FACTORS INFLUENCING THE ACCEPTANCE OF HSV 2 ANTIBODY TESTING AMONG ADOLESCENTS AND YOUNG ADULTS K.H. Fife 1, W. Tu 1, D.I. Bernstein 2, R. Brady 2, F. Biro 2, L. Stanberry 3, S. Rosenthal 3, K. Stone 4, J. Leichliter 4, and G.D. Zimet 1 1 Indiana University School of Medicine, Indianapolis, IN, 2 Children’s Hospital Medical Center, Cincinnati, OH, 3 University of Texas Medical Branch, Galveston, TX, and 4 Centers for Disease Control and Prevention, Atlanta, GA

BACKGROUND n The seroprevalence of HSV 2 antibody among US adults is 21.9% n Most seropositive individuals shed HSV 2 from the genital tract n Fewer than 10% of seropositives have a clinical history of genital herpes n “Asymptomatic” HSV 2 antibody positive individuals may play an important role in ongoing transmission of HSV 2

BACKGROUND n Older HSV serologic tests were not truly type-specific n Recently introduced tests have made type-specific HSV antibody testing possible n There have been no studies of which patients will desire or accept HSV antibody testing

STUDY OBJECTIVES n To determine the factors associated with acceptance or refusal of HSV 2 antibody testing in: –STD clinic attendees (age 18-30) –Primary care clinic attendees (age 18-30) –College students (age 18-30) –Adolescent clinic attendees (age 14-19)

METHODS n Subjects at each of the 4 clinical sites with no history of genital herpes were asked to complete a questionnaire about their knowledge and attitudes about herpes and other STDs as well as personal behavior n After completing the questionnaire, subjects were offered free HSV 2 antibody testing n Acceptance or refusal of HSV 2 testing was correlated with questionnaire responses

FACTORS EVALUATED IN LOGISTIC REGRESSION ANALYSIS 1 n Demographics n Knowledge of genital herpes (GH) n Perception of severity of GH n Perception of vulnerability to GH n Perceived benefits of testing for GH n Perceived impact of GH on life

FACTORS EVALUATED IN LOGISTIC REGRESSION ANALYSIS 2 n Fear of blood drawing n Perceived stigma of STDs n Presence of genital symptoms like GH n Number of sexual partners n History of STD n Condom use n Perceived test characteristics

DEFINITIONS n Vulnerability to genital herpes was measured by 4 questions related to self-perceived fear of and likelihood of genital herpes infection n Fear of needles was measured by 3 questions related to perceived pain and anxiety about blood drawing

RESULTS 1 n At the time of analysis, 520 subjects were enrolled n 64% of subjects were female, 36% male n 58% were Caucasian, 34% African American, 8% other n Complete data were available on 452 subjects

RESULTS 2 n HSV 2 testing was accepted by 60.6% of subjects (274/452) n Overall seropositivity rate was 15% (41/274) Clinic STD n=56 PC n=68 Coll. n=77 Adol. n=73 # HSV 2 (%) 15 (26.8) 17 (25.0) 8 (10.4) 1 (1.4)

RESULTS OF MULTIPLE LOGISTIC REGRESSION ANALYSIS 1 Parameter Odds ratio 95% CI Female gender , 3.8  2 partners in last 6 mo , 8.4 h/o STD 7.4* 1.6, 33.6 Vulnerability , 1.3 *Possible interaction with clinic site

RESULTS OF MULTIPLE LOGISTIC REGRESSION ANALYSIS 2 n Increased age correlated with test acceptance, but the effect varied with clinic site n The only negative correlation with test acceptance was fear of needles (odds ratio 0.92, 95% CI 0.86, 0.99)

CONCLUSIONS 1 n There is interest in HSV 2 antibody testing among adolescents and young adults in a variety of clinical settings n The factors that predict test acceptance overlap with those that place individuals at risk for acquiring genital herpes n Self-perceived vulnerability predicted acceptance independent of number of partners or STD history

CONCLUSIONS 2 n Knowledge about genital herpes did not predict test acceptance n The presence of genital symptoms suggestive of herpes did not predict test acceptance n Fear of needles may be a deterrent to HSV 2 testing in some individuals

IMPLICATIONS n Free HSV 2 antibody testing would be accepted by many individuals at risk for genital herpes n The psychological impact of a positive HSV 2 antibody test in an asymptomatic individual has not been measured, but could be significant

ACKNOWLEDGEMENTS The authors would like to thank the following individuals for assistance in the conduct and analysis of this study: Judi Bell, Timothy Breen, Lisa Brockman, Sara Hanson, Laura Pace, Gretchen Ricketts, Stanley Taylor, Sue Waddell, Michelle Woodard, and Jingwei Wu We would also like to thank Dr. J. Dennis Fortenberry for input into the study design