The findings are published in the July 21 online edition of BMJ. Health officials in the United States have been urging vaccination of young women and girls.

The researchers estimate that the virus causes an estimated 500,000 cases of cervical cancer in women each year around the world. The virus can also cause warts in the genital area and low-grade cervical growths. Those two conditions are thought to strike 30 million people annually.

In the just-released randomized control trial, researchers studied 17,622 women in 24 countries and territories who had been assigned to take the vaccine or a placebo over a six-month period. The women were aged 16 to 26.

Joakim Dillner, of the department of medical microbiology, Lund University, Malmo University in Sweden, and colleagues found that the vaccine provided significant protection against the warts and tumors in susceptible women. For example, 168 of 7,632 women who took the placebo developed cervical growths attributed to HPV strains, while just seven of the 7,629 who took the vaccine did, they noted.

In the big picture, the study authors wrote, the vaccine “provided strong and sustained protection” for four years against various types of warts and low-grade female genital growths.

The study was funded by Merck Research Laboratories, a division of Merck & Company, maker of the HPV vaccine Gardasil.

Dr. Clyde Crumpacker, a professor of medicine at Harvard Medical School in Boston, said in an interview that the study is useful because it shows the vaccine can do more than prevent the virus from spreading.

“The vaccine has not yet been licensed for boys, but this study provides a strong case that boys should be vaccinated to prevent acquisition of HPV and prevent genital warts,” said Crumpacker.

Technorati Tags: Gardasil, Genital Warts, HPV Vaccine, human papillomavirus, prevent genital warts

The findings, from two studies in Uganda, suggest there may be additional benefits to offering circumcision to men in countries with high rates of heterosexual HIV transmission.

What the findings could mean for other countries, including the U.S., is less clear, researchers say.

In 2005 and 2006, three clinical trials in Uganda, South Africa and Kenya showed that circumcision can cut a man’s risk of HIV infection through heterosexual sex by up to 60 percent. Subsequent studies of those men also found a lower prevalence of HPV among those who were circumcised and HIV-negative.

But it hadn’t been clear whether that lower prevalence was specifically due to a lower risk of HPV infection. Nor has it been known whether circumcision affects HPV risk in HIV-positive men, according to Dr. Ronald H. Gray, a professor at Johns Hopkins University School of Public Health in Baltimore and the senior researcher on the Ugandan studies.

HPV is a highly common virus with more than 100 strains, some of which cause genital warts. While the immune system clears the infection in most people, persistent infection with certain HPV strains can lead to cancer. HPV is the primary cause of cervical cancer in women, and it can also lead to penile and anal cancers.

Gray noted that HPV-related cancers are a serious public health problem in sub-Saharan Africa — in contrast to developed countries, where, for example, women have access to regular Pap tests to detect cervical cancer early and, in recent years, HPV vaccination.

Moreover, people with HIV infection often have HPV infections as well, and are especially susceptible to developing HPV-related cancers, Gray said.

The current studies, published in the Journal of Infectious Diseases, found that circumcision appeared to lower the rate of infection with cancer-related HPVs in both HIV-negative and HIV-positive men — by 33 percent and 23 percent, respectively, compared with uncircumcised men.

The studies included 210 HIV-positive and 840 HIV-negative men between the ages of 15 and 49 who were randomly assigned to undergo immediate or delayed circumcision. At the outset, 39 percent of HIV-negative and roughly three-quarters of HIV-positive men carried at least one cancer-related strain of HPV.

Circumcision appeared to lower the men’s rates of new high-risk HPV infections, and, in HIV-negative men, it increased the rate at which their immune systems cleared established infections. Still, after two years, many circumcised men were still found to carry a cancer-related HPV: more than 20 percent of HIV-negative men and 55 percent of HIV-positive men.

However, Gray said, given the severity of the problem of HPV and HPV-related cancers in sub-Saharan Africa, “anything we can do to lower the risk is a good thing. It’s possible that circumcision would have benefits for preventing cancers in both men and women.”

The researchers are currently looking at whether circumcision has helped to lower HPV infection in the study participants’ female partners. Gray said that the preliminary results suggest benefits.

The World Health Organization (WHO) currently recommends medically supervised circumcision as one way to lower men’s risk of HIV in countries where heterosexual transmission is common — but in junction with other measures, including HIV education and access to condoms. The WHO also states that men in these countries who are already HIV-positive “should not be denied” circumcision unless there is a medical reason, Gray said.

