The Herpes Epidemic Among College Students: There is no such thing as "safe sex."

We recently saw a young patient in her late 30’s who had blinding herpes in one eye that required multiple corneal transplants. She contracted herpes in college and it eventually destroyed her eye. She was a very pretty girl but after multiple failed corneal transplants and years of drops and frustration, she has given up on her left eye. Her eye used to look like this below, but now looks less red but still has scar tissue on the cornea with some residual eaten up sutures from the last failed corneal transplant. . 

It was assumed initially the herpes was due to HSV1, which is oral herpes (the kind of herpes you can get from kissing someone with a cold sore). But a special test from a corneal sample showed the subtype of the virus was HSV 2, which is genital herpes. 

Eye surgeons do not routinely test which herpes has cause the eye infection and subsequent corneal scar tissue and vision loss requiring a corneal transplant.

Surprisingly the CDC does not consider Herpes a reportable disease. Thus the statistics the CDC has on it’s website are misleading. It appears they have no idea what the true incidence or prevalence is.

Herpes Simplex can be devastating. Abbreviated HSV for Herpes Simplex Virus, there are 2 strains:

1. HSV 1 which usually occurs around the mouth (‘‘cold sores:’’a term many doctors really dislike as it makes is sound benign/not dangerous when the fact is that these simple “cold sores” can develop on the surface of the cornea and lead to blindness–though reversible ) and 

2. HSV 2 (see photos below) which is most often around the genitals: it is almost exclusively transmitted through sexual contact but there are published case reports, as well, of HSV 2 causing corneal scarring. 
When people talk about genital herpes they mean it can be caused by type 1 and type 2 herpes simplex virus (HSV-1 and HSV-2). Both strains can destroy the cornea and eyeball but we have no data to tell us how often herpes (genital or oral version) affect the eye.

Both can cause corneas scarring and inflammation in the eye with potentially blinding results.

Herpes Simplex remains the #1 reason for needing a corneal transplant in the US.

Corneal transplant surgery is the most common organ transplant done in the world. And even though our rates of success are excellent and the risks have decreased, it is still an organ transplant which means you will need to put in drops for the rest of your life or risk rejection and another round of surgeries and pain and vision loss. 

Global prevalence of genital herpes is rapidly increasing with approximately 140 million people aged 15–49 years infected with genital HSV-1 infection and an estimated 417 million infected with HSV-2 internationally.

Genital herpes caused by HSV-2 is a global issue, and an estimated 417 million people worldwide were living with the infection in 2012. Prevalence of HSV-2 infection was estimated to be highest in Africa (31.5%), followed by the Americas (14.4%). It was also shown to increase with age, though the highest numbers of people newly-infected were adolescents.
More women are infected with HSV-2 than men; in 2012 it was estimated that 267 million women and 150 million men were living with the infection. This is because sexual transmission of HSV is more efficient from men to women than from women to men.

We all need to warn young people to avoid sex before marriage. It is possible. It is possible to know your partner very well. It is possible to marry as a virgin. What a radical idea! But one that is possible and sight saving!

Recently a friend told me about a “Rainbow Party” which devastated her high school son it was so traumatic. I had never heard of it before and was shocked to think of how much herpes virus could be spread in such a horrific party.

I found this online about it:

The story was originally related by American pediatrician Meg Meeker in her 2002 book Epidemic: How Teen Sex Is Killing Our Kids.[2] The book related case stories of adolescents suffering cancer, sterility, acute infections, and unwanted pregnancies as a consequence of starting sexual activity too early in life. Meeker relates the following story from a 14-year-old patient from Michigan:

[Allyson] had heard some kids were going to have a “rainbow party,” but had no idea what that meant. Still, she thought it might be fun, and arranged to attend with a friend. After she arrived, several girls (all in the eighth grade) were given different shades of lipstick and told to perform oral sex on different boys to give them “rainbows.” Once she realized what was happening, Allyson was too stunned and frightened to do anything. When a girl gave her some lipstick, she refused at first but, with repeated pressure, finally gave in. “It was one of the grossest things I’ve ever done.”[3]

Teachers and parents need to warn their sons and daughters about these horrific “virus spreading” parties and the peer pressure one can suffer to not participate. 

