The Wall Street Journal - December 10, 1997
Andrea Petersen

The scourge of singles bars in the late 1970s and early '80s, herpes moved to the back burner of public-health concerns after the inception of the AIDS crisis. "People said, 'Let's put all our energy toward HIV,' " says Linda Alexander, president and chief executive officer of the American Social Health Association, a nonprofit education group. "Herpes just fell to the wayside."

But a new study by the Centers for Disease Control and Prevention is casting a spotlight on the herpes epidemic's scope. Released in late October, the study reports that by the mid-1990s, 1.2 million young people, or 5.6% of the 12-to-19-year-old population, were infected with the sexually transmitted disease. That's more than double the 505,000 in the same age group in the late 1970s.

Among white teenagers, the herpes prevalence rate jumped fourfold, to 4.5% from less than 1%. In all, the researchers estimate that one of every five people aged 12 and over has herpes.

While the CDC study only tracks herpes prevalence through 1994, doctors say that in the three years since then herpes is still on the rise. "We've seen easily a doubling or tripling of the cases we see on a monthly basis," says Peter Leone, medical director of the HIV/S program in Wake County, N. C. "And we're seeing it in a younger age group from what we did even a few years ago."

Perhaps the most troublesome aspect of the herpes epidemic among teenagers is the fact that policy makers, educators and public health officials didn't do more to stop it. Faced with the double whammy of AIDS and teenage pregnancy, health authorities failed to attack herpes aggressively with public funding and education.

While the CDC spends more than $100 million on efforts to prevent and treat syphilis, gonorrhea and chlamydia, herpes gets next to nothing. And herpes is mentioned only once in the HIV-prevention guidelines the CDC gives schools.

"Things will get worse as long as there is absolutely no plan to control this disease," says Anna Wald, a herpes specialist at the University of Washington in Seattle.

A new $50 million per year federal sex-education program launched last month might have been good news for herpes specialists. But the program stresses abstinence only; talk about condom use is prohibited. According to a study by the Sexuality Information and Education Council of the U.S., a nonprofit group that supports the teaching of comprehensive sex education, most states require sex-education classes to talk about the symptoms of sexually transmitted diseases but only nine states discuss the acts that can transmit the diseases.

"If you're not allowed to mention specific sexual behaviors, how do you begin to address prevention, especially with diseases like herpes?" asks Debra Haffner, the organization's president.

Because there is little public discussion about herpes, the disease is far from teenagers' minds. "We don't think about it," says 15-year-old Tariq Shakirullah of Irvington, N. J. Others have more pressing worries. "I consider pregnancy and AIDS my biggest concerns," says Christine Bayeux, a 17-year-old senior at Clifton High School in Clifton, N. J. "I'm not really worried about herpes."

The most common symptom of herpes is a cluster of sores in the genital area, sometimes painful and sometimes accompanied by fever, swollen glands and fatigue. Symptoms usually appear from about two to 30 days after infection, can last for a couple of weeks and can reoccur in periodic outbreaks.

Because many people have mild symptoms or confuse them with something else, as many as nine out of 10 people with herpes don't know they have it. The result is an epidemic of people who aren't aware they should be taking steps to protect their partners.

Many teenagers also don't realize that herpes sores can open up a pathway to the bloodstream. New research found that people with genital ulcers, the majority of which were herpes sores, are 11 times more likely to go on to acquire HIV than those who don't have ulcers.

And while condom use among adolescents is growing, condoms are less effective in protecting against herpes than they are in preventing other sexually transmitted diseases, such as HIV or gonorrhea.

A huge population of future children may also be at risk. A newborn can catch herpes while moving through the birth canal of an infected mother, leading to mental retardation and death. Lawrence Corey of the University of Washington, one of the country's foremost specialists in the disease, estimates that about one in every 3,500 babies born in the Western U.S. is infected with herpes. With the jump in herpes infection among teenage girls, who are twice as likely as boys to get the disease, doctors expect the number of neonatal infections to increase.

Even a concerted effort to quell the epidemic will run into difficult obstacles. First, it can be difficult for a teenager to get a diagnosis. Laboratory tests are still expensive and often inconclusive, though this should change soon with some new testing methods on the horizon. Also, many school districts require teachers to notify a student's parents before giving a referral to a clinic treating sexually transmitted diseases, a move that can deter even the bravest from getting treatment.

As painful as the physical symptoms might be, the emotional repercussions of herpes can also be devastating for the young. "I just got so depressed," says a 21-year-old University of Cincinnati student with herpes. "I cried every day. There were moments that I felt my life was over."

For those with painful physical symptoms, antiviral drugs such as Glaxo Wellcome PLC's Zovirax and Valtrex and SmithKline Beecham PLC's Famvir can help to shorten the length of a herpes attack. Studies are under way to see if they reduce the risk of transmission, but even that would require constant use of the drug, not a likely strategy among teens.

Most doctors think the only way to stem the rising tide of herpes infection among teenagers is to find a vaccine. "It is unlikely that the sexual habits of an entire population will change because there is a risk of genital herpes," says the University of Washington's Dr. Wald. "The only way you're going to really control herpes is by universal vaccination."

A promising vaccine by Chiron Corp. was scuttled after clinical trials produced disappointing results. Some doctors are hopeful that an experimental vaccine by SmithKline Beecham, which is currently in the final stage of trials, will be effective. But doctors generally agree that a vaccine is still years away.

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