Herpes rates are high among affluent populations

Researchers say significant prevalence in people often perceived as low-risk should raise physicians' index of suspicion.

By Victoria Stagg Elliott, AMNews staff. Sept. 1, 2003.

More than a quarter of patients presenting at primary care offices in affluent areas test positive for the virus that causes genital herpes. This rate jumps to nearly a third among patients in their 40s, according to a study presented at the International Society for Sexually Transmitted Diseases Research 15th Biennial Congress in Ottawa in July.

"It certainly breaks the stereotype that sexually transmitted disease only affects certain populations with low incomes, risky behaviors, drug use or lack of education," said Douglas Fleming, MD, lead study author and assistant professor in the Dept. of Medicine at the Robert Wood Johnson Medical School in New Brunswick, N.J.

Public health agencies have long acknowledged that herpes prevalence is high. Widespread screening, however, has never been recommended because the cost-benefit ratio has never favored this kind of strategy. Also, until a few years ago, doctors had little to offer patients who tested positive and, for many, the course of the disease is fairly benign.

The paper's authors say, however, that this research indicates a need for physicians to have an increased index of suspicion for the infection because, while the virus prevalence is high, the diagnosis rate is low -- only 4%.

"The fact that our study picked up a high prevalence does not mean that screening is for everyone," said Dr. Fleming. "At this point, our main concern is raising awareness."

And affluent, well-educated, white patients are at just as much risk for genital herpes as those presenting at an STD clinic.