But the public-health value of circumcision in other countries, including the U.S., is under debate. In the U.S., most HIV infections are related to homosexual sex or IV drug use, and studies have found no good evidence that circumcision lowers HIV transmission among men who have sex with men.

With HPV, in contrast, it’s estimated that most sexually active people in the U.S. will carry some strain of the virus at some point in their lives. However, any risk reduction from circumcision might have little public-health impact in the U.S. — where Pap screening for cervical cancer is routine, penile and anal cancers in men are uncommon, and HPV vaccination is available for girls and women.

The American Academy of Pediatrics does not recommend routine circumcision for newborns, citing insufficient evidence of overall health benefits. The U.S. Centers for Disease Control and Prevention, meanwhile, is currently developing recommendations on adult and infant circumcision for lowering HIV risk.

“My personal feeling,” Gray said, “is that we shouldn’t make any specific recommendations (on newborn circumcision). But we should inform parents of the potential benefits of circumcision.”

But even in countries where circumcision is recommended for HIV prevention, the procedure may have only “marginal” effects on the population prevalence of HPV, according to an editorial published with the studies.

The decrease in HPV prevalence related to circumcision was “significant but modest,” write Drs. Raphael V. Viscidi and Keerti V. Shah, also with Johns Hopkins.

In developed countries where the expensive HPV vaccines are available, the shots are the “preferred public health strategy” for preventing HPV-related diseases, according to the editorialists.

Viscidi has served as a paid consultant to GlaxoSmithKline, which makes Cervarix, one of the two HPV vaccines on the market. Shah has been a consultant to both GlaxoSmithKline and Merck, maker of the other HPV vaccine, Gardasil.

Circumcision is thought to lower the heterosexual transmission of HIV and other sexually transmitted diseases through several mechanisms. One is by reducing the amount of mucosal tissue exposed during sex, which limits the viruses’ access to the body cells they target. Another theory is that the thickened skin that forms around the circumcision scar helps block the viruses’ entry.

SOURCE: Journal of Infectious Diseases

Technorati Tags: Circumcision, genital wart virus, GlaxoSmithKline, HIV infection, human papilloma virus, preventing cancers

Black women had the highest rate of infection at 48 percent and women were nearly twice likely as men to be infected, according to an analysis by the U.S. Centers for Disease Control and Prevention.

About 21 percent of women were infected with genital herpes, compared to only 11.5 percent of men, while 39 percent of blacks were infected compared to about 12 percent for whites, the CDC said.

There is no cure for genital herpes, or herpes simplex virus type 2 (HSV-2), which can cause recurrent and painful genital sores and also increases the likelihood of acquiring and transmitting the AIDS virus. It is related to herpes simplex virus 1, or oral herpes, which causes cold sores.

Several drugs are available to treat herpes symptoms and outbreaks, including acyclovir, which is available generically or under the Zovirax brand name, and valacyclovir, known generically as Valtrex — both made by GlaxoSmithKline PLC. Ganciclovir, sold as Zirgan, is made by privately-held Sirion Therapeutics, Inc.

The CDC estimates that more than 80 percent of people with genital herpes do not know they are infected.

“The message is herpes is quite common. The symptoms can be often very innocuous,” Dr. John Douglas of the CDC said in a teleconference.

“Because herpes is so prevalent it becomes … a really important reason to use condoms on a consistent and correct basis with all of your partners,” Douglas said.

Douglas said the increased rate of infection in blacks women is not due to increased risk behavior.

“As with other STDs, biological factors may make women more susceptible to HSV-2 infection.

“Additionally, racial disparities in HSV-2 infection are likely perpetuated because of the higher prevalence of infection within African-American communities, placing African-Americans at greater risk of being exposed to herpes with any given sexual encounter,” the CDC said in a statement.

The CDC estimates that there are 19 million new sexually transmitted disease infections every year in the United States, costing the health care system about $16 billion annually.

Technorati Tags: genital herpes, herpes simplex virus, HSV-2 infection, U.S. herpes rates, Valtrex, Zovirax

The findings, presented at the 2010 National STD Prevention Conference, indicate that herpes remains one of the most common sexually transmitted diseases (STDs) in the United States.

The new estimate, for 2005-2008, comes from CDC’s National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the U.S. household population that assesses a broad range of health issues.

