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Journal Club: Patient attitudes to type specific serological testing in the diagnosis of genital herpes
Jul 5, 2013 by Chanelle Edwards, R2 Family Practice
Fairley I, Monteiro E F. Patient attitudes to type specific serological testing in the diagnosis of genital herpes. Genitourin Med 1997;73:259-262.
Purpose of study
The purpose of this research study was to assess patient attitudes towards serotesting for herpes simplex virus type 2 (HSV-2), and to assess the effect of providing detailed information about genital herpes, the blood test and result implications. Physicians in a family practice setting are commonly asked about screening for HSV-2 (i.e., genital herpes) by individuals who have never had genital lesions or known contacts. This journal review was completed in order to assess patient attitudes towards genital herpes testing and the psychological impact of a positive test on patient well-being.
The researchers in this study used a structured self-administered questionnaire with attendees of a genitourinary medicine clinic. Participants were separated into two groups to determine if baseline attitudes were altered by provision of detailed information on HSV, testing and result implications. The first group received the minimal information needed to consent for the study. The second group received a detailed three page information sheet to read prior to completing questionnaire, which included information relating to aspects of herpes virology, recognition of disease, modes of transmission, prevention and treatment.
The key findings in this study included a large potential demand for routine, type specific serological testing for HSV among genitourinary medicine clinic patients. This highlights the importance of assessing lab and counseling resources needed to introduce such testing. On the contrary, as this study was conducted in 1997, we now understand that HSV-1 can present as genital lesions and thus testing negative for HSV-2 is not confirmatory.
Implications on clinical practice
A systematic review of studies, conducted across variety of clinical settings , cites a number of findings about serological testing for HSV-2 in persons without a recognized history of genital herpes:
- Testing did not cause persistent mental health problems, including anxiety, depression, distress or changes in sexual attitude;
- Before testing, patients anticipated their HSV-2 diagnosis to be quite severe, but after positive diagnosis, patients viewed it as less severe;
- Most patients interested in HSV-2 testing did not regret being tested.
The implications for practice include the fact that physicians need to carefully consider the management, therapeutic implications and pitfalls of testing. Physicians need to be clear on what the test indicates and what to advise patients regarding the results. Finally, future studies may address whether higher rates of HSV-2 diagnosis can lead to a reduction in transmission through partner notification, antiviral suppressive medication and condom use.
- Fairley I, Monteiro E F. Patient attitudes to type specific serological testing in the diagnosis of genital herpes. Genitourin Med 1997;73:259-262.
- Ross K, Johnston C, Wald A. Herpes simplex virus type 2 serological testing and psychosocial harm: a systematic review. Sex Transm Infect 2011;87:7 594-600. Published Online First: 8 September 2011.
Categories: Journal club