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. 2003 Feb;79(1):35–41. doi: 10.1136/sti.79.1.35

Genital herpes serotesting: a study of the epidemiology and patients' knowledge and attitude among STD clinic attenders in Coventry, UK

N Narouz 1, P Allan 1, A Wade 1, S Wagstaffe 1
PMCID: PMC1744594  PMID: 12576612

Abstract

Objectives: To examine the seroprevalence and correlates of antibodies to herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), and to assess patients' knowledge and attitude towards genital herpes infection and its serotesting, before and after counselling.

Methods: A cross sectional study among genitourinary medicine (GUM) clinic attenders in Coventry, a UK metropolitan city. Participants were asked to complete a self administered questionnaire before and after counselling. Patients were counselled before testing and after receiving the result. A commercially available enzyme immunoassay (EIA) was used to identify HSV-1 and HSV-2 antibodies (Gull/Meridian EIA).

Results: 223 patients participated in the study (97% of eligible patients). Overall, prevalence of HSV-2 antibody was 43/216 (20%) (19/103, 18% for males and 24/113 (21%) for females, p=0.61) while prevalence of HSV-1 antibody was 129/215 (60%) (60% for both sexes, p=0.91). In the multivariate analysis HSV-2 seropositivity was higher among black people and those with a history of genital herpes. HSV-1 seropositivity was independently associated with less education, increased years of sexual activity (between 14–25 years), and history of cold sores. The majority of patients wanted this serotesting to be available in the clinic (204/222 (92%) before and 216/218 (99%) after counselling, p=0.0003) and 97% accepted the test when offered. Only three patients regretted having the test and four patients contacted the department within 6 months of receiving the results for more counselling.

Conclusion: The vast majority of the study population not only wanted to be tested, but accepted the test when offered. HSV-2 infection is common and largely unrecognised among our study population. The psychological impact of introducing type specific HSV serological testing in a clinical setting seems to be minimal. Counselling could improve patients' awareness of the infection and the acceptability of the test and its results.

