Herpes Simplex Virus: To disclose or not to disclose. An exploration of the multi-disciplinary team’s role in advising patients about disclosure when diagnosed with genital herpes simplex virus (HSV). Pauline Caulfield Advanced Nurse Practitioner Sandyford Services Glasgow City Community Health Partnership North West Sector

Background  Herpes Simplex Virus (HSV) – First UK prosecution for transmission 2011  Implications to clinical practice/protocols regarding the now legal issue of disclosure – change in local protocol  The psychological morbidity and stigma associated with HSV is well documented  Factors affecting disclosure have been widely explored in literature  Gap in literature: what do the multidisciplinary team advise patients diagnosed with HSV regarding disclosure?

 Aim The overall aim of the study was to explore the nature of advice given to patients by the multidisciplinary team regarding HSV disclosure to partners.  Objective To explore different staff group’s views on HSV disclosure and the nature of advice they give to patients.

Methods  Design ▪Qualitative descriptive approach  Sample  A Stratified Convenience sample of 10 members of the multidisciplinary team  Data Collection  10 Semi-structured interviews were conducted in March 2014  Data Analysis  Interviews were transcribed verbatim and analysed using Burnard’s Thematic Content Analysis

FINDINGS THEME 1: HSV – The Facts  Physical Care/Management ‘I would talk about the immediate symptomatic relief and treatment to reduce the severity and duration of her lesions.’ (Participant 9)  Normalising HSV ‘I often use the image of an iceberg. This is particularly useful when talking about partners. The people with symptoms are the bit of the iceberg above the water and the part of the population infected who never get symptoms is the big chunk underneath.’ (Participant 2)

FINDINGS THEME 2: Stigma and Psychological Aspects of HSV The Aftermath’  ‘ The Aftermath’ ‘It is definitely the one that brings the most tears…it is more the psychological aspects of having HSV that we deal with rather than the physical symptoms.’ (Participant 4) The Future’  ‘The Future’ ‘they become concerned about the future and if they will ever have a sexual partner again cause they don’t want to transmit it to somebody else.’ (Participant 6)

FINDINGS THEME 3: The Challenge of Disclosure  Patient’s Choice ‘Ultimately it is up to them. It is the patient’s choice. If patients choose not to tell their partners, that is up to them.’ (Participant 3)  Casual Versus Regular ‘I say I think it is up to you to gauge each relationship and each partner and obviously if it is casual sex and it is a one off I think it is much less likely that someone will be willing to do that.’ (Participant 5)  Lack of Guidance ‘I think we need some clear guidance as to what should form part of the consultation about the partner notification aspects of HSV.’ (Participant 10)

FINDINGS THEME 4: The Legal Case: Revenge not Justice ‘I just wonder whether some of these cases are driven more by revenge and that justice really isn’t well served by pursuing them.’ (Participant 10) ‘I think it is really sad and unfortunate that it got to court and there was a successful prosecution.’ (Participant 4) ‘Makes no sense to me given the prevalence of herpes. How could they prove it was him?’ (Participant 7)

Discussion Participants provided accurate information on HSV Disclosure more likely to occur to a regular partner General consensus disclosure not required due to the prevalence of HSV Participants believed disclosure to be the patient’s choice Participants not following local protocol on disclosure

Conclusions and Recommendations Conclusions:Conclusions:  Participants believed that disclosure was the patient’s choice  Participants had not altered their practice to advise disclosure to all partners in accordance with local protocol. Recommendations:Recommendations:  Clearer guidance on disclosure required to guide advice given and ensure continuity of practice  Larger multi-centre study to assess current practice