Doctors alarmed as herpes returns with a vengeance

One in 10 women in London could be infected with virus

Genital herpes, the incurable sexually transmitted disease that was lost from sight in the shadow of Aids, is infecting record numbers of people in Britain.

The number of new cases of women with the disease has almost doubled in six years, but leading specialists believe that even these official figures belie the real scale of the problem.

Latest Department of Health figures show 27,000 new cases of men and women over the past 12 months, the largest number ever recorded in a year. This compares with 19,000 cases recorded in 1990.

But one of Britain's leading specialists in the area, Dr Frances Cowan, estimates that one in 10 women in London carries the virus, which means they have been exposed directly or indirectly to high-risk sexual behaviour. The increase and the scale of the problem put a question mark over how much people have changed their sexual activities since the arrival of Aids.

"The evidence that people have changed their sexual behaviour isn't that great," says Dr Cowan of University College Medical School in London. "Although they use condoms more, they are having sex younger and having more partners than in the past.

"The fact is that in a decade of Aids when supposedly everyone has been practising safe sex and using condoms, the overall prevalence of genital herpes has gone up."

It was in 1982 that alarm bells first sounded over herpes simplex virus 2, the cold-sore-like virus that is sexually transmitted. That year it made the cover of Time magazine and there were worldwide fears about a disease that was regarded by some as a biological backlash to the permissive Sixties and Seventies. But within the space of the next couple of years, it became all but forgotten in the panic over Aids.

Since then herpes has been little noticed in the shadow of Aids and HIV, but latest figures in Britain and the UK show significant increases, particularly among women.

Among women the number of cases has risen in England from 8,000 in 1989 to 15,500. In Wales, the number of first attacks among women has doubled in five years from 171 to 338, while in Scotland the number of women affected has almost doubled from 353 to 658 since 1990.

Cases among men in England have risen from 9,900 in 1989 to 11,550 today; in Wales, from 189 in 1992 to 200 today, and in Scotland from 400 in 1991 to 489.

Specialists say these figures are based on the people who are most seriously affected and who turn up at clinics.

"The figures are going up all the time, year on year, but are not a true indicator," says Dr Cowan, consultant and senior lecturer in genito-urinary medicine and a member of the Herpes Simplex Advisory Group which has been looking at the treatment guidelines for the virus.

"From research we have carried out on the blood of volunteers, I believe that about one in 10 women in London carries the virus, and that is a very high figure. A high proportion will not know they are infected and it is estimated that about one-third of them will have symptoms."

Similar research on men has shown an infectivity rate of three per 100.

"Only a tiny proportion of people who have genital herpes ever turn up to have it diagnosed, and it is only the ones that are diagnosed in our clinics that are reported," says Dr Raj Patel, consultant and senior lecturer with Southampton University Hospitals Trust. "The figures are the tip of the iceberg. A lot of patients, for example, are going to their GPs."

The reasons for the increase may be complex. "It may be that condoms are not good at protecting from herpes or that only certain sections have changed behaviour," Dr Cowan says.

"We know large sectors do not perceive themselves to be at risk. Gay men have adapted much better than young heterosexual men, who don't see themselves as being at risk."

Another contributory theory is the decline of the cold sore which may have protected people from being infected with genital herpes.

"In the 1940s and 1950s just about everybody in Britain had herpes simplex virus type one as cold sores, which may give some protection against genital herpes," Dr Cowan says.

"Improved living standards have meant that HSV1 has dropped dramatically over the course of the century, and now only about 50 per cent of the population have the cold sore.

"There is a theory that because there are now generations who have not been exposed to the herpes simplex virus, and have no history of cold sores, they may be more likely to get genital herpes."

In the US it is now estimated that 500,000 people contract genital herpes each year.

Nancy Herndon of the American Social Health Association says: "Herpes increased during a period when there has been unprecedented amounts of sex education. It is much more contagious than HIV, and is spread by skin- to-skin contact during genital, oral or anal sex."

A new problem looming for people with herpes is that they may be infectious for longer periods that they thought.

"People think it is a disease that is only active when they have an attack, but we know that the virus comes to the surface when it is not clinically manifesting," says Dr Patel. "Potentially, that activity is infectious."