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Genital Herpes Infection -- United States, 1966-1984

Genital herpes infection remains a major public health problem in the United States. Data collected by the National Disease and Therapeutic Index (NDTI) from 1966 to 1981 showed marked increases in the numbers of patient consultations for genital herpes (1,2). Current analysis shows continued upward trends in symptomatic genital herpes infections among private patients in the United States.

The NDTI survey is a national stratified random sample of data from private practitioners' office-based practices in the contiguous United States (3). This survey is a continuing compilation of statistical information about patterns and treatments of various diseases and represents a sample of patient-physician interactions. Included in the data coded are: (1) "consultations" about genital herpes between patients and physicians, including office visits, house calls, telephone calls, and hospital visits; (2) "office visits," referring to initial or repeat visits for genital herpes; and (3) "first office visits," coded if the patient presents to a physician participating in the survey for the first time with genital herpes. No laboratory confirmation of the physicians' diagnoses is included in the survey.

The estimated number of physician-patient consultations for genital herpes increased 15-fold between 1966 and 1984, from 29,560 to 450,570 (Figure 2). Office visits accounted for 79% of these consultations. Also, first office visits--a more likely indicator of newly acquired infection--increased nearly ninefold, from 17,810 in 1966 to 156,720 in 1984. Although a decline in consultations, office visits, and first office visits was evident from 1978 to 1980, the upward trends remain statistically significant for all three types of physician-patient interaction (p 0.004).

The number of first office visits for genital herpes was approximately the same for both men and women. However, over the 19-year span, women made more total office visits for genital herpes than did men. In each of three time periods--1966-1972, 1973-1978, and 1979-1984--the number of consultations increased for men and women in each age group, except for men 40-44 years of age (Figure 3). Adults 20-29 years of age continued to account for the largest proportion of consultations in all age groups in each period.

Genital herpes infections increased uniformly in all regions of the country. The specialists most likely to see patients with genital herpes over the 19-year span were obstetricians-gynecologists (36% of total), general practitioners (19%), dermatologists (13%), internists (12%), and urologists (5%). Office visits to all other types of specialists accounted for the remaining 15%. Reported by Div of Sexually Transmitted Diseases, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The trends in symptomatic genital herpes infection reported here are comparable to data reported from a population-based study in Rochester, Minnesota, where investigators found a consistent annual increase in the incidence of genital herpes from 1965 to 1979 (4). The Rochester study also showed a similar age distribution for patients with symptomatic genital herpes infections, as in this report.

These data do not show the actual number of genital herpes cases in the United States. Patients with genital herpes may seek care in public health-care facilities and from other private ambulatory-care providers. Therefore, the total number of visits are minimum estimates. However, the data are useful in describing trends in health-care seeking for genital herpes by private patients over the 19-year period.

At least five other factors may have affected the trends in genital herpes measured by the NDTI:

  1. Recent media attention--especially since 1982--may have increased both physicians' and patients' awareness of the signs and symptoms of genital herpes, thus increasing the numbers of patients seen in recent years.

  2. A patient seen by a surveyed physician for the first time for genital herpes may not actually represent a newly diagnosed case.

  3. Asymptomatic infections are increasingly recognized to be common and would not be represented in the survey (5,6).

  4. Many of those with symptomatic genital herpes may not seek medical attention at all.

  5. The licensing of topical acyclovir by the U.S. Food and Drug Administration in 1982 for treatment of genital herpes may account for some increase in numbers of patients seen in the most recent years of this survey. Despite these caveats, upward trends of genital herpes among

private patients probably reflect a true increase in the numbers of cases of this sexually transmitted disease nationwide.

References

  1. CDC. Genital herpes infection--United States, 1966-1979. MMWR 1982;31:137-9.

  2. Becker TM, Blount JH, Guinan ME. Genital herpes infections in private practice in the United States, 1966 to 1981. JAMA 1985;253:1601-3.

  3. Coding manual and descriptive information for the national disease and therapeutic index diagnosis volume. Rockville, Maryland: IMS America Ltd., 1984.

  4. Chuang TY, Su WPD, Perry HO, Ilstrup DM, Kurland LT. Incidence and trend of herpes progenitalis: a 15-year population study. Mayo Clin Proc 1983;58:436-41.

  5. Mertz GJ, Schmidt O, Jourden JL, et al. Frequency of acquisition of first-episode genital infection with herpes simplex virus from symptomatic and asymptomatic source contacts. Sex Transm Dis 1985;12:33-9.

  6. Rooney JF, Felser JM, Ostrove JM, Straus SE. Acquisition of genital herpes from an asymptomatic sexual partner. N Engl J Med 1986;314:1561-4.

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