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Impact of Knowledge of Herpes Simplex Virus Type 2 Serostatus on STD Clinic Patients

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.

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Impact of Knowledge of Herpes Simplex Virus Type 2 Serostatus on STD Clinic Patients

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  1. Impact of Knowledge of Herpes Simplex Virus Type 2 Serostatus on STD Clinic Patients Karen A Kroeger1, Richard C Knaup2, Michael P Williams2, Bradley P Stoner1 1Washington University School of Medicine 2Department of Health, St Louis County, MO

  2. Background and Objectives • 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 • Goal of this study: to examine patient reactions to a positive serological test for HSV-2

  3. Methods • 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 • Follow up interviews within two weeks • 15 minute phone interview regarding psychosocial and behavioral impact of test

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

  5. Interview sample (N=43) • Gender • Female 60.5% • Male 39.5% • Age • Range 17-55 yrs • Mean 30 yrs • Median 25 yrs • Ethnicity • African-American 81.6% • White 18.4%

  6. Interview sample • Partners last 6 months % • 1 or less 59.5 • 2-4 31.0 • 5 or more 9.5 • Previous hx of STD 66.7 • Use condoms “none of the time” 35.7

  7. Reactions to Diagnosis (N=43) % Important to know I have herpes 100.0 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

  8. How likely are you to talk about your diagnosis with someone else in your life? “Highly likely” or “pretty likely” to talk with: % • Close friend 44.2 • Parent 38.0 • Family member 27.9 • Other 23.2

  9. How likely are you to talk about your diagnosis with sex partners? “Highly likely”or “pretty likely” to talk with: n % • All current partners 40 65.0 • Current main only, not secondary 37 64.8 • Current secondary, not main 28 35.7 • Most recent past partner 34 50.0 • Other past partners 40 22.5 • None of my current partners 42 9.5

  10. 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 partners 39.0

  11. Likelihood of Behavior Change % Use condoms more often 86.0 Have fewer new sex partners 78.0 Tell partners before having sex 60.0 Use condoms, but not disclose 39.0 Attend support group/emotional 23.3 Attend support group/find partner 11.6

  12. Recall of Prior Symptoms % • No previous symptoms recalled 76.2 • Retrospective recall of symptoms 16.7 • Suspected herpes/did not seek care 7.1 (i.e.“cold sores, itching,blisters”)

  13. Discussion • 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 • STD programs must anticipate additional workload if implementing HSV testing

  14. Conclusions • 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 • Many other patients say they will use condoms to protect partners but not disclose diagnosis

  15. Conclusions • 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 long term impact of a diagnosis with HSV-2

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