These days, very few of us think about genital herpes as an epidemic. We know it's out there. We've seen the TV ads for medications. We know it's not exactly curable. But are we really at risk?

Herpes prevalence
Let's start with the numbers. The government-sponsored National Health and Nutrition Examination Survey (NHANES) includes extensive random testing for herpes, and the results are nothing short of dramatic:

According to NHANES, more than one in five Americans over the age of 12 is infected with type 2 herpes simplex virus, the most frequent cause of genital herpes. The survey results also show that genital herpes increased from 16.4% prevalence circa 1980 to 21.7% in 1991. Ironically, this remarkable 30% increase occurred during the decade that introduced Americans to the idea of "safer sex."

You're not alone if you're now saying to yourself, "Wait a minute, I don't even know five people with herpes—so how can I believe that one out of every five people has it?"

It's a good question.  The catch here is that these tests for herpes detect antibodies circulating in the bloodstream rather than identifying people who volunteer that they have herpes. The tests don't lie, and according to researchers, neither do most of the subjects in the studies. It's just that herpes usually has quite subtle symptoms. Therefore up to 90% of those who test positive honestly don't know they're infected.

A number of studies have taken things a step farther. Researchers have recruited people who test positive for herpes but say they have never had symptoms. They then educate these individuals about herpes symptoms and follow them over time. The result? Once educated, more than half report that have noticed a herpes outbreak within the first six months after counseling.

How it spreads
In many ways, of course, one would think it's good news that herpes is usually a mild or unrecognized infection. Less pain, less angst, right? The problem is that herpes continues to spread through the population at an alarming rate.  And even if it doesn't usually cause big physical problems, it has its downsides. Herpes increases the risk of acquiring or getting HIV/AIDS, and it's also very damaging to newborns. Last, a person newly diagnosed with herpes sometimes has a tough time adjusting emotionally.

Experts say the true prevalence of genital herpes today is probably even higher than the 21.7% projected by NHANES. For one thing, the last published NHANES data was collected a decade ago, and researchers believe that there are up to 1 million new infections every year. For another, it reflects only HSV-2 prevalence, and a growing percentage of genital herpes is caused by HSV-1. (Click here for more information about HSV-1 versus HSV-2.)

"This is now a serious problem requiring some hard thinking and some action in the public health realm," says Lawrence Corey, MD, of the Fred Hutchinson Cancer Research Center in Seattle. Assuming the same rate of increase, prevalence could now be approaching 30%. "No one has calculated how quickly this figure will rise, but without some public health intervention it's logical to think that at some point the majority of sexually active adults will have genital herpes."

The fact is that genital herpes is tough to stop.  It can be spread by people who don't know they have it, which is a hard problem from a public health standpoint. Preventing herpes transmission is also tricky for the person who knows he or she is infected, because people infected don't know when the virus is contagious.

Can it happen to me?

So, what do people think about all of this? In recent years, attitude and knowledge surveys conducted by the American Social Health Association point to an interesting phenomenon: A majority of those polled are aware of how widespread herpes is, and many also know that it can be spread by those who don't have symptoms. But people generally aren't worried they themselves will get herpes. They don't talk with partners about it. They don't get tested. They don't take precautions.

One explanation for this carefree attitude might be that herpes no longer carries as much of a social stigma and is understood to be treatable. But most people surveyed still view herpes as a potentially traumatic diagnosis--more traumatic, for example, than getting fired or breaking up with a loved one.  It appears, then, that people don't express concern about herpes because it won't happen to them.

Well, with over 25% of American adults walking around with genital herpes, it can happen to anyone. While there's really no surefire method, there are steps people can take to lower the risk of spreading or getting a herpes infection. We'll discuss these in part 2 of our series.

-- Charles Ebel