The World Health Organization (WHO) recently released new estimates suggesting around 846 million people aged between 15 and 49 live with a genital herpes infection.

That’s equivalent to one in every five people from that age group.

At least one person each second (42 million people annually) contracts a new genital herpes infection.

So what is genital herpes, and are cases on the rise? Here’s what to know about this common infection.

First, what causes genital herpes?

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus, which also causes cold sores.

There are two types of herpes simplex virus, HSV-1 and HSV-2 (and it’s possible to be infected by both at the same time).

HSV-1 most commonly spreads through oral contact such as kissing or sharing infected objects such as lip balm, cups or utensils, and presents as cold sores (or oral herpes) around the mouth. But it can also be sexually transmitted to cause a genital herpes infection.

An estimated 3.8 billion people under the age of 50 (64%) globally have HSV-1.

HSV-2 is less prevalent, but almost always causes a genital herpes infection. Some 520 million people aged 15–49 (13%) worldwide are believed to have HSV-2.

The initial episode of genital herpes can be quite painful, with blisters, ulcers and peeling skin around the genitals over 7–10 days.

Not all people have severe (or any) initial symptoms. This means a person might not know they have been infected with a herpes virus.

Herpes is a lifelong infection, which means once you contract the virus, you have it forever. After an initial episode, subsequent episodes can occur, but are usually less painful or even symptom free.

Both oral and genital herpes are particularly easy to spread when you have active lesions (cold sores or genital ulcers). But even with no symptoms, herpes can still be spread to a partner.

And although relatively rare, oral herpes can be transmitted to the genital area, and genital herpes can be transmitted to the mouth through oral sex.

If an expectant mother exhibits a genital herpes infection close to childbirth, there are risks to the baby. A herpes infection can be very serious in a baby, and the younger the infant, the more vulnerable they are. This is also one reason why you should avoid kissing a baby on the mouth.

Changing trends

WHO’s recent figures brought together data from around the world to estimate the prevalence of genital herpes in 2020, compared with previous estimates in 2012 and 2016.

This data shows no significant difference in the prevalence of genital herpes caused by HSV-2 since 2016, but does highlight increases in genital herpes infections caused by HSV-1.

The estimated number of genital HSV-1 infections globally was nearly twice as high in 2020 compared with 2016 (376 million compared with 192 million).

A 2022 study looking at Australia, New Zealand and Canada found more than 60% of genital herpes infections are still caused by HSV-2. But this is declining by about 2% each year while new genital infections that result from HSV-1 are rising.

There’s no simple fix, but safe sex is important

Genital herpes causes a substantial disease burden and economic cost to health-care services.

With such a large proportion of the world’s population infected with HSV-1, evidence this virus is increasingly causing genital herpes is concerning.

There’s no cure for genital herpes, but some medications, such as antivirals, can help reduce the amount of virus present in the system. While this won’t kill it completely, it helps to prevent symptomatic genital herpes recurrences, improve quality of life, and minimise the risk of transmission.

To prevent the spread of genital herpes and other STIs, practise safe sex, particularly if you’re not sure of your partner’s sexual health. You need to use a barrier method such as condoms to protect against STIs (a contraceptive such as the pill won’t work). This includes during oral sex.

As herpes is now so common, testing is not usually included as part of a regular sexual health check-up, except for in specific circumstances such as during pregnancy or severe episodes.

So it’s wise not to let your guard down, even if your partner insists they have received the all-clear from a recent check-up.

If there are herpes lesions present around the genitals, avoid sex entirely. Even condoms are not fully effective at these times, as exposed areas can still transmit the infection.

Immune health

If you are infected with HSV-1 or HSV-2 it’s more likely symptoms will appear when you’re stressed, tired or overwhelmed. During these times, our immune system may not be as functional, and dormant viruses such as herpes can start to develop quickly in our bodies.

To reduce the risk of recurrent herpes infections, try to eat healthily, get at least seven hours of sleep each night if possible, and look out for when your body may be telling you to take a step back and relax. This self-care can go a long way towards keeping latent viruses at bay.

While the prevalence has increased significantly in recent years, we have not lost the war on genital herpes just yet. Safe sexual practices, education and awareness can help reduce its spread, and the stigma around it.

If you have personal concerns, you should discuss them with a medical professional.

Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow in Medicine, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.

While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.

Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.

Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.

But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.

In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.

Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.

Contraception options

Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.

Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.

The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.

Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.

Oral retinoid use over time

For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.

We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.

Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.

Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.

A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.

One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.

But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.

What are the solutions?

Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.

But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.

Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.

A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.

Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.

Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.

Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.

Dr Laura Gerhardy from NSW Health contributed to this article.

Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.