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Which STDs are in greatest need of a vaccine?
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Cases of STDs have reached record high numbers in the past few years, and the epidemic has shown no signs of slowing down. Infectious Diseases in Children asked Lynn Barclay, president and CEO of the American Sexual Health Association, about some of the STDs that are in greatest need of a vaccine.
Herpes simplex virus (HSV) is common, according to U.S. surveillance data from the CDC, which indicates that about half of Americans aged 14 to 49 are infected with HSV-1, often acquired in childhood and most often experienced as an orolabial infection manifesting as cold sores on the lips or face. The number of new cases of genital herpes attributed to HSV-1 is increasing.
Also, according to CDC, approximately 12% of Americans are seropositive for HSV-2, which is almost always experienced as an anogenital infection.
Most cases of HSV are not clinically significant — about 85% of genital herpes is undiagnosed and unrecognized — but a herpes vaccine could have significant value. Ulcerative outbreaks of HSV, coupled with an associated local proliferation of CD4 cells, amplify the risk for HIV acquisition. Also, those with HIV and genital herpes coinfection are more likely to transmit HIV. Neonatal herpes, while fortunately very uncommon, is a devastating condition that can cause permanent neurological damage and even lead to death.
As with most STDs, there are troubling and persistent racial, ethnic and gender disparities with genital HSV infections. One can argue that HSV prevention overlaps public health and medical science with matters of justice.
Finally, there is the enormous psychosocial impact of genital herpes diagnosis, which is especially keen immediately following diagnosis but for some remains pernicious months or even years later. For decades, the American Sexual Health Association has operated STD-focused contact centers for the general public, and the volume of calls and emails around HSV — virtually all containing a significant emotional component — dwarfs our combined interaction around all other STDs.
Therapeutic and/or prophylactic vaccines that would be effective against HSV, especially HSV-2, could be a major boon to public health and the well-being of individuals and communities. The elements that are crucial to the development of these much-needed interventions are prioritization of HSV-2 as a public health issue and increased collaboration between public and private sectors to develop and effectively distribute any new immunizations.
Disclosure: Barclay reports no relevant financial disclosures.
Editor’s note: To read our February cover story on the STD epidemic, click here.