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Almost 90 percent of Americans have the most common form of herpes – Herpes Simplex Virus type 1 (HSV-1) or oral herpes (“cold sores”) at some time in their life. Half a million Americans are diagnosed with genital herpes every year. However, many more do not know they have herpes because they have never had or noticed the symptoms.

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Changes in sexual behavior may be reducing the number of Americans infected with the herpes simplex virus type 2, which causes most cases of genital herpes.

Researchers also found that the prevalence of herpes simplex virus type 1 infection — which is typically spread during childhood via nonsexual contact — is also falling.

“The most exciting finding is that we looked at the proportion of Americans infected with the herpes simplex virus and found a decrease over the past decade,” said lead author Dr. Fujie Xu, from the U.S. Centers for Disease Control and Prevention. His team reported the findings in the Aug. 23-30 issue of the Journal of the American Medical Association.

Overall, the number of Americans aged 14 to 49 who tested positive for herpes 2 infection fell by a relative rate of 19 percent between 1988 and 2004 — from a prevalence of 21 percent in the late 1980s and early 1990s to 17 percent 10 years later, the researchers reported.

Herpes simplex virus type 2 causes most genital herpes and is one of the most common sexually transmitted infections. Herpes simplex virus type 1 is usually transmitted non-sexually but is a principal cause of genital herpes in some developed countries.

In the study, researchers at the CDC compared data from the National Health and Nutrition Examination Surveys (NHANES) from two time periods: 1988-1994 and 1999-2004. Together, the surveys included more than 20,600 Americans aged 14 to 49.

The drop in herpes type 2 infections between 1988 and 2004 was particularly significant among teens, the researchers found. The number of people aged 14 to 19 who tested positive for herpes simplex 2 dropped from 5.8 percent in the 1988-1994 survey to just 1.6 percent 10 years later.

“The decrease appears to be due to changes in sexual behavior,” Xu said. These changes may include careful partner selection, condom use and choosing oral sex over vaginal sex, the researchers noted.

Xu’s team also found that the proportion of people with herpes simplex virus type 1 also decreased — from 62 percent in 1988-1994 to 57.7 percent in 1999-2004, a relative decline of 6.9 percent. This decrease was not unexpected and is due to improvements in living and hygiene conditions, the researchers said.

However, the number of people affected by genital infections linked to type-1 herpes infection appears to be rising. The authors explained that, because fewer Americans are getting infected with the type 1 virus during childhood, they may be more susceptible to sexually acquired genital infections later on.

While there has been a drop in the number of Americans infected with either form of the virus, herpes still affects millions of people in the United States, Xu pointed out. “Overall, the prevalence is 17 percent — that means one in six Americans are still infected with this virus,” she said.

Increased efforts to stop the spread of herpes could bring those numbers down, however. “The surest way to stop the spread of any sexually transmitted disease is abstinence,” she said. “Consistent and correct condom use can reduce, but not eliminate, the risk of transmission,” she added.

In addition, treatment for herpes can also help prevent the spread of the virus, Xu noted.

One expert thinks these new findings confirm how prevalent herpes is in the United States.

“The important message from this study is how common herpes is and that most people don’t know they have it,” said Dr. Cynthia Krause, an assistant clinical professor of obstetrics/gynecology at Mount Sinai School of Medicine, in New York City. “The decline is a small percent compared to the incredible prevalence of the infection.

Another expert believes much more can be done to curb infection rates.

“There is no herpes-control program in the United States,” said Dr. Jeffrey D. Klausner, director of STD Prevention and Control Services at the San Francisco Department of Public Health. “I hope that by highlighting that tens of millions of Americans have herpes infections, it will get people to think about what kind of control programs may be necessary.”

Klausner believes steps such as screening, treatment, education and counseling can all help reduce the rate of herpes infections.

“There is evidence that condom use is being recognized as a very effective means to prevent STDs. So people may be using them more,” Klausner said. “It is [also] possible that younger people are having fewer partners,” he added.

However, Klausner doesn’t believe abstinence has had any effect. “I would not attribute anything to the abstinence-based campaigns. They have been shown repeatedly not to be effective,” he said.

