I'm not trying to come off as an a-hole but:
Married couples take extra precautions. When you're married, it's easier to plan when to have sex. When you're single, you may be a little more reckless. On top of that, the studies of married couples is much more recent. Maybe 15% of that 25 may have gotten it a long time ago before there was such good medication.
1. I think that US stats refer to 25% having HSV2, and that another 10% has genital HSV1. It's a different picture in Europe ( and also in some parts of the US ) where HSV1 is responsible for more than half of genital cases.
2. Exposure to HSV1 is likely to be universal, with reaction depending on the individual's immune response. HSV2 probably works the same way.
3. In my opinion, this is supposition. In non-compatible couples, infection is infrequent because the infected partner knows how to deal with their disease. The vast majority of genital herpes sufferers are unaware of their condition. This is the main reason for rising infection rates. Shedding is however a great selling point for those ridiculously expensive drugs..
4. Medication is not a vaccine. It may help reduce transmission, but does not prevent it. Judging by the number of posts by married men worried about transmission after an encounter with a sex worker, I'd say being married has little to do with it. Also, I've been reading a report on HSV2 infection rate amongst monogomous Cosa Rican woman : 39.4% !! The publishers claim this is a direct result of the male population's sexual behaviour.
These stats are consistent to me. Like ali-jay said, the majority of people (90%) with herpes are walking around completely unaware that they have it. That means when they are having an "outbreak," they don't know it is herpes. They think it is jock itch, an ingrown hair, a shaving burn, a paper cut (although how in the hell you'd get a paper cut on your genitals is anybody's guess), or irritation from soap, shampoo, or clothes detergent.
Now given how mild the above scenarios would be to many people experiencing them, how many do you think are having sex while having their "irritation, jock itch, or ingrown hairs?" Plenty. That means they are unknowingly putting their partners at risk for herpes.
I am in the minority here, but I remain unconvinced that viral "shedding" accounts for the majority of cases of genital herpes. Amounts of viral particles in open outbreaks must be much larger than those found on the surface of the skin through shedding. So the significant statistic here remains the incredibly high numbers of people who don't know they have herpes and are likely passing it on during their very subtle and not-very-inconvenient symptoms. I'm sure I'll be slammed for this opinion, though, because the "shedding theory" remains the accepted dogma in transmission discussions.
And like the first poster said, a herpes-positive person in a monogamous couple is more likely to know when they are having outbreaks and can refrain from sex at that time with their primary partner, thus decreasing the risk of infecting the partner.
Also, in the Uk at least, you can go for what you believe is a full STD check-up free with the NHS, but nobody tells you this doesnt include herpes. So you can beleive and tell people you dont have anything not realising you can still have this. My firends were all very shocked to hear this.
If you read my post earlier in the day you will see I completely agree with you. I don't believe they add up to 25% infection rate.
Here's the abstract from an article published in New England Medical Journal. You have to subscribe to read the full text, but you'll already get the picture from the following quote :
Underdiagnosis of genital herpes by current clinical and viral-isolation procedures
LA Koutsky, CE Stevens, KK Holmes, RL Ashley, NB Kiviat, CW Critchlow, and L Corey
BACKGROUND. The current clinical strategy for diagnosing genital herpes simplex virus (HSV) infection in women relies on clinical findings plus the selective use of viral culture. The effectiveness of this approach for identifying women with genital herpes is unknown. METHODS. We performed physical examinations, colposcopy, Pap smears, viral cultures, and HSV type-specific serologic assays of 779 randomly selected women attending a sexually transmitted disease clinic. RESULTS. Evidence of HSV type 2 infection was detected in 363 women (47 percent), and 9 others (1 percent) had positive cultures indicative of urogenital or anal infection with HSV type 1. Of these 372 women, only 82 (22 percent) had symptoms. Fourteen women (4 percent) had viral shedding without symptoms, 60 (16 percent) had formerly had symptomatic episodes, and 216 (58 percent) had antibodies to HSV-2 with neither viral shedding nor a history of clinical episodes. Characteristic ulcerations of the external genitalia were present in only two thirds of the 66 women with positive HSV cultures; the others had atypical genital lesions or asymptomatic viral shedding. Isolation of HSV from a genitourinary tract specimen was the most sensitive (77 percent) test for confirming a first episode of infection. The detection of HSV-2-specific antibodies was the most sensitive (97 percent) way to confirm symptomatic reactivations of HSV-2 infection. HSV-2 serologic testing also identified the 290 women with asymptomatic HSV-2 infections (37 percent), including 14 (5 percent) who were shedding virus asymptomatically on the day of the examination. CONCLUSIONS. The current strategy for diagnosing genital HSV infection in women misses many cases. Newly developed type-specific serologic methods can identify women with recurrent genital HSV-2 infection, as well as those with unrecognized or subclinical infection.
Department of Epidemiology, School of Public Health, University of Washington, Seattle.