The findings suggest relatively stable HSV-2 prevalence since CDC’s last national estimate (17 percent for 1999-2004), because the slight decline in prevalence between the two time periods is not statistically significant.

The study finds that women and blacks were most likely to be infected. HSV-2 prevalence was nearly twice as high among women (20.9 percent) than men (11.5 percent), and was more than three times higher among blacks (39.2 percent) than whites (12.3 percent). The most affected group was black women, with a prevalence rate of 48 percent.

As with other STDs, biological factors may make women more susceptible to HSV-2 infection. Additionally, racial disparities in HSV-2 infection are likely perpetuated because of the higher prevalence of infection within African-American communities, placing African-Americans at greater risk of being exposed to herpes with any given sexual encounter.

“This study serves as a stark reminder that herpes remains a common and serious health threat in the United States. Everyone should be aware of the symptoms, risk factors, and steps that can be taken to prevent the spread of this lifelong and incurable infection,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “We are particularly concerned about persistent high rates of herpes among African-Americans, which is likely contributing to disproportionate rates of HIV in the black community.”

Research shows that people with herpes are two to three times more likely to acquire HIV, and that herpes can also make HIV-infected individuals more likely to transmit HIV to others. CDC estimates that over 80 percent of those with HSV-2 are unaware of their infection. Symptoms may be absent, mild, or mistaken for another condition. And people with HSV-2 can transmit the virus even when they have no visible sores or other symptoms.

“Many individuals are transmitting herpes to others without even knowing it,” said John M. Douglas, Jr., M.D., director of CDC’s Division of STD Prevention. “We can’t afford to be complacent about this disease. It is important that persons with symptoms suggestive of herpes – especially recurrent sores in the genital area – seek clinical care to determine if these symptoms may be due to herpes and might benefit from treatment.”

Combination of Prevention Approaches Needed to Reduce National Herpes Rates

Although HSV-2 infection is not curable, there are effective medications available to treat symptoms and prevent outbreaks. Those with known herpes infection should avoid sex when herpes symptoms or sores are present and understand that HSV-2 can still be transmitted when sores are not present. Effective strategies to reduce the risk of HSV-2 infection include abstaining from sexual contact, using condoms consistently and correctly, and limiting the number of sex partners.

CDC does not recommend HSV-2 screening for the general population. However, such testing may be useful for individuals who are unsure of their status and at high risk for the disease, including those with multiple sex partners, those who are HIV-positive, and gay and bisexual men.

Source:
Centers for Disease Control and Prevention

Technorati Tags: genital herpes, herpes, herpes infection, herpes simplex virus, women herpes

“While the HIV-disease ameliorating effect we have observed is modest, it could add one more tool to help people with HIV infection stay healthy for longer,” study co-author Dr. Jairam Lingappa, of the University of Washington, said in a news release from The Lancet.

The study, published online in the journal, analyzed what happened to almost 3,400 people in Africa who were infected with both diseases.

Half were assigned to take 400 milligrams of acyclovir twice a day, and the others took a placebo. Researchers tracked their progress for up to 24 months.

The risk of HIV progression was reduced by 16 percent in those who took acyclovir, the study found.

However, other research has suggested that acyclovir does not prevent transmission of HIV to heterosexual partners by people who take the drug, the scientists said.

The researchers said that other HIV drugs would have a greater impact on the progression of HIV in those who were infected. But , acyclovir could be an option for people who had not progressed far enough to need antiretroviral therapy, they said.

Technorati Tags: acyclovir, AIDS virus, antiretroviral therapy, Herpes Drug, herpes simplex virus, HIV, HIV drugs

As a matter of fact, even when it’s not causing an outbreak, the virus is shedding tiny bits of itself in the genital tract.

While the study did not specifically address whether or not the very small amounts of virus being continually shed are enough to infect someone else, the findings have the potential to change the way in which scientists view the life cycle of the disease.

The herpes virus is believed to hide out in the neurons around the spine during latent periods, then periodically travel down neurons that end in the genital tract, where it infects the skin cells, causing a lesion.

The accepted view is that the virus was largely inactive during latent periods, said study author Dr. Joshua Schiffer, a senior fellow at the University of Washington in Seattle.

“We’ve known for many years that herpes maintains a latent state in the nerves around the spinal cord. In effect, it hibernates there,” Schiffer said. “The older idea was that it didn’t do much while it was there … But what our model suggests is the virus is continually being released from the neurons.”

