Table 1

Study characteristics and results

Study	Participants	Size	Female %	Median age (range)^*mean	Serological test	HSV-2 test results	Psychosocial assessment	Follow-up	Summary results
Qualitative cohort
Melville26 (USA, 2003)	Attendees from four academic university clinics No history of genital HSV before diagnosis 7/24 pregnant at diagnosis	24	58	35 (19–55)	HSV western blot	Positive, per inclusion criteria 24/24	1 h semi-structured interview	Post results (<1 month to 1 year post-diagnosis)	Subjects reported surprise, fear of transmission/disclosure, feeling undesirable and ongoing acceptance over time. Knowledge and social support were moderators of response.
Prospective cohorts
Mark25 (USA, 2008)	Students at an urban college campus No history of genital HSV diagnosis or genital sores Sexually active in past 6 months	100	64	24.5^* (18–39)	HerpeSelect and western blot	Eight (9%) tested positive by ELISA, three confirmed by western blot	Depression Scale (CES-D) General health questionnaire (GHQ-30)	3 months	Significant increase in GHQ-30 for HSV-2 positives compared with negatives at 2 months (13 points↑ vs. 3 points ↓, p<0.05). Slight ↑ on CES-D for positives, but not significant. Four out of eight positives asked for additional meeting with staff.
Meyer27 (USA, 2005)	Urban HIV clinic patients No negative HSV-2 test in past year 145 (67%) with AIDS diagnosis 56 with history of genital herpes	248	15	40 (22–66)	HSV western blot	172 (69.4%) positive, 116 without previous history of genital HSV	Mood states scale Genital herpes HRQoL Sexual satisfaction-MSSCQ Ways of coping Perceived severity of diagnosis	2 weeks, 3 months, 6 months	No significant changes on any measure over time for positive subjects, no significant difference when comparing positive and negative subjects or subjects with previous HSV-2 history.
Miyai28 (USA, 2004)	STD clinic attendees No history of genital HSV diagnosis or symptomatic infection at enrollment Asking for HSV testing at STD clinic	196	17	No of subjects by age group 18–20 years: 84 30–39 years: 75 40+ years: 37	HerpeSelect 2	41 (21%) tested positive	Modified Rand mental health inventory (MHI-5) Sexual self-concept questionnaire Modified MSSCQ Genital herpes perceptions	1 week, 3 months	No change in MHI-5 at 1 week (0.33, p=0.44) or 3 months (0.31, p=0.6) in HSV-2-positive participants relative to baseline, no significant difference between positive and negative groups. Decline in sexual attitude at 1 week for positive subjects compared with negative subjects, resolved by 3 months.
Narouz29 (UK, 2003)	Genitourinary medicine clinic patients Presenting at clinic for new problem and routine syphilis screening HIV negative	223	52	28 (16–66)	Gull/Meridian gG EIA	43 (20%) tested positive for HSV-2, 14 had a previous history of genital herpes	Subjects asked if they regretted having testing done when given results	1 week	Three patients regretted being tested. Four out of 43 people who were positive contacted department for more counselling.
Richards30 (USA, 2007)	Urban HMO enrollees recruited via mail and phone	201	60	46 (19–67)	HSV western blot	26% (87 of 344) tested positive, 44 without previous diagnosis of HSV-2, 87 positives and 114 negatives were enrolled in the follow-up study	Perceived susceptibility and severity mood states Genital herpes HRQoL Sexual optimism Sexual satisfaction Ways of coping	2 weeks, 3 months, 6 months	6% ↑ on mood disturbance for newly diagnosed subjects relative to baseline (p=0.003), no significant difference when comparing between groups except within HSV-specific mood disturbance. At 2 weeks, newly diagnosed coped by wishing situation would disappear (0.038 points higher, p=0.014) relative to previously diagnosed and other time points (0.37, p<0.001).
Rosenthal31 (USA, 2006)	Students from an urban university setting, attendees from an STD clinic, primary care clinic and adolescent clinics No previous history of genital HSV 7% of positives were adolescents	93	87	22.7^* (criteria: 14–30 years)	HSV-2 antibody test	18% (149 of 820) tested positive, 33 positives and 60 negatives were enrolled in the follow-up study	Perceived social support Relationship quality STD-related stigma Perceived quality of sex Genital herpes HRQoL	3 months	No significant difference between positive and negative subjects on depression, anxiety, paranoia, hostility, interpersonal sensitivity, STD stigma, relationship quality, or quality of sex. No effect for time.
Smith32 (AU, 2000)	Sexual health centre attendees No symptoms or history of genital HSV Presenting for genital and serological screening tests	180	46	No of subjects by age group 18–30 years: 127 31–40 years: 32 >40 years: 21	HSV-2 enzyme immunoassay and HSV-1 western blot	21 (11.7%) tested positive	General health questionnaire (GHQ-12) State anxiety index Self-esteem inventory Sexual attitudes scale	3 months, 6 months	No change in GHQ-12 or other scales for HSV-2-positive or negative participants over time.
Wilkinson33 (UK, 2000) letter to the editor	Attendees from three hospitals (outpatient) Subjects enrolled in study comparing POCKit to standard HSV serology 35/90 with history of genital herpes	90	50	Not specified	POCKit HSV-2	51 (57%) tested positive, 25 without previous HSV-2 diagnosis	Hospital anxiety and depression questionnaire (HAD)	3 months, 6 months	No significant difference in the number of cases of anxiety or depression in those who tested positive with or without a previous history of HSV-2.

↵* Mean age.
EIA, enzyme immunoassay; ELISA, enzyme-linked immunosorbent assay; HMO, health maintenance organisation; HSV, herpes simplex virus; STD, sexually transmitted disease.