BERKELEY, CA (UroToday Inc.) - Genital herpes is a sexually transmitted disease that is associated with substantial psychosexual and physical morbidity, including genital and extragenital lesions. The psychosocial impact on those infected with genital herpes can lead to feelings of shame, depression and fear of transmission to partners. The infection is commonly unrecognized, and 70% of transmission may result from sexual contact during periods of asymptomatic viral shedding. To reduce transmission within couples, risk behaviors associated with transmission of HSV-2 need to be identified so that preventative educational can be designed and implemented.

The objective of a recent cross-sectional study performed by the multinational Valacyclovir HSV transmission substudy group headed by R. K. Rana was to examine demographic, behavioral, and knowledge factors associated with HSV-2 seropositivity among males whose current female partners have confirmed genital herpes. The study was published in the May, 2005 issue of Sexually Transmitted Diseases.

The study group was comprised of 717 men who denied a history of genital herpes themselves and were engaged in a heterosexual, monogamous relationship with a partner who had self-identified symptomatic, recurrent genital herpes. The genital herpes of the partner was confirmed by laboratory analysis. The men were given self-completed questionnaires that were organized into three main sections detailing demographic characteristics, behaviors and knowledge about and awareness of genital herpes.

Results showed that of the 717 men, 179 (25%) were HSV-2 seropositive and were unaware of their infection. Demographic characteristics showed a mean age of 38 years. Almost 90% of participants were white (6% Hispanic, 5% black and 1% other). The population was relatively well educated with greater than one-half having had college or university experience and over 80% were in paid employment.

Results regarding sexual habits revealed that the median length of the partnership was 5 years in seropositive men and only 2.3 years in uninfected men, and for each additional year in the partnership, there was a 5% increase in the odds of infection. Those with a prior history of another STD had double the odds of being infected with HSV-2 (32% vs. 18%). Reported condom use was lower among infected men compared with those uninfected. This resulted in almost a 50% decrease in odds of HSV-2 infection. There was a distinct reduction in the rates of men engaging in vaginal, oral and anal intercourse during times of active genital outbreaks, and men who did not change their sexual practices during these times had a significantly increased risk of seropositivity.

As far as knowledge of the disease, over 90% were aware that genital herpes was an STD, but fewer understood that transmission was still possible after a lesion had completely healed (69%) and that genital herpes was infectious between outbreaks (60%). Most knew that genital herpes was incurable (57%) although a significantly higher proportion of uninfected men compared to infected men agreed with this statement. The mean knowledge score was lower among infected men compared to those that were uninfected.

In conclusion, the study results show that there are clearly some modifiable elevated risk factors for HSV-2 infections including engaging in vaginal sex during symptomatic episodes, never using condoms and lower knowledge of genital herpes. Education about the disease must clearly include discussion on these aspects of disease transmission if we are to reduce the risk of HSV-2 infection.

Sex Transm Dis. 2005 May; 32(5):308-313