The study appears in the Nov. 18 issue of Science Translational Medicine.

The study looked at herpes simplex 2 virus, not herpes simplex 1 virus, which causes cold sores or fever blisters, though it can also cause genital lesions. Schiffer said he suspected the findings would hold true for herpes simplex 1 as well, though previous studies suggest herpes simplex 1 may shed less often.

Schiffer and his colleagues used data from two previous studies. In the first, participants swabbed their genitals every day during an outbreak and until their lesions went away. In the second, patients swabbed their genitals four times a day for 60 days, even when they were asymptomatic.

The data was then put into a mathematical model to determine the probable rate of shedding. According to the study, 85 percent of shedding episodes were asymptomatic, or did not cause a lesion. About 60 percent lasted less than 12 hours.

About 45 million Americans, or one in five over the age of 12, are infected with the genital herpes virus in the United States, according to the U.S. Centers for Disease Control and Prevention. But many of them aren’t aware they are infected because they’ve never had, or have never been aware of, their lesions. “Within their skin there is this constant battle going on within the virus and the immune system,” Schiffer explained.

Typically, patients are counseled to avoid having sex during an outbreak and to use a condom to prevent transmission when they are not having symptoms.

Antiviral drugs available, including acyclovir, valacyclovir and famciclovir, can control many, but not all, outbreaks, Schiffer said.

Nancy Sawtell, a researcher in the division of infectious diseases at Cincinnati Children’s Hospital Medical Center, said the study opens up new avenues for research. But it’s too soon to suggest that low levels of viral DNA necessarily mean a person can still infect another.

She noted that the researchers tested for viral DNA, which is only a portion of the virus and doesn’t in and of itself mean a person is infectious. “The presence of viral DNA does mean you are infected, but it doesn’t necessarily mean you have an infectious particle there,” Sawtell said.

Secondly, because the neurons themselves were not examined, it’s possible the viral DNA that’s present could have originated from somewhere else in the body. Previous animal studies have shown herpes does indeed go into an inactive state.

“It would be really nice to be able to look at the neurons in this human model to determine that the virus is coming from the spine, and wasn’t just present in the genitalia and missed by an earlier swab,” Sawtell said.

Couples trying to avoid infecting one partner should continue to take the same precautions they did prior to the study, including using condoms even when asymptomatic.

“I wouldn’t panic over it,” Sawtell said. “We have a lot to learn about how infectious these low levels of viral DNA actually are.”

Technorati Tags: acyclovir, antiviral drugs, famciclovir, genital herpes, herpes simplex 2 virus, herpes virus, valacyclovir

Acyclovir
The oldest antiviral medication for herpes is acyclovir. Acyclovir is available as a generic drug and is also sold under the brand name Zovirax®. It has been available since 1982 in a topical form (as an ointment) and sold since 1985 in pill form. Acyclovir has been shown to be safe in persons who have used it continuously (every day) for as long as 10 years. (Buy Acyclovir Zovirax online)

Valacyclovir
A newer drug, valacyclovir (brand name Valtrex®), actually uses acyclovir as its active ingredient. This medication delivers acyclovir more efficiently so that the body absorbs much of the drug, which has the advantage of taking the medication fewer times during the day. (Buy Valacyclovir Valtrex online)

Famciclovir
Famciclovir (brand name Famvir®) utilizes penciclovir as its active ingredient to stop HSV from replicating. Like valacyclovir, it is well absorbed, persists for a longer time in the body, and can be taken less frequently than acyclovir.

Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy. (Buy Famciclovir Famvir Online)

Episodic Therapy
In this approach, a person begins taking medication at the first sign of recurrence (or ideally at first signs of prodrome) and would continue for several days, in order to hasten the healing, or even prevent an outbreak from fully occurring. All three of the antiviral treatments mentioned above have been proven to help shorten the amount of time that a person may experience symptoms of herpes. However, keep in mind that results may vary from person to person.

Many people feel the advantages of using medication for recurrent episodes are marginal compared with use in a primary episode. But for others, episodic therapy offers a useful way to manage outbreaks by cutting the length of an outbreak by a day or two, on average. The benefits may be greater for those whose outbreaks tend to last longer.

Also, episodic therapy has its best results when treatment begins at the very first sign of prodrome. If lesions are already present, therapy may offer little benefit. Because the medications differ in their absorption rate and duration of effectiveness, dosages vary with episodic therapy treatment ranging from one to five pills every day for three to five days during an outbreak.