I saved the gory photos of syphilis, another STD I have seen affect the eye recently in 2 young people in the form of chronic uveitis: also a potentially blinding disease. 


                                                                          NOTE: Herpes Zoster or Shingles is NOT  just                                                                                   Sexually transmitted: it is from the VARICELLA virus  that causes Chicken Pox (chicken pox is super contagious from sputum, The virus spreads mainly by touching or breathing in the virus particles that come from chickenpox blisters, and possibly through tiny droplets from infected people that get into the air after they breathe or talk, for example..

I have herpes symptoms – What should I do?

1. Get diagnosed

Sores or bumps on your genitals can be caused by a range of conditions. You need to see a doctor or you can use our online photo diagnosis to get diagnosed. If you have sores you can use a swab test for herpes. 

2. Get treated

Antiviral medication helps your body fight the herpes virus and speeds up recovery. You can get your treatment from your GP or order online from Superdrug Online Doctor.

3. Prevent further outbreaks

Living healthily and avoiding stress are believed to help reduce the risk of recurrent outbreaks. You may also notice that certain things trigger outbreaks, which will help you avoid symptoms in the future. If you suffer from 6 or more outbreaks in a year you may wish to consider suppressive treatment.

The below post by Dr. Vaughn, is a travesty! Could this be malpractice to even tell college students to relax about one of the most devastating STDs out there?

Herpes is a big deal. The anxiety college students could feel about “getting herpes” is nothing compared to the true anxiety, depression, and despair that occurs in students who contract herpes.

I am perplexed of why he would post this. Was this even challenged by anyone?