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Selected References

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  1. Ashley R. L. Laboratory techniques in the diagnosis of herpes simplex infection. Genitourin Med. 1993 Jun;69(3):174–183. doi: 10.1136/sti.69.3.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ashley R. L., Wu L., Pickering J. W., Tu M. C., Schnorenberg L. Premarket evaluation of a commercial glycoprotein G-based enzyme immunoassay for herpes simplex virus type-specific antibodies. J Clin Microbiol. 1998 Jan;36(1):294–295. doi: 10.1128/jcm.36.1.294-295.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Austin H., Macaluso M., Nahmias A., Lee F. K., Kelaghan J., Fleenor M., Hook E. W., 3rd Correlates of herpes simplex virus seroprevalence among women attending a sexually transmitted disease clinic. Sex Transm Dis. 1999 Jul;26(6):329–334. doi: 10.1097/00007435-199907000-00004. [DOI] [PubMed] [Google Scholar]
  4. Benedetti J., Corey L., Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994 Dec 1;121(11):847–854. doi: 10.7326/0003-4819-121-11-199412010-00004. [DOI] [PubMed] [Google Scholar]
  5. Brown Z. A., Selke S., Zeh J., Kopelman J., Maslow A., Ashley R. L., Watts D. H., Berry S., Herd M., Corey L. The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997 Aug 21;337(8):509–515. doi: 10.1056/NEJM199708213370801. [DOI] [PubMed] [Google Scholar]
  6. Chen C. Y., Ballard R. C., Beck-Sague C. M., Dangor Y., Radebe F., Schmid S., Weiss J. B., Tshabalala V., Fehler G., Htun Y. Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection. Sex Transm Dis. 2000 Jan;27(1):21–29. doi: 10.1097/00007435-200001000-00005. [DOI] [PubMed] [Google Scholar]
  7. Connor-Greene P. A. The role of counseling in the treatment of genital herpes. J Am Coll Health. 1986 Jun;34(6):286–287. doi: 10.1080/07448481.1986.9938953. [DOI] [PubMed] [Google Scholar]
  8. Corey L. Raising the consciousness for identifying and controlling viral STDs: fears and frustrations--Thomas Parran Award Lecture. Sex Transm Dis. 1998 Feb;25(2):58–69. doi: 10.1097/00007435-199802000-00002. [DOI] [PubMed] [Google Scholar]
  9. Cowan F. M., Johnson A. M., Ashley R., Corey L., Mindel A. Antibody to herpes simplex virus type 2 as serological marker of sexual lifestyle in populations. BMJ. 1994 Nov 19;309(6965):1325–1329. doi: 10.1136/bmj.309.6965.1325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Cowan F. M., Johnson A. M., Ashley R., Corey L., Mindel A. Relationship between antibodies to herpes simplex virus (HSV) and symptoms of HSV infection. J Infect Dis. 1996 Sep;174(3):470–475. doi: 10.1093/infdis/174.3.470. [DOI] [PubMed] [Google Scholar]
  11. Cowan F. M. Testing for type-specific antibody to herpes simplex virus--implications for clinical practice. J Antimicrob Chemother. 2000 Apr;45 (Suppl T3):9–13. doi: 10.1093/jac/45.suppl_4.9. [DOI] [PubMed] [Google Scholar]
  12. Cunningham A. L., Lee F. K., Ho D. W., Field P. R., Law C. L., Packham D. R., McCrossin I. D., Sjögren-Jansson E., Jeansson S., Nahmias A. J. Herpes simplex virus type 2 antibody in patients attending antenatal or STD clinics. Med J Aust. 1993 Apr 19;158(8):525–528. doi: 10.5694/j.1326-5377.1993.tb121867.x. [DOI] [PubMed] [Google Scholar]
  13. Cusini M., Cusan M., Parolin C., Scioccati L., Decleva I., Mengoli C., Suligoi B., Palú G. Seroprevalence of herpes simplex virus type 2 infection among attendees of a sexually transmitted disease clinic in Italy. Italian Herpes Forum. Sex Transm Dis. 2000 May;27(5):292–295. doi: 10.1097/00007435-200005000-00011. [DOI] [PubMed] [Google Scholar]
  14. Fairley I., Monteiro E. F. Patient attitudes to type specific serological tests in the diagnosis of genital herpes. Genitourin Med. 1997 Aug;73(4):259–262. doi: 10.1136/sti.73.4.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Fleming D. T., McQuillan G. M., Johnson R. E., Nahmias A. J., Aral S. O., Lee F. K., St Louis M. E. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997 Oct 16;337(16):1105–1111. doi: 10.1056/NEJM199710163371601. [DOI] [PubMed] [Google Scholar]
