The Straight Dope on Herpes Statistics

On April 3, 2014, in Blog, Education, by Admin

businesspsdicon8If you try to look up herpes statistics on the Internet, you may well come to one of two conclusions: either nobody knows what the hell they’re talking about, or nobody really knows how many people actually have herpes.

Herpes statistics abound and nearly all of them are untrue.  Not because the science is faulty, but because the people communicating the statistics are not communicating them properly.  They keep attempting to apply other people’s statistics to their own idea of what “herpes” is.

Statistics can be pretty confusing – especially herpes statistics.  Why?  Mainly because they all include the term “have herpes”, while they’re all talking about completely different things.  Yet, whoever cites them remains utterly convinced that they are armed with the truth, that they know what they’re talking about and that communicating the finer details doesn’t matter.  However, it actually does.  A lot.  Let’s go through a few of the more popular examples:

1 in 4 people have herpes

Well, that’s all kinds of wrong.  But the main problem is that statistic is a from 30 years ago.  (it all also doesn’t address all herpes; just one type in one location).

Another:

1 in 5 people have herpes

Wrong.  Why?  Because 100% of people “have herpes”.  There are 8 species of human herpesvirus (9 if you include HHV6b, which became official in 2011).  Virtually all humans have at least a few herpesviruses; most of us have a handful of them.  Herpesviruses are endemic to humans: they’re as normal as eyelashes.

Let’s try another.

1 in 6 (16.2%) people have herpes

Wrong again.  It’s more specific, but it’s wrong for the same reasons.  Which herpes?

Another:

1 in 6 (16.2%) Americans aged 14-49 have Genital Herpes

Wow.  That’s specific.  It’s even the one people cite from the CDC.  It’s also dead wrong.  

What??  Yeah.  Totally wrong.  How do we know?  Because they got the statistic from the National Health & Nutrition Information Survey (NHANES), and the NHANES determined the number via HSV antibody blood tests.  A blood test can determine HSV type, but using a blood test to determine HSV location is utterly impossible.

So, you simply cannot measure “Genital Herpes” prevalence via blood testing; such a test can only determine that the Herpes Simplex Virus is present, in some nerve, somewhere in your body.

Want to see the most correct CDC statistic?

1 in 6 (16.2%) of Americans aged 14–49 carry HSV-2

Now that one is fairly accurate.*  What the CDC should have done – at a bare minimum – is explained to the lay reader how the determination was made and explain the limitations: that most, but not all HSV-2 infections are genital and that exact location can’t be determined by such testing.   So, they were making an assumption by transferring the number for HSV-2 seroprevalence to “Genital Herpes”.

[In all fairness, In the past 6 months, they actually have begun editing their website to make much of this more clear.  Even prior to that, if you really dug into the fine print, the CDC did explain how the numbers were derived, but they didn’t explain that HSV-1 causes genital herpes, too, or that not all HSV-2 is genital.   They still don’t explain the latter.  The public doesn’t dig that deep, though; they just read the main statistic and run around repeating it without understanding or supplying the parameters.  It’s more accurate to say that the CDC didn’t remind the audience not to ignore the details and add in a few limitations.]

However, believe it or not, that CDC statistic would still be wrong in regard to Genital Herpes.  Why?  That reason is simple: HSV-2 isn’t the only thing that causes Genital Herpes.  

What wasn’t widely known a few decades ago, but is widely known now – by researchers, but not the public –  is that HSV-1 is equally capable of causing Genital Herpes, which renders the CDC’s original 16.2% (1 in 6) statistic pretty much useless.  (The CDC, of course, knows this.  They’re just trying to figure out what, exactly, to do about it.  They also need to plan out what (and how) to test on the next NHANES in order to compile some accurate national statistics.)

Within the past year, even the CDC has added a note on its Genital Herpes page explaining that:

“The overall prevalence of genital herpes is likely higher than 16.2%, because an increasing number of genital herpes infections are caused by HSV-1. Increases in genital HSV-1 infections have been found in patient populations worldwide.”

They just haven’t changed their 16.2% statistics yet, as no national Genital HSV-1 numbers are actually available.  Not yet, anyway.  So, their HSV-2 and genital herpes statistics still match, when it’s impossible for them to actually do so.  Government wheels turn slowly.

It’s also worth mentioning that Oral HSV and HSV-1 are all but nonexistent on the CDC site.

So how many people really do have Genital Herpes?

The only correct answer is, “we don’t know”.  We do know it’s a lot more than 16.2%.  For example, the University of Wisconsin did a 9-year study which ended in 2003 that showed that during those 9 years, 78% of the new genital herpes infections which came through their clinic were HSV-1, not HSV-2.   Another research project in Nova Scotia, Canada revealed that, of women under age 30 who had genital herpes, 73.7% were due to HSV-1.  Various other studies have shown that HSV-1 was responsible for at least 50% of new genital herpes infections.  However, the CDC gets their information from the National Health and Nutrition Examination Survey (NHANES) and the NHANES only does blood tests to determine the prevalence of HSV-1 and HSV-2.  It has never determined where on the body those infections actually were.

A blood test can tell you, for the most part*, who carries a virus.  However, it cannot tell you where that virus is, so you can’t call that “genital” or any other location with any level of certainty.  And, since herpes is a neural infection contained within specific nerves – not the entire body – blood tests alone simply cannot determine genital herpes prevalence.  No two ways about that.   It just can’t.  Blood tests look for antibodies in the blood, not the disease itself.  Certainly not the location.

