P2-S3.10 HSV-2 serologic testing and psychosocial harm: a systematic review

Abstract

Background: Serologic testing for herpes simplex virus type-2 (HSV- 2) in persons without a history of genital herpes is currently not recommended partly due to the concern that HSV-2 diagnosis would lead to negative psychosocial sequelae, such as anxiety and depression. We conducted a systematic review to assess the evidence as to whether HSV-2 serologic testing among asymptomatic persons results in persistent negative psychosocial consequences. Method(s): Eight electronic databases and unpublished data sources were searched to identify studies measuring the psychosocial impact of HSV-2 serologic testing in persons without a history of genital herpes. To be included, studies had to test for HSV-2 using an HSV type-specific serologic test and to perform at least one psychosocial assessment of participants after they received HSV serologic results. We compared psychosocial responses in HSV-2 positive persons over time and vsHSV-2 negative persons (when available). Result(s): Nine studies satisfied the inclusion criteria. Studies were published from the years 2000-2008 and were conducted in the USA (N=6), Australia (N=2), and the UK (N=1). In total, 1355 participants were included; 596 (44%) participants were HSV-2 positive, and of these 341 (57%) lacked prior history of genital herpes. Participants were recruited from a variety of settings (ie, STD clinics, HMO enrollees, college campuses). Follow-up ranged from immediately after diagnosis to 1 year afterwards. Seven studies reported that HSV-2 diagnosis by serologic test did not have a persistent negative impact on participants' mental health (anxiety, depression, self-esteem) or sexual attitude and satisfaction. Two studies reported a negative impact of testing; one found that 5 HSV- 2 seropositive college students had increased distress 3 months posttesting as compared to HSV-2 negatives, and the other found selfreports of sexual undesirability up to one year after diagnosis. A genital herpes diagnosis was perceived as moderately severe for participants prior to testing; however, after HSV-2 testing, the perceived severity of a herpes diagnosis was lower among those testing HSV-2 positive. Conclusion(s): Diagnosis of HSV-2 by type-specific serologic testing did not result in long-term psychosocial harm in most asymptomatic persons. Concerns about sustained emotional impact should not deter clinicians from testing individuals without a history of genital herpes for HSV-2.