Letters to the Editor
Transmission of Herpes Simplex Virus via Oral Sex
TO THE EDITOR: I am trained in, and am an avid supporter of, family medicine. As a lecturer on sexually transmitted infections, I was eager to read the article by Dr. Beauman, "Genital Herpes: A Review,"1 in the October 15, 2005, issue of American Family Physician. The article was thoughtful and the author handled the complexities of genital herpes simplex virus (HSV) infection well.
I was dismayed, however, by the patient education handout entitled, "Genital Herpes: What You Should Know,"1 which followed the article and has a significantly inaccurate statement in the first paragraph. The handout states: "Genital herpes is caused by a different type of the same virus that causes cold sores on the mouth."1 This statement does not reflect the current incidence of HSV-1 among new cases of genital herpes.2-4 Historically, HSV-2 was by far the most common cause of genital herpes; however, studies5,6 over the past few years document a rising incidence of HSV-1 in genital lesions, as high as 50 percent in adolescent populations and as high as 78 percent in college populations.
Explaining the transmission of genital herpes and the risks of oral sex to young people, who often do not view oral sex as "sex," requires that we, as family medicine specialists, be on the forefront of educating our patients about this worrisome trend. This statement in the handout is outdated and a disservice to our patients.
REFERENCES
1. Beauman JG. Genital herpes: a review. Am Fam Physician 2005;72:1527-34,1541-2.
2. Manavi K, McMillan A, Ogilvie M. Herpes simplex virus type 1 remains the principal cause of initial anogenital herpes in Edinburgh, Scotland. Sex Transm Dis 2004;31:322-4.
3. Jonsson MK, Wahren B. Sexually transmitted herpes simplex viruses. Scand J Infect Dis 2004;36:93-101.
4. Auslander BA, Biro FM, Rosenthal SL. Genital herpes in adolescents. Semin Pediatr Infect Dis 2005;16:24-30.
5. Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 2003;30:797-800.
6. Lowhagen GB, Tunback P, Andersson K, Bergstrom T, Johannisson G. First episodes of genital herpes in a Swedish STD population: a study of epidemiology and transmission by the use of herpes simplex virus (HSV) typing and specific serology. Sex Transm Infect 2000;76:179-82.
editor's note: Thank-you to Dr. Groves for pointing out the discrepancy between the article and patient education handout. As Dr. Beauman states, both types of herpes simplex virus (HSV-1 and HSV-2) may cause genital infections that are clinically indistinguishable. We agree that oral-genital contact is an underrecognized but increasingly common mode of transmission of both types of herpes simplex virus. Accordingly, this patient education handout has been updated on our Web site (http://www.aafp.org/afp/20051015/1541ph.html).
The article "Diagnostic Approach to Polyarticular Joint Pain" (September 15, 2003, page 1151) incorrectly stated in Table 4 that inflammation of the earlobe is a sign of relapsing polychondritis. The earlobes are spared in relapsing polychondritis, because the rare condition affects cartilage and earlobes do not contain cartilage. Therefore, the article should have stated that inflammation of the ear, sparing the earlobe, is a sign of relapsing polychondritis. The online version of this article has been corrected.
Send letters to Kenny Lin, M.D., Assistant Editor, American Family Physician, e-mail: afplet@aafp.org. Letters submitted via regular mail should be sent (on disk) to: 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-6272.
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