Innovation Is Needed in Herpes Care and Prevention

Sexually transmitted infections (STIs) are much more common than many people think. So common, in fact, that more than half of U.S. citizens will contract an STI at some point. Despite this, few people openly talk about their experiences with STIs, further perpetuating the stigma associated with a diagnosis. After the Centers for Disease Control and Prevention (CDC) released the latest national data on STI rates, media coverage of the sharp increase in syphilis rates was extensive. While this coverage is important, it offers an incomplete picture of STI risk and frequency.

There are many good reasons why human immunodeficiency virus (HIV), chlamydia, gonorrhea, and syphilis seem to garner the most attention, despite the fact that they are not the most common STIs. Human papilloma virus (HPV), which can cause cervical cancer; and herpes simplex virus type 2 (HSV-2), better known as genital herpes, are the two most common STIs by a considerable margin. While vaccination before a person becomes sexually active significantly decreases the risks associated with HPV, there is no vaccine for genital herpes or oral herpes (HSV-1). Genital herpes’ high prevalence and limited treatment options present a unique public health challenge. Until Congress directed the Department of Health and Human Services (HHS) to add both types of HSV to the Sexually Transmitted Infections National Strategic Plan in 2022, little attention was paid to it at the federal level.

In February 2024, HHS released an HSV Addendum for public comment. The document outlines the public health landscape and impact of HSV along with five goals to help control transmission and manage existing cases. Although the addendum includes many useful suggestions, one point that stands out is the need for innovative testing, treatment, and prevention tools.

While testing is a key component in decreasing transmission of any STI, HSV testing presents several challenges. Existing HSV blood tests commonly return false positive results, especially if a person has no symptoms. This is one reason why the U.S. Preventative Services Task Force and the CDC do not recommend routinely testing most asymptomatic people for HSV. Innovation resulting in improved diagnostic tools for HSV infection could change these recommendations, but access to STI testing facilities remains a barrier for many people.

Additionally, HSV treatment options are limited. Although a person with HSV can take antiviral medications either as-needed or continuously, the timing of as-needed treatment must be precise in order to shorten outbreak duration—and continuous treatment does not completely eliminate the risk of transmission. More research is also needed to better understand the effects of these medications. To maximize the well-being of people with HSV, the addendum recommends the development of long-term treatments that can both suppress outbreaks and prevent transmission. Not only would these treatments give people with HSV better control over their health, but they would also benefit public health overall.

When it comes to prevention, condoms are the most effective tool for preventing genital herpes—although they must cover all virus-shedding areas, since HSV is transmitted through skin-to-skin contact. Innovations that could improve prevention options include topical products containing antiviral compounds or antiviral vaginal gels and rings. There is precedent for an antiviral vaginal ring, though the one developed to prevent HIV is not approved in the United States. Finally, the HSV Addendum notes that the development of separate vaccines to prevent HSV transmission and to minimize HSV symptoms and outbreak frequency would be useful for improving prevention and treatment options.

It is past time that HSV received more attention and carried less stigma. Although the virus is extremely common, public knowledge about it is poor. As HSV gains attention from federal health bodies, and as patient advocacy increases, so should efforts to produce innovative treatments and prevention tools for the market.