30% of all new cases of Genital
Herpes results from HSV-1 the virus of "cold sores".
The difference between
"genital" Herpes and "oral" Herpes is in location only, not viral type.
50 to 80% of all Americans
carry the antibodies to HSV-1.
A staggering number of people,
even those who have been infected for years, are unaware that these
oral/facial outbreaks are a form of Herpes, and are therefore highly
contagious.
HSV-1 infection of the genital areas are
passed via oral sex with someone who has a cold sore.
Many people mistakenly refer to type 2 as
"genital herpes," and type 1 as "oral herpes," when in fact, Herpes types 1
and 2 can and do infect either area. While many people have type 1 oral
infections and type 1 or 2 genital infections as well, it is extremely rare
for a person to have infections with type 1 and type 2 simultaneously in the
same location.
The gold standard for the antibody
test for Herpes infections is the Western blot (WB) analysis which
has the ability to distinguish between types 1 and 2 antibodies. However
due to its cumbersome nature WB is not a practical option for the
routine clinical laboratory.
Recently, type-specific purified glycoproteins G (gG1 and gG2) have
been used to develop reliable type-specific immunoassays to detect
antibodies to herpes simplex. The tests we use are based on
these purified glycoproteins, and when compared to Western Blot, have a
sensitivity of 98% and
a specificity of 97% for HSV-2.
Herpes Simplex Type 1 (HSV-1) is the virus responsible
of "cold sores" which are known as fever blisters, This virus is related to, but not the same
as, the HSV-2 virus which causes genital herpes. Oral-facial herpes simplex virus (HSV-1) infection is a common, worldwide
problem. HSV is an acronym for the Herpes Simplex Virus. Research has
shown that between 50 to 80% of all Americans carry the antibodies to HSV-1.
Between 10 to 20% of that population suffers recurring outbreaks.
Even though a
person may visibly show no signs of recurrence, it is possible for a person
to pass the HSV-1 virus. A staggering number of people, even those who have
been infected for years, are unaware that these oral/facial outbreaks are a
form of Herpes, and are therefore highly contagious. There is very little
public awareness, education, or discussion of Herpes. Most people are
infected with the virus by the time they are 10-years-old. Studies in the
United States indicate that 30 to 60 percent of children under the age of 10
years have been exposed to the virus. The incidence of infection steadily
increases with age, reaching 80 to 90 percent among adults 50 years of age
and older.
The virus usually enters the body through the mouth. The initial contact
with the disease does not result in a cold sore, but can be either
asymptomatic (no obvious symptoms of infection) or with symptoms more
readily associated with an upper respiratory infection, and often lesions in
the mouth.
Following the initial episode, the virus moves away from the nerve
endings up into portions of the nervous system close to the lips. The HSV-1
virus remains in the body for the remainder of the person's life. What
causes approximately one-third of those initially infected to suffer from
recurrent cold sores is unknown. However, for those individuals who do
suffer from recurrent cold sores, certain triggers will initiate the
development of a cold sore.
Serology is an effective way to diagnose subclinical HSV type 2
infections, but currently most available tests are of limited value
because they cannot accurately discriminate between HSV-1 and HSV-2
antibodies. Because herpes virus types 1 and 2 share many common
antigens, there is considerable cross-reactivity among most type 1 and
type 2 enzyme immunoassays (EIA) based on whole viral proteins.
The National Health and Nutrition Examination Surveys have shown that the estimated seroprevalence of herpes simplex 2 in individuals over 12 years of age
is greater than 20% and increasing. The prevalence in women is about 8%
higher than in men (25.6% versus 17.8%). Subclinical infections are
present in 90% of those infected with HSV-2. This lack of awareness of
infection contributes to virus spread. With the high prevalence of HSV-2
in the population, the risk of contracting herpes is significant in
those individuals who have multiple sex partners.
We offer an HSV-2 specific glycoprotein G IgG assay and an
HSV-1 specific glycoprotein G IgG in our serology laboratory. Both these
tests have high sensitivities and specificities (99% and 98%
respectively for HSV-2 and 96% and 97% for HSV-1). Serum levels may take
4-6 weeks to reach their peak with HSV-2 initial infections.
Studies suggest that many patients seeking care for sexually
transmitted disease (STD) are interested in learning their herpes
status. These new serological tests can be used as part of the STD
workup. This is especially true in pregnant women in their third
trimester where the risk of herpes transmission through an infected
birth canal is high following genital herpes acquisition.
1) A
negative result indicates that there was no prior exposure to HSV-.A
negative result however does not rule out the possibility of recent
infection with the serum being tested before the appearance of IgG
antibodies. If recent infection is suspected it is recommended that:
a)
The serum sample be tested for the IgM antibodies.
b) A
second sample taken 1-2 weeks later be tested for IgG antibodies to see
if seroconversion has occurred.
A
negative serological test does not exclude the possibility of past
infection.Following primary HSV infection,antibody may fall to
undetectable levels and then be boosted by later clinical infection
with the same or heterologous type.
2) A
positive result indicates that there was prior exposure at some
undetermined time to HSV.A low positive or mid positive result is
inconclusive in determining recent infection.
A
highly positive result may indicate acute or recent disease.In order to
confirm recent infection it is recommended that:
a)the
site of infection be tested for viral isolation.
b)The
serum sample be tested for the IgM antibodies.
c) A
second sample taken 1-2 weeks later be tested for HSV IgG antibodies to
check if seroconversion has occurred.
3)
Specimens showing equivocal results must be retested: if they remain
equivocal after repeat testing they should be tested by an alternative
serologic procedure.
Herpes 2
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Where can I get more information?
Division of STD Prevention (DSTD)
Centers for Disease Control and Prevention
Web site: www.cdc.gov/std/
Personal health inquiries and information
about STDs:
CDC National STD and AIDS Hotlines
(800) 227-8922 or (800) 342-2437
En Espanol (800) 344-7432
TTY for the Deaf and Hard of Hearing (800) 243-7889
National Herpes Hotline
(800) 227-8922
National Herpes Resource Center
Web site: http://www.ashastd.org/hrc
Email: herpesnet@ashastd.org
American Social Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877
Web site: www.ashastd.org
STD questions: std-hivnet@ashastd.org
