Background Herpes simplex virus type 2, the main cause of genital herpes, is found worldwide among populations. US National seroprevalence is estimated at 16.2%, with highest rates among women (20.9%) & non-Hispanic blacks (39.2%). Medical consequences of HSV-2 infection includes a two- to five-fold increased risk for HIV 1 transmission & neonatal herpes. The advent of type-specific HSV serologic tests offers accurate methods of diagnosis for those who are asymptomatic. However, diagnosis of HSV-2 has been noted to be distressing for those who are asymptomatic & unaware of infection. The purpose of this study is to understand social & emotional impact of HSV-2 serodiagnosis on asymptomatic women over time.
Methods Purposeful sampling was conducted & 28 women, newly diagnosed as HSV-2 serologic positive & asymptomatic, were recruited from a Midwestern STD clinic & urban community court. A series of three open-ended interviews were conducted over 6-month period. Interviews were audio recorded & transcribed. Important areas explored: emotional & social responses to diagnosis; motivations for (non) disclosure of HSV-2 status; exploration of sexual behaviour post-diagnosis; use of condoms & suppressive therapy. Qualitative analysis was done using manual coding.
Results Age of participants ranged from 19 to 61 yrs. Majority were African-American (71%) with 21% white. No participants reported knowledge of HSV-2 status at diagnosis. Five themes emerged during analysis of first interviews: rumination & disclosure anxiety; knowledge deficit anxiety; stigmatisation & alteration in self-concept; fear/apprehension regarding future; impact on sexuality & partnering. With analysis of 6-month interviews there was an iteration of two themes--alteration in self-concept & impact on sexuality & partnering. Of 23 participants who completed three interviews-22% had no plans for sex after diagnosis, 39% never disclosed HSV-2 status to partners & 56% never used suppressive therapy.
Conclusions Findings suggest that despite increased public information related to HSV-2, initial diagnosis remains traumatic, & for a small percentage anxiety lingers for at least 6 months. Providers should be aware of need for written information targeted to non-clinicians & that further follow-up should be initiated after diagnosis to reinforce learning, clarify concerns, counsel & support. Providers should plan additional time for client integration of diagnosis, implications & questions.