Suppressive Therapy
People with genital herpes who want to eliminate (suppress) outbreaks altogether can take antiviral medication daily to hold HSV in check so that it’s less likely to flare up and cause symptoms. For individuals who have frequent recurrences (six or more per year), studies have shown that suppressive therapy can reduce the number of outbreaks by at least 75% while the medication is being taken. Also, for some, taking an antiviral on a daily basis can prevent outbreaks altogether.

While antivirals can be successful in controlling herpes symptoms, researchers also have turned their attention to the important issue of antiviral therapy and asymptomatic shedding. Does suppressive therapy lower the risk of unrecognized herpes reactivation as well as curb recognized outbreaks? One study addressing this question found that women on suppressive acyclovir (400 mg, twice daily) had a 94% reduction in subclinical shedding while taking daily therapy. This type of study has also been done with famciclovir and valacyclovir, yielding similar reductions in both men and women.

Suppressive therapy has been studied in thousands of patients and it appears to be both safe and effective. Because the medications differ in their absorption rate and duration of effectiveness, dosages vary with suppressive therapy treatment ranging from one to two pills every day.

The poll included 503 U.S. adults with genital herpes and about 1,400 other adults who said they didn’t have genital herpes.

Participants answered questions about their relationships and views of genital herpes.

They ranked genital herpes second for social stigma, out of all sexually transmitted diseases (HIV took the top spot for STD stigma).

The poll also included a list of other potentially taboo topics, including HIV, gonorrhea, mental illness, obesity, substance abuse, and cancer.

Most participants — 64% of those without genital herpes and 56% of those with genital herpes — said they didn’t think any of those topics were taboo. However, genital herpes was the top-ranked “taboo” topic.

Among genital herpes patients, 39% said they were troubled by societal stigma about genital herpes. Far more genital herpes patients — 75% — were troubled by bothersome symptoms of genital herpes outbreaks.

Most people without genital herpes said they would avoid having a relationship with someone who has genital herpes and break up with a partner who had genital herpes.

Among people with genital herpes, 36% said they tell their partners about their genital herpes “well in advance of having sexual intercourse for the first time,” and 68% said they were concerned about transmitting genital herpes to their sexual partners.

But that doesn’t mean it’s easy for patients to talk to their partners about their genital herpes.

For instance, of the 325 genital herpes patients who reported having genital herpes outbreaks, 38% said they’d made up an excuse to avoid having sex during a genital herpes outbreak, instead of telling their partner about their outbreak.

Harris Interactive conducted the poll between Dec. 14, 2006, and Jan. 12, 2007. The poll was commissioned by the drug company Novartis.

SOURCE: Harris Interactive: “State of Genital Herpes 2007: Personal Story and Societal Stigma.”

Best medications for genital herpes treatment are Valtrex and Famvir.

Yes this is the reality. The disease is surprisingly common in the United States and beyond, and according to studies, as many as 50% of the adult population suffer from some infection at least once in their lives. So naturally, even herpes symptoms are fairly common.

The Herpes Simplex virus or HSV can be further classified as HSV 1 and HSV 2. HSV a cause of oral herpes, which is also known as cold sores.

When someone has been infected with HSV 1, the person is likely that the symptoms of herpes in the face or mouth. In principle there is only a bit of itching or burning in the nose or mouth. And then he began to become red-containing fluids blisters begin to appear at this stage. There may be only one or two blisters, or a cluster of many. The blisters also tend to vary in size.

An infection with HSV 2, on the other hand, the causes of genital herpes and herpes symptoms to appear in the genital areas of men and women. However we have seen that ladies have a higher risk of contracting the disease compared to their male counterparts. HSV 2 is essentially a sexually transmitted disease that spreads through sexual contact with an affected person.

Herpes symptoms of HSV 2 in men are mostly in the penis or areas close to it. But ladies, the symptoms of genital herpes in the form of injuries can be both inside and outside the vagina. When they are inside the vagina, it can lead to discharge white. So who is also a clear sign of symptoms of herpes. Internal injuries are difficult to see, as well.

No matter if it is HSV HSV 1 or 2, or a man or a woman, herpes some symptoms are common to all. What:

- Lymph glands get inflamed
- A constant headache
- Pain in the lower part of the body including back
- Fever
- The genital seem burning
- Problems and pain during urination
- Discharge from the vagina and penis