John Vaughn, MD, Director of Duke Student Health
There is a Herpes epidemic on campus. Not of the actual infection, but of an overwhelming, almost paralyzing fear about the possibility of getting the infection. 
For the sake of your mental health, my Dear Dukies, I’m going to go out on a limb here with a relatively bold statement:
In the grand scheme of things, Herpes is not that big of a deal, so everyone just CHILL OUT! 
I’m not making light of it. I’m not saying you shouldn’t think about, or do your best to protect yourself from it, or talk to your partners about it.  You should do all of those things, but do them with a healthy dose of perspective, which I will hopefully provide to you here. 
I get it.  The thought of being “infected” by anything – especially below the belt – can make you feel gross and embarrassed and affect relationships. Even the name sounds creepy.  But while Herpes is very common and there is no cure, it’s also very manageable, not a threat to your health or the health of your sexual partners1, will not make you a social pariah, and will not doom you to a life of celibate childlessness.  Dealing with the possibility of acquiring HSV is just part of the cost of doing business when you become an adult with an active and healthy sex life.
The CDC and the American Sexual Health Association both have excellent FAQ sheets about HSV that cover all of the bases, but here are the basics.
Wanna be really creeped out?  Many, probably most, people get HSV1 from their mom or grandma!  That’s because when we talk about Herpes we are talking about two types of viruses – Herpes simplex type 1 (HSV1) and Herpes simplex type 2 (HSV2) – and for the most part, HSV1 is the “cold sore” virus that affects the mouth and lips.  So all of those smooches you got from family when you were a kid were probably exposing you to HSV1.  Have fun at that next family reunion!
HSV2 has traditionally affected the genitals.  However, both viruses are spread by direct skin-to-skin contact, and either can infect the mouth or genitals, so we are starting to see more HSV1 infections “south of the border.”  A 2011 study showed that HSV1 accounted for 78% of female and 85% of male genital herpes infections in college students. 
Why?  Because like most people, college students assume that oral sex is totally safe and are therefore much less likely to use a condom then they are with vaginal or anal sex.  Now, unless you have a really bad sense of direction, you can safely say that oral sex eliminates the risk of pregnancy, but it definitely does NOT eliminate the risk of transmitting STI’s.  In fact, it increases the risk of transmitting HSV1 because it is spread by direct contact. 
How many people have HSV?  About one in six people aged 14 to 49 years have it, and up to 90% of those people don’t even know it. 
Why is it so common?  Because about one in six people aged 14 to 49 years have it, and up to 90% of those people don’t even know it.  (Are you paying attention??)  And unfortunately, an infected individual can just as easily spread the infection when they don’t have any symptoms as when they do. 
So how do you know if you have it?  Your healthcare provider can often diagnose Herpes based on a history and physical examination if you are having symptoms, but there are some lab tests that can be done as well.  If you’re having symptoms, the fluid from a blister can be tested directly for the presence of the virus. 
What if you’ve never had any symptoms?  A blood test for antibodies to both viruses can be done.  The presence of these antibodies doesn’t necessarily mean you have or will ever have an outbreak, but if you don’t have any antibodies to the virus, you can pretty safely say that you don’t have HSV.
Can we do all of the above testing at Student Health?  Yes.
So yes, there is a fairly good chance that you will be exposed to HSV when you become sexually active.  And yes, there is no cure.  But…
There is also a fairly good chance that you were exposed to HSV at your 3rd birthday party! And it’s not a threat to your health or your future sex life.  And there are good medications that can help manage flare-ups and decrease the risk of transmitting the virus.  And you can do 2 simple and effective things (that you should already be doing anyway) to decrease your chances of getting it.  What are those, you ask?
  1. Talk to anyone you plan on getting nekked with!  Even though it’s an awkward conversation to have at the beginning of a new relationship – or the end of a long night – it’s the best way to keep you and your partner safe.
  2. Use protection every time you have sex… yes, even with oral sex!  For those keeping score at home, that means condoms or dental dams: [[[SLC note: again I think this is malpractice to tell students and patients that this is “safe” that is not true! I have seen patients who have used these “preventions” and get herpes! What can Dr. Vaughn say to such patients except, “Sorry. Maybe you did not use it correctly.” Doctors and surgeons need to tell patients the truth! These are no where near 100% safe so do not use the word “safe” do not even indicate it is an option as it does not sometimes and Herpes is a lifetime of pain of and on or oral pills or drops for life. Doctors should tell patients this. ]]]]]
So to finish with some more bold straight talk (because that’s how I roll)… RELAX!  Be smart, be safe, be confident enough to be chatty with your partners, get tested if you are worried, and move on with your life.  There are much more important things to worry about at Duke – like where to park without getting towed, or figuring out why everyone you meet is an Econ major from New Jersey.
If you have any questions about HSV or any other sexually transmitted infections, make an appointment to see us at the Student Health Center.  We can answer your questions, take a look at what’s worrying you and perform any necessary lab testing.
John A. Vaughn, MD
Director, Student Health Services
Duke University
1Genital HSV can cause problems during pregnancy, so if you have HSV and are pregnant or planning to become so, be sure to discuss it with your health care provider.


 2018 May 15. doi: 10.1111/ddg.13529. [Epub ahead of print]

Vertical transmission of herpes simplex virus: an update.


Herpes simplex virus (HSV)-1 and -2 infections are highly prevalent worldwide. HSV infection during pregnancy can result in neonatal herpesinfection, which is characterized by lifelong infection with periods of latency and reactivation. HSV can be acquired by an infant during one of three periods: in utero (5 %), peripartum (85 %), or postnatal (10 %). Neonatal HSV is a rare but significant infection that may be associated with severe morbidity and mortality, especially if there is dissemination or central nervous system involvement. Diagnostic and therapeutic advances have led to a reduction in mortality and, to a lesser extent, improvement of neurodevelopmental outcomes, but further developments are still needed. It is essential to improve the clinician’s ability to identify infants who are at increased risk of HSV infection and to prevent mother-to-child transmission. The development of novel antiviral agents with higher efficacy is a worthwhile aim for the future.


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