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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4. Preventing Sexual Transmission of HSV

The discussions addressed epidemiologic and biomedical issues, behavior change, and professional education. The consultants recognized that most sexual transmission of HSV occurs during subclinical viral shedding; that HSV-1 prevalence in a population affects the transmission and clinical manifestations of HSV-2 infection; that both male and female condoms are likely to reduce the likelihood of transmission, but quantitative data are lacking on the actual protective effect; that the female condom may be more effective in preventing HSV transmission than the male condom, because the female condom covers a greater surface area of potentially infected susceptible tissues; that antiviral therapy reduces subclinical shedding but does not eliminate it, and the effect on transmission is not yet known; that complex prevention messages and strategies will be required in addition to condom promotion and antiviral therapy; and that both patient and clinician knowledge are poor concerning the epidemiology, clinical manifestations, transmission, and prevention of genital herpes. Low-prevalence, high incidence groups (e.g., adolescents and persons recently initiating sexual activity) were felt to represent ideal populations for the study of the effectiveness of a variety of interventions to prevent genital herpes; the results are likely to be broadly applicable to other populations in which incident infection is more difficult to measure.

It was acknowledged that because the strategies to prevent transmission of other causes of sexual and reproductive morbidity (HIV, bacterial STDs, pregnancy) are insufficient to completely prevent HSV transmission, and that condoms are not fully protective, additional herpes-specific prevention messages will be required. There was consensus that a national genital herpes education campaign should be undertaken as soon as possible. The specific goals of such a campaign were not delineated, but examples include promotion of male and female condom use, combined with recognition that protection is incomplete; information about the potential utility of the female condom; and the fact that subclinical viral shedding is common and accounts for most episodes of HSV transmission to sex partners.

A. Epidemiology and biomedical issues

It was recommended that existing data on transmission risks (e.g., among HSV-discordant couples in HSV vaccine trials) be promptly analyzed to assess the determinants of transmission, such as symptom status, specific sexual practices (e.g., anal vs vaginal intercourse), prior HSV-1 infection, age, duration of infection, antiviral therapy, hormonal status, and co-infection with HIV (high consensus, high priority).
Because of probable effects of chronic HSV-1 infection on HSV-2 transmission efficiency, it was recommended that the existing NHANES-III data on HSV-1 seroprevalence be analyzed and compared with data from NHANES-II and other available data bases (high consensus, high priority).

Studies should be undertaken or supported by CDC to determine the efficacy of male and female condoms in preventing genital herpes (consensus high, priority high); studies of use-effectiveness also are desirable, but with low priority because of uncertainties about the ability to design and conduct the necessary research .

It was recommended that CDC undertake or support demonstration projects among adolescents and other low prevalence/high incidence populations to assess the efficacy of male and female condoms, antiviral chemotherapy, partner communication/negotiation, and other strategies to prevent sexual transmission of HSV (consensus high, priority high).

B. Behavior change and professional education

A national campaign to enhance awareness of genital herpes, integrated with more general STD-prevention campaigns and messages, should be undertaken (consensus high, priority high).

CDC should support or conduct operational research in various populations on ways to communicate complex prevention messages to populations, including symptom recognition, abstinence during symptoms, and the threshold of symptom recognition and health care-seeking behavior (consensus high, priority not stated).

The most effective model(s) for testing persons at risk for HSV antibody and counseling them about their HSV serostatus is unknown, and undoubtedly will vary with symptoms, socioeconomic status, literacy, and other factors. It was recommended that these issues, and the clinician’s roles in implementation, be addressed in a demonstration project supported or conducted by CDC (high consensus, high priority).

CDC should undertake or support operational and behavioral research on the acceptability of using antiviral chemotherapy in infected persons to prevent transmission, including assessment of therapeutic compliance and effects on sexual behavior and practices (consensus high, priority high).

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