Low acceptance of HSV-2 testing among high-risk women.

We evaluated the acceptability of a community-based herpes simplex virus type 2 (HSV-2) screening programme for at-risk women and assessed factors related to uptake of point of care HSV-2 testing. One hundred recently arrested women (median age 34 years) were recruited from a community court handling lower-level misdemeanour cases in Indianapolis, Indiana. Individuals completed a survey assessing factors related to HSV-2 screening intentions and were offered point of care HSV-2 testing. Rates of HSV-2 infection in this population are high; 61.1% of women tested were positive. The majority (81%) accepted a prescription for suppressive therapy. Women in this sample indicated that HSV-2 screening is an important component of health care but were unwilling to pay the US$10 it cost to be tested. To encourage this and other high-risk populations to be screened for HSV-2, public health resources will be needed to help individuals overcome cost-related barriers to care.

Further validation and responsiveness assessment of the Herpes Outbreak Impact Questionnaire and Herpes Symptom Checklist.

OBJECTIVE: The Herpes Outbreak Impact Questionnaire (HOIQ) and Herpes Symptom Checklist (HSC) are patient-completed questionnaires for assessing genital herpes outbreaks. This report describes the validation of paper-and-pencil versions of the scales and responsiveness assessments in an Australian clinical trial. METHODS: Acceptability of the language of the original UK versions was tested with Australians. The HOIQ and HSC were then field-tested with patients. The new versions were validated using patients' daily responses to the questionnaires in a famciclovir study. RESULTS: The HOIQ and HSC were readily adapted into Australian English and were acceptable to patients. Psychometric sample: N = 151; 81 (54%) male; mean age 39.9 +/- 11.6 years; mean outbreaks 5.1 +/- 3.0 per year. Internal consistency was good (alphas at outbreak 1 ranged 0.84-0.90 HOIQ and 0.73-0.87 HSC). Rasch analysis showed item stability over time. Correlations between HOIQ and HSC ranged from 0.46 to 0.60. Both scales distinguished outbreak healing presence or absence at day 6 (P = 0.001), and the HOIQ scale distinguished between symptom severity groups (P < 0.001). Scale scores declined significantly over study duration, exhibiting large effect sizes. CONCLUSIONS: The paper-and-pencil HOIQ and HSC were reliable, valid, and responsive in a clinical trial setting. These instruments are recommended for use in clinical studies.

Sexually transmitted infections: impact on individuals and their relationships.

The impact of having genital herpes and genital human papilloma virus (HPV) on individuals and their relationships was investigated. A qualitative research methodology explored the lived experiences of 30 adults with genital herpes (15 men, 15 women), and 30 adults with HPV (15 men, 15 women). This study addressed individuals' feelings about the impact of stigma associated with having an STI, the impact of having an STI on sexuality and on intimate relationships, and feelings surrounding the process of disclosure. Implications of the findings for research and clinical practice are discussed.

HSV-2 serologic testing in an HMO population: uptake and psychosocial sequelae.

OBJECTIVES: To prospectively measure the uptake of Herpes simplex virus Type 2 (HSV-2) testing and psychosocial response to a new serologic diagnosis of HSV-2 in a health maintenance organization (HMO) population. STUDY DESIGN: Randomly selected urban HMO enrollees were invited to be tested for HSV-2 antibody at a research clinic. Participants had blood drawn and completed demographic and psychosocial questionnaires. RESULTS: Of 3111 eligible enrollees contacted, 344 (11%) were tested. Eighty-seven (26%) tested HSV-2 seropositive, and 44 (51%) of these did not report a prior genital herpes diagnosis. Distress, measured by the total mood disturbance, was 6.5 points higher on average following a new genital herpes diagnosis relative to baseline (actual range = 109 points, P = 0.003) but not statistically different from HSV-2 negative or previously diagnosed participants. CONCLUSIONS: HMO enrollees unexpectedly testing HSV-2 positive showed short-term psychosocial distress that resolved during 6-month follow-up. Findings suggest that concerns about psychosocial burden should not deter voluntary serologic HSV-2 testing in primary care settings.

Patients support innovative models of care in recurrent genital herpes clinics: results from a patient satisfaction study.

