Sexually Transmitted Diseases  >  Publications  >  Report of the Genital Herpes Prevention Consultants Meeting May 5-6, 1998

Report of the Genital Herpes Prevention Consultants Meeting May 5-6, 1998

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2. Magnitude and Burden of Genital Herpes

Through the National Health and Nutrition Examination Survey (NHANES), prevalence data for HSV-2 infection in the United States are better than those for any other STD. Nevertheless, poor understanding of the natural history (especially of initially subclinical infection), incidence of complications, and direct and indirect costs of genital herpes makes it difficult to assess societal costs and the cost effectiveness of prevention. Moreover, local and regional data are generally unavailable to program planners, health care providers, or the public. There was consensus that surveillance for genital herpes is warranted, but should begin with sentinel surveillance in targeted populations and settings. Surveillance should determine seroprevalence and seroincidence; clinical incidence and prevalence, with distinction between symptomatic and subclinical infection and among primary, initial non-primary, and recurrent infection; and population-specific results. Issues to be resolved in designing sentinel surveillance include the need for suitable case definitions, the ability to generalize sentinel surveillance data to populations outside those captured in the surveillance system, and resources to extend sentinel systems into ongoing surveillance, if warranted.

Estimates for the direct medical costs attributable to genital herpes were presented and discussed. Inherent difficulties in estimating such costs include the limitations of administrative databases (e.g., underdiagnosis and intentional miscoding to preserve confidentiality) and of pharmacy sales data. Although efforts are underway to refine these figures, even when the uncertainties are considered it seems likely that the direct medical costs resulting from genital herpes are relatively small in comparison with other STDs. Accordingly, there was consensus that these costs are unlikely to be a primary determinant of the resources that will be available or of public advocacy for genital herpes prevention. On the other hand, these estimates do not include indirect costs, such as lost wages, lost productivity, or intangible costs, such as pain, emotional burden, and effects on lifestyle, and thus underestimate the true burden of genital herpes.

A. Magnitude of Genital Herpes

It was recommended that population-based seroprevalence continue to be periodically assessed in future NHANES cycles, and perhaps expanded; and that HSV-1 seroprevalence should be determined and analyzed in the past (NHANES-II and III) and future NHANES cycles (consensus high, priority high).

CDC should conduct or support demonstration projects of sentinel surveillance for genital herpes (consensus high, priority high).

CDC should conduct or support mathematical modeling to understand HSV transmission patterns and trends and impact of interventions, while recognizing that refined estimates for some elements of the model (e.g., the risk of transmission per exposure in specified clinical and epidemiological settings) need to be continually reassessed and the models refined accordingly (consensus and priority uncertain)

B. Burden and costs of genital herpes

Further studies of the direct medical costs of genital herpes were felt to carry a low priority.

It was recommended that studies go forward on ways to quantify the indirect and intangible costs attributable to genital herpes (consensus high, priority high).

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