It’s fair to say that the vast majority of HSV-2 cases are genital.  It’d be very difficult, however, to determine any statistic to indicate what percentage of those cases are genital.  And to be honest, it really doesn’t matter.  What really matters is not so much where people carry HSV or which type.  Let’s look at the big picture in regard to HSV prevalence.

75%-80% of Americans carry at least one Herpes Simplex Virus (Type 1 or 2)

According to the body of scientific research, this is the current estimate for overall HSV prevalence.  It’s also the statistic upon which people should focus when discussing HSV; the one they should be communicating.  Why?  Because that is a far more realistic percentage of the people who could transmit HSV to someone’s mouth or genitals (or elsewhere); the real “risk pool”.  We know this because more and more, people are transmitting their seemingly harmless ‘cold sores’ to their partner’s genitals via oral sex.  Considering the number of new genital herpes cases above, it really doesn’t matter much anymore where your HSV is is or what type, does it?  The potential impact on the partner is the same.  Anyone with HSV of either type – anywhere on their body – can transmit their HSV to any part of their partner’s body, as long as those two body parts make contact.

This transmission isn’t guaranteed, of course.  As an example, research has shown that the average number of sexual intercourse encounters between discordant partners (one has HSV, the other does not) is about two dozen before HSV transmission occurs genitally.  Why is this?  Because your HSV doesn’t technically reside right at the skin’s surface; it resides within the nerve and only sometimes is available at the skin’s surface for transmission.  This transmission can occur with or without sores (outbreaks), but during an outbreak there is far more virus available for transmission.   So it is, as the doctor says, best to “avoid sex during outbreaks”.  You can still transmit it at other times, though.  Just not as likely.  And considering the prevalence of HSV, any of us could acquire it from just about anyone; it’s merely a matter of time.  Most of use already have; we just don’t know it.

So how do we keep people from getting HSV?  You can’t, no matter what you do.  Due to human contact, human beings acquire HSV.  That’s part of being human.  You can take steps to reduce the risk, but ultimately, nearly everyone acquires some type, somewhere, from someone.  So what’s the good news?  The good news is…

Over 80% of human beings tolerate HSV just fine.

They don’t even notice anything sufficient enough to alert them to see a doctor.

Never, ever make the mistake of assuming that your partner will experience the symptoms that you do.  The fact is, 8 out of 10 people would not.  This is the case with most other human herpesviruses, too: among nearly all of them, less than 20% who acquire a herpesvirus experience much of anything.  VZV is the main exception; most people do get chickenpox when they first acquire VZV, but in regard to recurrence – reactivation –  only a minority have that viral recurrence and experience “Shingles.”

Back to Herpes Simplex, there are those who do know exactly which type of HSV they have and exactly where they are infected.   However, if you do, you should not be self-centered in your statistics.  Do not be so focused upon yourself, your virus type and your location that you are not communicating the ‘big picture’ to others, as you will ultimately be miseducating them to a spectacular degree.  The truth is, around 75% of us carry HSV and 75% of us could give someone HSV, potentially causing genital herpes, cold sores, or some other location.  That is what you, a partner and the general public truly need to know.  Armed with that critical information, they can make educated, adult decisions in regard to taking the risks associated with human contact with you or with anyone else.

And now, for a truly accurate statistic:

Around 75% of Americans carry HSV 1 or HSV 2 somewhere on their body.  That virus can (but may not) be transmitted to any surface of someone else’s body, via physical contact.  If it does transmit, there’s an ~80% chance that they won’t recognize any symptoms from the infection.  However they, too, will retain the virus for life and be contagious.

Feel free to quote us on that.

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*Serology (blood) testing does not catch every HSV infection every time; serology testing catches most HSV infections most of the time.

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  • Jessica

    Interesting. Although for those of us not as familiar with the different types, there is some reading between the lines to figure it out. I’ve never had a problem with cold sores, fever blisters or had any signs of anything awry genitally but I did get the chickenpox as a kid and was diagnosed before with herpes keratosis (a strain of herpes in my eye.) They gave me acyclovir pills (sp?) and I tell you what sometimes I think I need to take that even if my eye doesn’t act up. If my body starts to feel extremely bloated and swollen and my energy drains suddenly and my head starts hurting, I feel flu like and my scalp starts being kinda weird tingly, I take one of those pills and it seems to fix it. I’m out of them now and don’t really know how to ask the doc for more, but I’m glad to see that this topic is becoming more socially acceptable to talk about. It does live in your body (how else did it get in my eye!?). I hope your next article focuses on the chicken pox vaccine for kids and if kids are still susceptible to any of the HSV’s after the vaccine.

  • Christian_XF

    Yes, the herpes keratosis is an infection in the eye from herpes, but isn’t specific to any type or species. You’d have to get it type-tested. Theoretically, it may not even be Herpes Simplex – it could be another type of herpesvirus – but most cases are HSV-1, a few are HSV-2; other species would be random exceptions.

    You could, if you like, go ask for a Type-Specific IgG HSV test and find out. Sometime around the time you get those symptoms would be best, as it indicates that the virus is active, so your antibody count would be higher and more readable by the test.

    i can tell you now that the chickenpox vaccine doesn’t stop other herpesviruses; it only works on the varicella zoster virus which causes chickenpox. Same goes for the 2nd vaccine later in life, for shingles (the recurrence of that same virus).

    We’ll do an article explaining that further, with a family tree of herpesviruses. It’s important to know that not all of them are so closely related genetically; they merely behave in a similar fashion. This is why they are classified together.

  • Pingback: Herpes: You Probably Already Have It, and It’s No Big Deal – ANNA Magazine, LLC()

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