Genital herpes is one of the most common sexually transmitted infections and is characterized by recurrent, painful, ulcerative lesions. Severe psychosocial disturbance has been described in a variety of settings and there are well-documented associations with poor self-esteem, centred around contagion and stigma. Recurrent genital herpes (RGH) is traditionally managed by doctors in the genitourinary medicine clinic setting; we wanted to evaluate patient's opinions on alternative models of care. We performed a questionnaire of patients attending our RGH clinic to ascertain patients' opinions and preferences. Seventy four percent of patients expressed a wish to see the same health-care professional at follow-up visits and 62% supported the idea of a nurse-led clinic. One-third found the concept of group sessions acceptable. Regarding GP follow-up management and prescribing, there was a split response with almost equal numbers accepting and rejecting this proposition (42 versus 45%). Seventy-six percent of patients thought that RGH had important psychological impact on their lives and 58% found the prospect of psychological referral acceptable.

Genital herpes in young adults: changing sexual behaviours, epidemiology and management.

Genital herpes is a common sexually transmitted infection throughout the world. The majority of new infections occur in adolescents and young adults, although prevalence rates generally increase with age and cumulative sexual experience. In young adults, herpes simplex virus 1 (HSV-1) infection is becoming a more common cause of genital herpes. Reasons for this trend include changing sexual practices, notably oral-genital exposure and the use of condoms for intercourse. Important implications of having genital herpes include the risk of transmission to sexual partners and the increased risk of acquiring and transmitting HIV. Genital herpes infections are often unrecognized, and transmission to uninfected partners is likely to occur during asymptomatic shedding. A diagnosis of herpes may also affect psychosexual development, particularly in adolescents. Such factors contribute to the growing global HSV prevalence and suggest a need to implement better screening programmes in young adults. Recognizing and treating HSV early offers benefits to patients and their sexual partners by reducing the frequency and severity of outbreaks, limiting the likelihood of disease transmission, and preventing new infections.

Health related quality of life in genital herpes: a pilot comparison of measures.

BACKGROUND: Genital herpes (GH) is a common sexually transmitted infection. Novel tools for the control of GH (for example, tests and vaccines) are emerging, but optimal assessment of the cost effectiveness of such interventions requires scaled, preference based estimates of the impact of GH on health related quality of life. METHODS: We provided self administered interviews to 39 individuals with recurrent GH recruited from an STD clinic and a GH support group in southern Ontario, Canada. Health preference estimates were generated using visual analogue scales (VAS), a time-tradeoff approach (TTO) and the Health Utilities Index Mark-II (HUI-II). Quality of life was also assessed with the Recurrent Genital Herpes Quality of Life scale (RGHQoL). RESULTS: Average (SD) health values for asymptomatic and symptomatic genital herpes were 0.89 (0.21) and 0.89 (0.22) using TTO, and 0.76 (0.30) and 0.71 (0.30) using VAS. Health utility estimates generated with HUI-II for transient symptomatic and asymptomatic health states were 0.93 (0.08) and 0.80 (0.16). Log transformed health value estimates exhibited convergent validity when compared to RGHQoL, as did health utility estimates for symptomatic GH. Utility scores for symptomatic GH increased (improved) with increasing age; no other subject characteristic was predictive of preference weights. CONCLUSIONS: Preference based measures of health related quality of life can be elicited with relative ease in the context of genital herpes, and preference weights are correlated with quality of life scores generated using the RGHQoL. Generation of preference weights will permit direct comparison of the economic attractiveness of herpes prevention interventions with that of other commonly available health interventions.

Psychological symptoms associated with genital herpes virus infections: epidemiology and approaches to management.

Genital herpes is a common, chronic, recurrent, viral sexually transmitted infection (STI) occurring worldwide. The first episode may be severe and prolonged, but most recurrences are usually short lived and minor. Although most individuals with this infection have no symptoms, STIs, including genital herpes, often cause psychological and psychosexual morbidity. Unfortunately, the existing data on the psychological symptoms associated with genital herpes have many limitations, including anecdotal reporting, evaluation of small and selected populations, use of varied and sometimes unevaluated questionnaires, and lack of controls. Some individuals with recurrent genital herpes display a range of emotional responses, including depression, anguish, distress, anger, diminution of self-esteem and hostility towards the person believed to be the source of infection. However, it is always important to consider the possibility of pre-existing psychopathology. Several retrospective studies have suggested that stress could lead to recurrences of genital herpes infection. However, prospective studies have been unable to demonstrate any relationship between pre-existing stress and recurrences. What these studies were able to demonstrate was that stress and recurrences occurred simultaneously, suggesting that perhaps it was the recurrences that were causing stress, rather than the reverse.

