Management of genital herpes by genitourinary physicians: does experience or doctor's gender influence clinical management?

Abstract

Objective-To determine the variation in management of genital herpes by genitourinary physicians, and whether their duration of experience or gender influence their clinical management. Methods-A postal questionnaire was sent to UK consultant genitourinary physicians with detailed questions about management of primary and recurrent herpes. The gender and duration of genitourinary medicine experience of the physicians were also recorded. Results-One hundred and eighty two questionnaires were sent, 112 (62%) returned. Eighty-one (72%) physicians treat all patients with primary genital herpes, but physicians with more than 20 years experience were significantly (p < 0.05) more likely to treat only "severe"y primary attacks. Most experienced physicians were also most likely (p < 0.05) to prescribe topical acyclovir. Prescription of suppressive acyclovir was also influenced by the experience of the physician, the least experienced physicians being more likely to prescribe to patients who were HIV antibody positive or to those entering new relationships, whereas the more experienced prescribed to those patients who were particularly anxious (p < 0.05 for each of these). Male physicians were significantly more likely to agree with the proposition that men cope better with genital herpes (54%) than female physicians (24%, p < 0-01).

The Value of Antivirals in Genital Herpes

“…This study demonstrated that there was no clinical advantage gained by the addition of topical therapy for patients treated with oral aciclovir. Despite this, two UK studies found that 30% of genito urinary physicians (Russell et al, 1993) and one-third of general practitioners (Woolley & Chandiok, 1996) routinely prescribe this combination for first episode genital herpes.…”

“…3). Despite little evidence of clinical benefit, topical aciclovir is prescribed by 34% ofgenitourinary physicians in the UK (Russell et al, 1993) Corey et al (1982). (n = 20)…”

“…Similarly, although there is little evidence for a clinical benefit for oral aciclovir in this setting, it is prescribed by 30% of genitourinary physicians (Russell et al, 1993) and 43% of general practitioners (Woolley & Chandiok, 1996). Valaciclovir has also been studied in the episodic treatment of individual recurrences of genital herpes.…”

“…Although continuous, suppressive antiviral therapy has been advocated for those with frequently recurring genital herpes, the most common indication reported by genitourinary physicians is to reduce the psychological morbidity associated with the unpredictability of recurrent episodes (Russell et al, 1993). To this end, suppressive therapy should aim at reducing the number of clinically confirmed recurrences to a minimum.…”

Clinical experience did not reduce the variance in physicians' estimates of pretest probability in a cross-sectional survey

“…The few studies that have evaluated the influence of experience on clinical decision-making have shown equivocal results [10][11][12][13][14][15]. In one study, cardiologists estimating the prognosis of patients with heart disease were correct, on average, less frequently than statistical computer software that used an epidemiologic database [10]; however, no significant difference was found between participants according to their clinical experience.…”