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.

“Charlie” is an eight-year-old child with autism. Her parents are worried because she often responds to requests with insults, aggression and refusal. Simple demands, such as being asked to get dressed, can trigger an intense need to control the situation, fights and meltdowns.

Charlie’s parents find themselves in a constant cycle of conflict, trying to manage her and their own reactions, often unsuccessfully. Their attempts to provide structure and consequences are met with more resistance.

What’s going on? What makes Charlie’s behaviour – that some are calling “pathological demand avoidance” – different to the defiance most children show their parents or carers from time-to-time?

What is pathological demand avoidance?

British developmental psychologist Elizabeth Newson coined the term “pathological demand avoidance” (commonly shortened to PDA) in the 1980s after studying groups of children in her practice.

A 2021 systematic review noted features of PDA include resistance to everyday requests and strong emotional and behavioural reactions.

Children with PDA might show obsessive behaviour, struggle with persistence, and seek to control situations. They may struggle with attention and impulsivity, alongside motor and coordination difficulties, language delay and a tendency to retreat into role play or fantasy worlds.

PDA is also known as “extreme demand avoidance” and is often described as a subtype of autism. Some people prefer the term persistent drive for autonomy or pervasive drive for autonomy.

What does the evidence say?

Every clinician working with children and families recognises the behavioural profile described by PDA. The challenging question is why these behaviours emerge.

PDA is not currently listed in the two diagnostic manuals used in psychiatry and psychology to diagnose mental health and developmental conditions, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the World Health Organization’s International Classification of Diseases (ICD-11).

Researchers have reported concerns about the science behind PDA. There are no clear theories or explanations of why or how the profile of symptoms develop, and little inclusion of children or adults with lived experience of PDA symptoms in the studies. Environmental, family or other contextual factors that may contribute to behaviour have not been systematically studied.

A major limitation of existing PDA research and case studies is a lack of consideration of overlapping symptoms with other conditions, such as autism, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, selective mutism and other developmental disorders. Diagnostic labels can have positive and negative consequences and so need to be thoroughly investigated before they are used in practice.

Classifying a “new” condition requires consistency across seven clinical and research aspects: epidemiological data, long-term patient follow-up, family inheritance, laboratory findings, exclusion from other conditions, response to treatment, and distinct predictors of outcome. At this stage, these domains have not been established for PDA. It is not clear whether PDA is different from other formal diagnoses or developmental differences.

Finding the why

Debates over classification don’t relieve distress for a child or those close to them. If a child is “intentionally” engaged in antisocial behaviour, the question is then “why?”

Beneath the behaviour is almost always developmental difference, genuine distress and difficulty coping. A broad and deep understanding of developmental processes is required.

Interestingly, while girls are “under-represented” in autism research, they are equally represented in studies characterising PDA. But if a child’s behaviour is only understood through a “pathologising” or diagnostic lens, there is a risk their agency may be reduced. Underlying experiences of distress, sensory overload, social confusion and feelings of isolation may be missed.

So, what can be done to help?

There are no empirical studies to date regarding PDA treatment strategies or their effectiveness. Clinical advice and case studies suggest strategies that may help include:

• reducing demands
• giving multiple options
• minimising expectations to avoid triggering avoidance
• engaging with interests to support regulation.

Early intervention in the preschool and primary years benefits children with complex developmental differences. Clinical care that involves a range of medical and allied health clinicians and considers the whole person is needed to ensure children and families get the support they need.

It is important to recognise these children often feel as frustrated and helpless as their caregivers. Both find themselves stuck in a repetitive cycle of distress, frustration and lack of progress. A personalised approach can take into account the child’s unique social, sensory and cognitive sensitivities.

In the preschool and early primary years, children have limited ability to manage their impulses or learn techniques for managing their emotions, relationships or environments. Careful watching for potential triggers and then working on timetables and routines, sleep, environments, tasks, and relationships can help.

As children move into later primary school and adolescence, they are more likely to want to influence others and be able to have more self control. As their autonomy and ability to collaborate increases, the problematic behaviours tend to reduce.

Strategies that build self-determination are crucial. They include opportunities for developing confidence, communication and more options to choose from when facing challenges. This therapeutic work with children and families takes time and needs to be revisited at different developmental stages. Support to engage in school and community activities is also needed. Each small step brings more capacity and more effective ways for a child to understand and manage themselves and their worlds.

What about Charlie?

The current scope to explain and manage PDA is limited. Future research must include the voices and views of children and adults with PDA symptoms.

Such emotional and behavioural difficulties are distressing and difficult for children and families. They need compassion and practical help.

For a child like Charlie, this could look like a series of sessions where she and her parents meet with clinicians to explore Charlie’s perspective, experiences and triggers. The family might come to understand that, in addition to autism, Charlie has complex developmental strengths and challenges, anxiety, and some difficulties with adjustment related to stress at home and school. This means Charlie experiences a fight, flight, freeze response that looks like aggression, avoidance or shutting down.

With carefully planned supports at home and school, Charlie’s options can broaden and her distress and avoidance can soften. Outside the clinic room, Charlie and her family can be supported to join an inclusive local community sporting or creative activity. Gradually she can spend more time engaged at home, school and in the community.

Nicole Rinehart, Professor, Child and Adolescent Psychology, Director, Krongold Clinic (Research), Monash University; David Moseley, Senior Research Fellow, Deputy Director (Clinical), Monash Krongold Clinic, Monash University, and Michael Gordon, Associate Professor, Psychiatry, Monash University

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