  16. Groen J., Van Dijk G., Niesters H. G., Van Der Meijden W. I., Osterhaus A. D. Comparison of two enzyme-linked immunosorbent assays and one rapid immunoblot assay for detection of herpes simplex virus type 2-specific antibodies in serum. J Clin Microbiol. 1998 Mar;36(3):845–847. doi: 10.1128/jcm.36.3.845-847.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Handsfield H. H., Stone K. M., Wasserheit J. N. Prevention agenda for genital herpes. Sex Transm Dis. 1999 Apr;26(4):228–231. doi: 10.1097/00007435-199904000-00009. [DOI] [PubMed] [Google Scholar]
  18. Higgins D. L., Galavotti C., O'Reilly K. R., Schnell D. J., Moore M., Rugg D. L., Johnson R. Evidence for the effects of HIV antibody counseling and testing on risk behaviors. JAMA. 1991 Nov 6;266(17):2419–2429. [PubMed] [Google Scholar]
  19. Johnson R. E., Nahmias A. J., Magder L. S., Lee F. K., Brooks C. A., Snowden C. B. A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. N Engl J Med. 1989 Jul 6;321(1):7–12. doi: 10.1056/NEJM198907063210102. [DOI] [PubMed] [Google Scholar]
  20. Koutsky L. A., Stevens C. E., Holmes K. K., Ashley R. L., Kiviat N. B., Critchlow C. W., Corey L. Underdiagnosis of genital herpes by current clinical and viral-isolation procedures. N Engl J Med. 1992 Jun 4;326(23):1533–1539. doi: 10.1056/NEJM199206043262305. [DOI] [PubMed] [Google Scholar]
  21. Langenberg A., Benedetti J., Jenkins J., Ashley R., Winter C., Corey L. Development of clinically recognizable genital lesions among women previously identified as having "asymptomatic" herpes simplex virus type 2 infection. Ann Intern Med. 1989 Jun 1;110(11):882–887. doi: 10.7326/0003-4819-110-11-882. [DOI] [PubMed] [Google Scholar]
  22. Mertz G. J., Benedetti J., Ashley R., Selke S. A., Corey L. Risk factors for the sexual transmission of genital herpes. Ann Intern Med. 1992 Feb 1;116(3):197–202. doi: 10.7326/0003-4819-116-3-197. [DOI] [PubMed] [Google Scholar]
  23. Munday P. E., Vuddamalay J., Slomka M. J., Brown D. W. Role of type specific herpes simplex virus serology in the diagnosis and management of genital herpes. Sex Transm Infect. 1998 Jun;74(3):175–178. doi: 10.1136/sti.74.3.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Nahmias A. J., Lee F. K., Beckman-Nahmias S. Sero-epidemiological and -sociological patterns of herpes simplex virus infection in the world. Scand J Infect Dis Suppl. 1990;69:19–36. [PubMed] [Google Scholar]
  25. Narouz N., Allan P. S., Wade A. H. Genital herpes: general practitioners' knowledge and opinions. Sex Transm Infect. 2002 Jun;78(3):198–200. doi: 10.1136/sti.78.3.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rooney J. F., Felser J. M., Ostrove J. M., Straus S. E. Acquisition of genital herpes from an asymptomatic sexual partner. N Engl J Med. 1986 Jun 12;314(24):1561–1564. doi: 10.1056/NEJM198606123142407. [DOI] [PubMed] [Google Scholar]
  27. Slomka M. J., Ashley R. L., Cowan F. M., Cross A., Brown D. W. Monoclonal antibody blocking tests for the detection of HSV-1- and HSV-2-specific humoral responses: comparison with western blot assay. J Virol Methods. 1995 Sep;55(1):27–35. doi: 10.1016/0166-0934(95)00042-s. [DOI] [PubMed] [Google Scholar]
  28. Smith A., Denham I., Keogh L., Jacobs D., McHarg V., Marceglia A., Wood V. Psychosocial impact of type-specific herpes simplex serological testing on asymptomatic sexual health clinic attendees. Int J STD AIDS. 2000 Jan;11(1):15–20. doi: 10.1258/0956462001914841. [DOI] [PubMed] [Google Scholar]
  29. Vonau B., Low-Beer N., Barton S. E., Smith J. R. Antenatal serum screening for genital herpes: a study of knowledge and attitudes of women at a central London hospital. Br J Obstet Gynaecol. 1997 Mar;104(3):347–349. doi: 10.1111/j.1471-0528.1997.tb11466.x. [DOI] [PubMed] [Google Scholar]
  30. Woolley P. D., Chandiok S., Pumphrey J., Sharratt S., Shanley L., Bennett S. Serological prevalence of herpes simplex virus type 2 amongst GUM clinic attenders in a district general hospital setting. Int J STD AIDS. 2000 Jun;11(6):379–382. doi: 10.1258/0956462001916092. [DOI] [PubMed] [Google Scholar]
  31. van de Laar M. J., Termorshuizen F., Slomka M. J., van Doornum G. J., Ossewaarde J. M., Brown D. W., Coutinho R. A., van den Hoek J. A. Prevalence and correlates of herpes simplex virus type 2 infection: evaluation of behavioural risk factors. Int J Epidemiol. 1998 Feb;27(1):127–134. doi: 10.1093/ije/27.1.127. [DOI] [PubMed] [Google Scholar]

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