Effectiveness of needs-based quality of life instruments.

Several years experience has now been gained in the use of needs-based measures in clinical trials and such use is increasing rapidly. This paper shows how four needs-based quality of life (QoL) instruments have proved effective in determining the benefits of interventions from the patients' perspective in clinical studies and trials. The instruments discussed are; the Quality of Life in Depression Scale (QLDS), the Migraine Specific Quality of Life Scale (MSQoL), the Recurrent Genital Herpes Quality of Life (RGHQoL), and the Quality of life-Assessment in Growth Hormone Deficient Adults (QoL-AGHDA).

Patient and physician partnerships in managing genital herpes.

Genital herpes simplex virus infections are widespread throughout the world and are characterized by stigma, myth, and anxiety by patients and the public but are perceived as trivial by most physicians. Surveys in the United States, Europe, Australia, and South Africa have measured the unfavorable effect of genital herpes on infected patients, health care resources, and workplace productivity. These surveys identified limited satisfaction of patients with current care and support (41% satisfied), although satisfaction scores were greater for patients receiving suppressive antiviral therapy (56% satisfied). Bridging the gap between patients and physicians is vital for improving the management of genital herpes. Key to facilitating patient-physician partnerships is education and recognition by physicians that patients with genital herpes may have expert knowledge. In effective partnerships, physicians and patients can have informed constructive discussions such that patients share in the responsibility for managing their disease and in therapeutic decision making.

The biopsychosocial burden of genital herpes: evidence-based and other approaches to care.

Genital herpes, an incurable disease, is increasing in epidemic proportions in the United States (Eng & Butler, 1997). Updated information on the epidemiology and psychosocial aspects of genital herpes is necessary to understand the biopsychosocial burden of living with the disease. Data from both qualitative and quantitative research are used to support evidence-based and other approaches to care.

Psychological investigation of genital herpes recurrence: prospective assessment and cognitive-behavioral intervention for a chronic physical disorder.

Previous studies suggest that anxiety and/or depressed mood are associated with recurrence of genital herpes lesions. The present study sought to extend the assessment of factors associated with genital herpes and to investigate the impact of psychological therapy on features of the disorder. Sixteen genital herpes patients received 5 weeks of either structured discussion or cognitive restructuring (CR) therapy in a group format. Measures of attitude about herpes, global coping, distress, loneliness, health locus of control, and recurrence frequency were administered at pretreatment, posttreatment, and 3 months follow-up. Patients also made daily reports during the 5 weeks of treatment from which information was extracted regarding their herpes symptoms, dysphoria, anxiety, and ongoing coping process. Therapy did not produce the expected reductions in reported distress or loneliness. The CR procedure, however, was associated with reduced frequency of lesion recurrence at follow-up. Avoidant coping was associated with lower recurrence rates, and loneliness scores were associated with higher recurrence rates. Prospective data indicated that recurrences were preceded by elevated anxiety that was independent of prodromal symptoms. These results provide support for the general proposals that psychological factors influence health status and that psychological intervention may reduce disease recurrence.

Relationship of smoking to lifestyle factors in women.

The purposes of this research were to examine the relationship of female smoking and lifestyle factors and to assess the applicability of an index of "emancipation" to smoking status in women who live in the Province of Ontario. The index of "emancipation," developed by Eide, was based on distinguishing women who are not following traditional roles as housewives from those who are. While reports in the literature confirm that occupational status, marital status and educational achievement are related to female smoking, little is known about the relationship of smoking to other lifestyle factors (e.g., sexual activity, use of cosmetic agents). Some of these relationships were examined through the secondary analysis of two data sets--one from a population survey design to assess relationships between socio-economic status, sexual behavior, and the occurrence of antibodies to herpes simplex virus type 2, and the other from a case-control study designed to test the hypothesis that oxidative hair dyes were carcinogenic. Five hundred and sixty-six women participated in the former study and 1,155 in the latter. Analyses revealed that smokers are more active sexually than "never" and "ex-smokers" for all groups of women. In addition, a curvilinear relationship with "emancipation" was found in two of the three groups of women. A higher level of smoking was found in women who were in the middle ranges of "emancipation," a finding very similar to that of Eide (1984, 1985). The possibility that increased levels of stress and/or personality characteristics underlie these relationships is discussed.