Impact of Knowledge of Herpes Simplex Virus Type 2 Serostatus on STD Clinic Patients Karen A Kroeger 1, Richard C Knaup 2, Michael P Williams 2, Bradley P Stoner 1 1 Washington University School of Medicine 2 Department of Health, St Louis County, MO

Background and Objectives A type-specific serotest for herpes simplex virus-type 2 (HSV-2) is now commercially available A type-specific serotest for herpes simplex virus-type 2 (HSV-2) is now commercially available Impact of this test on patients has not been thoroughly evaluated Impact of this test on patients has not been thoroughly evaluated Goal of this study: to examine patient reactions to a positive serological test for HSV-2 Goal of this study: to examine patient reactions to a positive serological test for HSV-2

Methods 500 consecutive STD clinic patients tested for HSV-2 antibody using MRL-EIA test (Department of Health, St. Louis County, MO) 500 consecutive STD clinic patients tested for HSV-2 antibody using MRL-EIA test (Department of Health, St. Louis County, MO) Patients with positive results notified and counseled by phone; if no previous clinical hx, permission requested to contact for later interview Patients with positive results notified and counseled by phone; if no previous clinical hx, permission requested to contact for later interview Follow up interviews within two weeks Follow up interviews within two weeks 15 minute phone interview regarding psychosocial and behavioral impact of test 15 minute phone interview regarding psychosocial and behavioral impact of test

Participation 500 people tested 500 people tested 197 (39.4%) tested positive for HSV-2 Ab 197 (39.4%) tested positive for HSV-2 Ab 135 (68.5%) positives notified and counseled 135 (68.5%) positives notified and counseled 105 (77.8%) of those notified agreed to be interviewed 105 (77.8%) of those notified agreed to be interviewed 43 (41.0%) of those who agreed to interview completed an interview 43 (41.0%) of those who agreed to interview completed an interview

Interview sample (N=43) Gender Gender –Female60.5% –Male39.5% Age Age –Range17-55 yrs –Mean30 yrs –Median25 yrs Ethnicity Ethnicity –African-American81.6% –White18.4%

Interview sample Partners last 6 months % Partners last 6 months % –1 or less59.5 – –5 or more 9.5 Previous hx of STD66.7 Previous hx of STD66.7 Use condoms “none of the time”35.7 Use condoms “none of the time”35.7

Reactions to Diagnosis (N=43) % % Important to know I have herpes100.0 Surprised to find out 90.7 Worry about infecting others 81.4 Worry about rejection 69.7 Worry about effect on sex life 67.4 Hard to believe I have herpes 60.5* Worry about effect on health 32.6 Afraid it will be difficult to live with 32.6 *female 73.1% vs. male 41.1%, p<.05

How likely are you to talk about your diagnosis with someone else in your life? “Highly likely” or “pretty likely” to talk with: to talk with: % % –Close friend44.2 –Parent38.0 –Family member27.9 –Other 23.2

How likely are you to talk about your diagnosis with sex partners? “Highly likely”or “pretty likely” to talk with: n % to talk with: n % –All current partners –Current main only, not secondary –Current secondary, not main –Most recent past partner –Other past partners –None of my current partners42 9.5

How easy or how difficult do you think it will be to talk about your diagnosis with sex partners? (N=43) “Extremely difficult” or “pretty difficult”to talk with: % % New sex partners 69.7 Current sex partners39.0 Current sex partners39.0

Likelihood of Behavior Change % Use condoms more often86.0 Have fewer new sex partners78.0 Tell partners before having sex60.0 Use condoms, but not disclose39.0 Attend support group/emotional23.3 Attend support group/find partner 11.6

Recall of Prior Symptoms % % No previous symptoms recalled76.2 No previous symptoms recalled76.2 Retrospective recall of symptoms16.7 Retrospective recall of symptoms16.7 Suspected herpes/did not seek care 7.1 Suspected herpes/did not seek care 7.1 (i.e.“cold sores, itching,blisters”)

Discussion Notification/counseling for asymptomatic patients was complex and labor intensive Notification/counseling for asymptomatic patients was complex and labor intensive Low response rate/small sample size limits generalizability of findings and may obscure significant gender and other differences Low response rate/small sample size limits generalizability of findings and may obscure significant gender and other differences STD programs must anticipate additional workload if implementing HSV testing STD programs must anticipate additional workload if implementing HSV testing

Conclusions Patients feel it is important to know they have HSV-2, but may feel surprise and disbelief at their diagnosis Patients feel it is important to know they have HSV-2, but may feel surprise and disbelief at their diagnosis Most patients say they will use condoms more frequently Most patients say they will use condoms more frequently Many other patients say they will use condoms to protect partners but not disclose diagnosis Many other patients say they will use condoms to protect partners but not disclose diagnosis

Conclusions Most patients recall no symptoms Most patients recall no symptoms More research is needed to assess the impact of diagnosis with HSV-2 and to develop appropriate counseling messages More research is needed to assess the impact of diagnosis with HSV-2 and to develop appropriate counseling messages More research is needed to assess the long term impact of a diagnosis with HSV-2 More research is needed to assess the long term impact of a diagnosis with HSV-2