58% of the randomly selected female STD clinic visitors who had HSV2 antibodies neither presented symptoms, nor asymptomatic shedding ! 47% of all the women tested had HSV2 antibodies ! Gosh ! so HSV2 must be pretty contageous, as well as pretty common...
1. ~25% of adults have some form of genital herpes (typically type II).
this stat only applies to hsv2. Throw hsv1 genitally into the mix and it's around 1 out of every 2 1/2 adults in the US has genital herpes of one sort or another. In the under 30 age group hsv1 accounts for 60% of all new herpes infections. Overall it's responsible for 30% of all NEW herpes infections ( hsv2 is still the #1 cause of all recurrences ) when you take into account all ages.
2. Among monogamous couples in which one person is HSV-positive, no protection is used, and they have sex 2-3 times per week that the probability of transmission over the course of a year is ~5%.
It's probably more accurate to break this down into gender. It's a 8-10% risk for females and 4% risk for males in a discordant relationship. I think seperating it for gender helps show just how more likely we females are to contract hsv2 since we have a larger area of non-keratinized skin in our genital area than your fellows do. If you are a female of child bearing age - you probably want to be a little more aggressive about protecting yourself - yes the chances of transmitting the virus to your child during delivery/pregnancy are very, very low but it's pretty tragic when it does happen so if you can avoid it - even better.
3. That HSV is typically transmitted when symptoms are absent.
In light of 2 & 3 I just don't understand how the rate of infection in the general population can be as high as 25%. Do these statistics strike anyone else as inconsistent?
I don't have the study name handy at the moment but in 1 shedding study where they measured not only the presence of hsv2 with swabbing but also looked at the amount of hsv2 detected - with and without obvious lesions - they were about the same. I know it seems only logical that an active lesion would be chock full of active virus but also just active shedding is a lot of virus too. I've done a shedding study myself - the first day I felt only itching but I knew it was hsv since I"ve had it for 21 years . it wasn't until the next day that I had an obvious lesion present. I was shedding the same amount of virus on both days. So if you aren't as in tune with your body as I am - you would think dang this itch and probably still have sex so yes you would be exposed to just as much virus as if you had had sex when the obvious lesion was present.
As was already touched on - if you don't know you are infected you are far more likely to be sexually active when you have mild symptoms. Just avoiding sex during obvious symptoms does go a long way in reducing the chances of contracting the virus from a partner. It's not 100% guaranteed obviously but it does help. Think of it as when you just turn off the burner on the stove - you don't touch it right then because you know you are going to get burnt. Walk into the kitchen and just randomly put your hand on the burner you may or may not get burned since you have no idea what the person in there before you was doing. Common sense tells you not to touch a hot burner because it could make you ill. Same thing with herpes - active symptoms means active virus present - no guessing about it. In between active symptoms it's a **** shoot. The virus is not always active just like there's not always someone in the kitchen using the stove. Hope that makes sense - I might be more tired than I think I am ;)
Also it has little to do with monogamy - it has to do with knowing your status. Unfortunately even medical professionals still don't test enough for herpes so that folks are aware of their status. Most clinics do not offer it as part of routine std testing but they neglect to tell their patients that. I'm sure the majority of us when we ask to be tested for std's - think we are getting the whole shebang including herpes so when you don't hear back from the clinic or get the phone call saying all is well you just assume that that means for everything. The reality is you usually only get tested for gonorrhea, syphillis, chlamydia and sometimes hiv. Leaves hepatitis, herpes and hpv out of the picture completely but too many times you are not told that. Also many women aren't properly educated on what a pap test is all about and assume that if you get one every year and it's negative that you are in the clear for all std's but a pap test doesn't routinely test for std's. Even the newest ones that do - it won't detect herpes unless you are actively shedding the virus at that time from your cervix which the chances of you shedding on that 1 day of the year you are seen are pretty slim when you do the math.
Also unfortunately many medical professionals still believe that unless you have obvious "classic" blister like lesions present that even a blind man could tell was herpes - they don't consider it as part of the diagnosis. If you are female especially - you could be misdiagnosed with uti's and never tested for herpes. Same goes with if you are someone who's never had anal sex you'd never think herpes as a cause of anal pain so you'd assume hemorrhoids. If you only get symptoms 2 or 3 times a year you and your doctor might never even think to test for herpes. Be in a long term monogamous relationship - be it married or other and they even less likely to test for herpes. Many medical professionals think ignorance is bliss in situations like that. Considering the stats on infidelity - it's well worth ruling it out periodically no matter what.
Anyways obviously I'm on my soapbox about this but believe the stats - they have been confirmed by multiple studies from the NHANES studies every 4 years to other studies in between. It's not something to be scared about it - it's something to be informed about so you can take precautions.
Are Herpes symptoms only found on the genital region? I have read that some people don't have symptoms ever on genitals but may have back pain or nerve pain. Is that true?