Impact of Knowledge of Herpes Impact of Knowledge of Herpes Simplex Virus Type 2 Serostatus Simplex Virus Type 2 Serostatus

on on STD Clinic PatientsSTD Clinic Patients

Karen A KroegerKaren A Kroeger11, Richard C Knaup, Richard C Knaup22, ,

Michael P WilliamsMichael P Williams22, Bradley P Stoner, Bradley P Stoner11

11Washington University School of Washington University School of Medicine Medicine 22Department of Health, St Department of Health, St

Louis County, MOLouis County, MO

Background and Background and ObjectivesObjectives

A type-specific serotest for herpes A type-specific serotest for herpes simplex virus-type 2 (HSV-2) is simplex virus-type 2 (HSV-2) is now commercially availablenow commercially available

Impact of this test on patients has Impact of this test on patients has not been thoroughly evaluatednot been thoroughly evaluated

Goal of this study: to examine Goal of this study: to examine patient reactions to a positive patient reactions to a positive serological test for HSV-2serological test for HSV-2

MethodsMethods 500 consecutive STD clinic patients tested 500 consecutive STD clinic patients tested

for HSV-2 antibody using MRL-EIA test for HSV-2 antibody using MRL-EIA test (Department of Health, St. Louis County, (Department of Health, St. Louis County, MO)MO)

Patients with positive results notified and Patients with positive results notified and counseled by phone; if no previous clinical counseled by phone; if no previous clinical hx, permission requested to contact for hx, permission requested to contact for later interviewlater interview

Follow up interviews within two weeksFollow up interviews within two weeks 15 minute phone interview regarding 15 minute phone interview regarding

psychosocial and behavioral impact of testpsychosocial and behavioral impact of test

ParticipationParticipation 500 people tested500 people tested 197 (39.4%) tested positive for 197 (39.4%) tested positive for

HSV-2 AbHSV-2 Ab 135 (68.5%) positives notified and 135 (68.5%) positives notified and

counseledcounseled 105 (77.8%) of those notified 105 (77.8%) of those notified

agreed to be interviewedagreed to be interviewed 43 (41.0%) of those who agreed to 43 (41.0%) of those who agreed to

interview completed an interviewinterview completed an interview

Interview sample (N=43)Interview sample (N=43)

GenderGender – FemaleFemale 60.5%60.5%– MaleMale 39.5%39.5%

AgeAge– RangeRange 17-55 yrs17-55 yrs– MeanMean 30 yrs30 yrs– MedianMedian 25 yrs25 yrs

EthnicityEthnicity– African-AmericanAfrican-American 81.6%81.6%– WhiteWhite 18.4%18.4%

Interview sampleInterview sample Partners last 6 months Partners last 6 months

% %– 1 or less1 or less 59.559.5– 2-42-4 31.031.0– 5 or more5 or more 9.5 9.5

Previous hx of STDPrevious hx of STD 66.766.7 Use condoms “none of the time”Use condoms “none of the time”

35.735.7

Reactions to Diagnosis (N=43)Reactions to Diagnosis (N=43) %%

Important to know I have herpesImportant to know I have herpes 100.0100.0

Surprised to find outSurprised to find out 90.7 90.7

Worry about infecting othersWorry about infecting others 81.4 81.4

Worry about rejectionWorry about rejection 69.7 69.7

Worry about effect on sex lifeWorry about effect on sex life 67.4 67.4

Hard to believe I have herpesHard to believe I have herpes 60.5*60.5*

Worry about effect on healthWorry about effect on health 32.6 32.6

Afraid it will be difficult to live with Afraid it will be difficult to live with 32.6 32.6

*female 73.1% vs. male 41.1%, p<.05*female 73.1% vs. male 41.1%, p<.05

How likely are you to talk about your How likely are you to talk about your diagnosis with someone else in your life?diagnosis with someone else in your life?

““Highly likely” or “pretty likely” Highly likely” or “pretty likely”

to talk with:to talk with:

%%– Close friendClose friend 44.244.2– ParentParent 38.038.0– Family memberFamily member 27.927.9– Other Other 23.223.2

How likely are you to talk about your How likely are you to talk about your diagnosis with sex partners?diagnosis with sex partners?

““Highly likely”or “pretty likely”Highly likely”or “pretty likely” to talk with:to talk with: n n

% % – All current partnersAll current partners 4040 65.0 65.0– Current main only, not secondaryCurrent main only, not secondary 3737 64.8 64.8– Current secondary, not mainCurrent secondary, not main 2828 35.7 35.7– Most recent past partnerMost recent past partner 3434 50.0 50.0– Other past partnersOther past partners 4040 22.5 22.5– None of my current partnersNone of my current partners 4242 9.5 9.5

How easy or how difficult do you think How easy or how difficult do you think it will be to talk about your diagnosis it will be to talk about your diagnosis

with sex partners? (N=43)with sex partners? (N=43)

““Extremely difficult” or Extremely difficult” or ““pretty difficult”to talk with:pretty difficult”to talk with:

%%New sex partners New sex partners 69.769.7

Current sex partnersCurrent sex partners 39.039.0

Likelihood of Behavior ChangeLikelihood of Behavior Change

%%

Use condoms more oftenUse condoms more often 86.086.0

Have fewer new sex partnersHave fewer new sex partners 78.078.0

Tell partners before having sexTell partners before having sex 60.060.0

Use condoms, but not discloseUse condoms, but not disclose 39.039.0

Attend support group/emotionalAttend support group/emotional 23.323.3

Attend support group/find partner 11.6Attend support group/find partner 11.6

Recall of Prior SymptomsRecall of Prior Symptoms

%%

No previous symptoms recalledNo previous symptoms recalled 76.276.2

Retrospective recall of symptomsRetrospective recall of symptoms 16.716.7

Suspected herpes/did not seek careSuspected herpes/did not seek care 7.1 7.1

(i.e.“cold sores, itching,blisters”)(i.e.“cold sores, itching,blisters”)

DiscussionDiscussion Notification/counseling for Notification/counseling for

asymptomatic patients was complex asymptomatic patients was complex and labor intensiveand labor intensive

Low response rate/small sample Low response rate/small sample size limits generalizability of size limits generalizability of findings and may obscure significant findings and may obscure significant gender and other differencesgender and other differences

STD programs must anticipate STD programs must anticipate additional workload if implementing additional workload if implementing HSV testingHSV testing

ConclusionsConclusions Patients feel it is important to know Patients feel it is important to know

they have HSV-2, but may feel they have HSV-2, but may feel surprise and disbelief at their surprise and disbelief at their diagnosisdiagnosis

Most patients say they will use Most patients say they will use condoms more frequentlycondoms more frequently

Many other patients say they will Many other patients say they will use condoms to protect partners use condoms to protect partners but not disclose diagnosisbut not disclose diagnosis

ConclusionsConclusions Most patients recall no symptomsMost patients recall no symptoms More research is needed to assess More research is needed to assess

the impact of diagnosis with HSV-2 the impact of diagnosis with HSV-2 and to develop appropriate and to develop appropriate counseling messagescounseling messages

More research is needed to assess More research is needed to assess the long term impact of a the long term impact of a diagnosis with HSV-2diagnosis with HSV-2