The Department of Health and Human Services (HHS) recently updated the National Sexually Transmitted Infection Strategic Plan for the United States: 2021–2025 to include an add-on for herpes (HSV). HSV is widespread in the United States. An estimated 18.5 million adults are infected with HSV-2, which mainly causes genital herpes. It is also estimated that 48% of people aged 14 to 49 have HSV-1 which can cause either oral or genital herpes.
The STD Plan, first released in 2020, sets out a roadmap for the prevention and control of four of the most common STDs: chlamydia, gonorrhea, syphilis and human papillomavirus (HPV). HSV was not initially included. In 2022, Congress directed HHS to modify the plan to address herpes prevention and treatment.
There are many challenges that come with HSV prevention and treatment.
- It is highly contagious and already widespread. Herpes is spread by skin-to-skin contact. Anyone who has oral, anal, or vaginal sex can get HSV-1 or HSV-2.
- It is a lifelong condition. There are treatments for herpes, but there is no cure. For most people the symptoms of herpes are very mild. Some people will experience sores only once, while others will have “breakouts” throughout their lives.
- It can be difficult to know if/when you are contagious. People with herpes are more contagious when there are sores. However, not all sores are visible, and some can be mistaken for other skin problems, such as an ingrown hair. People with HSV may also experience ‘asymptomatic shedding’. This happens when the virus cells are in their skin, but they have no symptoms. HSV is contagious during this time.
- There are few prevention methods for sexually active people. There is no vaccine for HSV and no biomedical methods like Doxy PEP for bacterial STDs or PREP for HIV. Condoms are an effective tool for preventing the transmission of genital herpes, but herpes sores can appear in areas not covered by a condom, such as on a person’s scrotum or butt. Condoms may also not cover areas affected by asymptomatic shedding.
- Routine testing for HSV is not recommended. Herpes is easy to diagnose during an outbreak. Health care providers can dip the lesions and tests can determine whether the sores are caused by HSV-1 or HSV-2. Control when there are no wounds is more complicated. There are blood tests that can look for the antibodies your immune system makes when exposed to HSV, but these tests aren’t very accurate. Because of these testing challenges, the United States Preventive Services Task Force does not recommend widespread testing for herpes. Instead, the Task Force recommends that people get tested if they have possible symptoms or have reason to believe they have been exposed.
- Many people with HSV do not use medications to suppress outbreaks. Antiretroviral drugs can suppress the virus. This can reduce the number of outbreaks someone has and the severity of symptoms. It can also reduce asymptomatic shedding and the risk of transmission. In one study, however, only 29% of HSV patients reported taking this drug. Most people did not believe their cases were severe or frequent enough to require treatment.
- There is a lot of stigma surrounding HSV. HSV is a lifelong condition caused by sexual activity. Unfortunately, some people still believe that having an STD, especially herpes, is a sign of promiscuous or irresponsible behavior. Herpes sores are still seen by some as a sign of being “dirty”. People diagnosed with genital herpes often experience anxiety, depression and low self-esteem. They may worry about rejection by their current or future sexual partners. Health care providers are often not as sensitive to these fears as they should be.
THE HSV suffix incorporates the latest science in the diagnosis, prevention, care and treatment of HSV into the STD Plan in hopes of overcoming these challenges.
It also prioritizes federal action steps in each of these areas and identifies the agencies responsible for each. These action steps are integrated into the five goals of the STI plan, which include preventing new infections, reducing negative outcomes of STIs, accelerating STI research and innovation, reducing STI-related health disparities, and coordinating efforts to address the STD epidemic.