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Q: Five years ago, I kissed a man who had what I thought was a cold sore on his lip. About two weeks later, I broke out in vaginal sores that were diagnosed as genital herpes. I did not have any sexual contact with this man or any man four years prior to the kiss. I have only had the one outbreak. Is it possible for genital herpes to be transmitted from a kiss, and can herpes tests have false-positive results?

A: There is widespread confusion regarding herpes infections and how they are transmitted. In case you don’t know, there are two viruses that cause herpes — herpes simplex viruses (HSV) 1 and 2. HSV-2 causes most cases of herpes on the genitals, while HSV-1 causes most cases of oral herpes (on the lips and mouth). However, either virus can cause either illness.

Oral herpes is a common infection, affecting more than half of all Americans. The initial infection usually causes no symptoms, but in some people it can be severe, with fever, intense pain, blisters in the mouth and throat and headaches. HSV is never eradicated from the body, so recurrent infections occur. Fortunately, these recurrences are generally not severe, manifesting mainly as cold sores on the lip, as you describe.

Genital herpes is similar to oral herpes in that the initial infection, if symptomatic, tends to be more severe than recurrences are. In addition to the manifestations I described for severe oral herpes, there can be meningitis (inflammation of the membranes covering the brain and spinal cord) and bladder problems.

HSV-1 and HSV-2 are transmitted by direct contact. That may mean contact with a sore on an infected person, but it may also mean contact with the oral or genital region of an infected person who has no visible sores. Since the virus is spread by direct contact, I would not expect you to acquire genital herpes after only a kiss.

The incubation period (time from infection to the first manifestations of disease) for herpes is usually less than a week. The short incubation period also speaks a bit against you having contracted herpes from the encounter you describe, but incubation periods of two weeks or more have certainly been reported.

There are several possibilities in your case. First, you may not have had herpes at all. A few other conditions can mimic the infection. Laboratory tests can easily prove or disprove the diagnosis. Second, you could have transferred the virus from your mouth (or his mouth) to your genital region. This seems a bit unlikely, but it is certainly possible. Frequently, people will develop herpes infections of the finger after touching lesions on the mouth or genitals. The third — and I think the most likely — possibility is that you actually had a recurrence of a genital herpes infection that occurred previously. If you had never had genital lesions before, then your initial infection was asymptomatic. This commonly occurs in genital infection, and it is the most common presentation of oral infections. In other words, the first manifestation of any herpes infection is often a recurrence.

As to your last question, the best way a physician can diagnose a herpes infection is by sending the fluid from a sore to a laboratory for culture (growing any microbes present). Rapid tests are also available for detecting the virus without waiting for it to be cultured in a lab. If your lesions tested positive for herpes either from culture or from one of the newer techniques for viral detection, I would say that you almost certainly had herpes. In rare cases, there can be false-positive tests, but if your physician thought you had herpes, and if one of these tests were positive, then you probably had herpes. On the other hand, blood tests for antibodies against herpes are not as reliable.

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Diagnosis with herpes usually hits people like a ton of bricks. When your doctor or practitioner first uttered the words you probably thought to yourself, or exclaimed “what?!” Many emotions raced through your mind. How did this happen? Who gave this to me? Will I ever be able to date again? Will I ever be able to have SEX again? These feelings are totally normal. As time progresses things will get easier.

How Did This Happen?

Most people think sexually transmitted diseases will ‘happen to someone else’ or that using a condom is 100% foolproof in protecting against STD’s. The most important thing to realize is that ANYONE who is sexually active has an extremely high likelihood that they will come into contact herpes. Genital herpes is very common. Many estimates have placed the lifetime likelihood of getting genital genital to be in the range of 20%. Think about that for a second. That is 1 out of every 5 people! It is almost impossible to be sexually active with more than one partner your entire life and avoid herpes. While most do not know they have the virus because it does not cause any visible symptoms, they are still able to transmit the virus to others. While this does sound alarming it is comforting to know that most people are exposed to herpes and for most it does not cause any harm. Informing your current or future dating partner armed with these statistics makes it a whole lot easier to swallow.

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