
“Thus, even though we educated the subjects on how to recognize infections, the majority were unaware of their infections and would not undertake additional efforts to prevent transmission.”
For 20 months, Bernstein and colleagues followed 3,438 women who were enrolled in the control arm of the HERPEVAC Trial for Women. The women were aged 18 to 30 years and were initially seronegative for HSV. Among these women, 127 became infected with HSV-1 and 56 became infected with HSV-2. HSV-1 occurred at a rate of 2.5 per 100 person-years, which was more than double the rate of 1.1 per 100 person-years for HSV-2. Most of the infections for both groups were unrecognized.
HSV-2 was more common among non-Hispanic black women: 2.6 times higher than in Hispanics and 5.5 times higher than in non-Hispanic whites. Women aged 18-22 were more likely to acquire HSV-1, but older participants were more likely to have recognized disease. Most of the cases of recognized disease were genital.
“It is important for clinicians to understand the changes in the epidemiology and the differences by race as they counsel patients with these infections,” Bernstein said. “It is also of interest that data from the vaccine trial these women were enrolled in showed that the vaccine was effective in preventing HSV-1 but not HSV-2. Thus, the emergence of HSV-1 as the more common infection may lead to reevaluation of the benefits of that vaccine or others.”
Bernstein said that it will be important to continue monitoring the trends in HSV infections and to determine why the epidemiology has changed. In addition, future HSV vaccine researchers should consider these changes when designing vaccines and trials.
In an accompanying editorial, Richard Whitley, MD, of the departments of pediatrics, microbiology, medicine and neurosurgery at the University of Alabama at Birmingham, said that the study has reinforced the knowledge of genital HSV infection.
“For so many of us, HSV-1 was thought to be only a trivial infection of the mouth or lips,” Whitley wrote. “Now that sexual practices have changed with increased oral-genital sex, it is likely that we can account for the displacement of HSV-2 as the most common cause of initial infection. Because of this changing epidemiology of genital HSV infections, future vaccine trials will need to be rethought.”
Disclosure: Bernstein and Whitley report no relevant disclosures.
David Bernstein, MD, can be reached at: Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, 333 Burnet Ave., ML 6014, Cincinnati, OH 45229; email: david.bernstein@cchmc.org.
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