Distribution and Incidence

Infection by herpes virus is reported worldwide, as determined by antibody studies, and is related to the socioeconomic state. The prevalence of positive antibody tests to HSV-1 approaches universality (100 percent) in the lower strata, falling to 30 to 50 percent among those of higher socioeconomic levels. Obviously, transmission is more likely among those living in a crowded and unhygienic environment. The prevalence of positive antibody response begins in early childhood and rises to its peak in adult life. Transplacental antibodies are present in infants up to 6 months of age. Then a sharp rise in antibodies occurs for those aged 1 to 4 years, mainly to HSV-1. This is followed by a slight rise from 5 to 14 years, and after 14 there is a marked rise in antibodies through late adulthood, which is in part due to HSV-2 infection (see Figure VIII.64.1).

mo mo yr yr yr yr yr yr yr yf No. 24 15 20 19 15 29 27 40 24 26

Figure VIII.64.1. Percentage distribution of antibodies to HSV-1, HSV-2, and intermediate form (types 1 and 2) in 239 patients of various age groups. (From A. J. Nahmius and D. E. Campbell. 1983. Infections caused by herpes simplex viruses. In Infectious Diseases, 3d edition, ed. Paul D. Hoeprich, 859, by permission of Harper & Row, publishers.)

mo mo yr yr yr yr yr yr yr yf No. 24 15 20 19 15 29 27 40 24 26

Figure VIII.64.1. Percentage distribution of antibodies to HSV-1, HSV-2, and intermediate form (types 1 and 2) in 239 patients of various age groups. (From A. J. Nahmius and D. E. Campbell. 1983. Infections caused by herpes simplex viruses. In Infectious Diseases, 3d edition, ed. Paul D. Hoeprich, 859, by permission of Harper & Row, publishers.)

Because HSV-2 infection is a sexually transmitted disease, it has been studied more intensively in recent years than the more common HSV-1 infection.

On the other hand, most observers agree that herpes genitalis has been on the increase in recent years, and in 1983 the National Institutes of Health estimated that there were 20 million cases in the

United States, with 300,000 to 500,000 new cases developing annually. Undoubtedly, contributing factors include increased sexual activity as well as a preference for the use of oral contraceptives over the condom, although a wider use of diagnostic tests may account for some of the apparent increased prevalence. Certainly, publicity concerning herpes genitalis has alerted the medical profession to the disease and has made the public aware that "chafing of a menstrual pad" and lesions on the male genitals may entail more than temporary annoyance.

In any event, beginning with its 1983 Annual Summary, Morbidity and Mortality Reports, the U.S. Public Health Service has included herpes genitalis. The report for 1984, based on physician consultations, office visits, and the first office visits for the disease, "reflects a 16 fold increase from 28,000 to 423,000 in the number of consultations for genital herpes in the period 1966-1983" (see Figure VIII.64.2).

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