Serologic Screening for Herpes Simplex Virus Among University Students: A Pilot Study

Abstract

Objective-The authors examined the feasibility of conducting serologic testing for the herpes simplex virus 2 (HSV-2) among university students and assessed the psychosocial impact of an HSV-2 diagnosis.Methods-The authors recruited a convenience sample of 100 students (aged 18-39 years) without a history of genital herpes from 1 university between September 2004 and March 2006. Participants received HSV-2 antibody testing by Focus ELISA and Western Blot assays and completed a questionnaire that addressed psychological functioning. Twenty-eight participants completed the questionnaire again at a 3-month follow-up visit.Results-The study revealed (1) low test-reliability in the student population, (2) that positive test results may cause a decline in psychological well-being, and (3) that substantial resources are required to support students with positive HSV-2 results.Conclusions-Test performance, psychological impact, and availability of resources for counseling students with positive diagnoses should be considered before implementing HSV testing programs. Keywords clinical medicine; mental health; sexually transmitted diseaseIn the United States, approximately 17% of adults are infected with herpes simplex virus type 2 (HSV-2) and 58% are infected with herpes simplex virus type 1 (HSV-1). 1 More than twothirds of those infected are unaware of their infection, and the majority of infections are transmitted by these individuals. 2 Herpes infections are associated with substantial morbidity and transmission and acquisition of the human immunodeficiency virus (HIV). 3 University students (at either the undergraduate or the graduate level) often engage in sexual behaviors that put them at high risk for contracting HSV and other sexually transmitted diseases (STDs). Several studies have documented high levels of sexual risk behavior among college students in the form of inconsistent or no condom use, multiple lifetime sex partners, and alcohol and other drug use combined with sexual activity. [4][5][6][7] The most recent national survey on HSV rates indicates that 10.6% of 20-to 29-year-olds are infected with HSV-2 and 54.4% are infected with HSV-1. 1 Although HSV-1 has historically been the primary cause of oral-

Herpes simplex virus type 2 serological testing and psychosocial harm: a systematic review

“…Four studies also compared participants who tested HSV-2 positive with participants who tested HSV-2 negative 25 28 31 32. Three studies compared responses in HSV-2-positive participants with and without a history of genital herpes 27 30 33…”

“…Two studies reported a negative impact following an HSV-2 diagnosis 25 30. Three months after HSV serological testing, Mark et al 25 found that five HSV-2-seropositive college students reported significantly higher levels of distress than 23 students who tested HSV-2 negative, but found no differences in depression.…”

“…Three months after HSV serological testing, Mark et al 25 found that five HSV-2-seropositive college students reported significantly higher levels of distress than 23 students who tested HSV-2 negative, but found no differences in depression. Similarly, among HMO enrollees, HSV-2-positive persons reported higher levels of mood disturbance at multiple time points compared with baseline (p=0.003), yet these mood scores were not significantly different from HSV-2-negative persons 30…”

“…Mark et al 25 found that six (75%) of eight HSV-2-positive college students contacted study staff for additional counselling. In the other two studies, few participants requested additional counselling (one (4%) of 2533 and four (2%) of 223) 29…”

Disclosure of HSV-2 serological test results in the context of an adolescent HIV prevention trial in Kenya

“…Some U.S. studies have raised concerns about disclosure after serological screening in the absence of pre-existing symptoms or diagnosis, given the low calculated positive predictive value (PPV) of existing enzyme-linked immunosorbent assay (ELISA) tests [22] and the possibility of psychosocial harm. [23] Young adolescents are likely to have a low prevalence of HSV-2 infection,[19, 16] and PPV for all diagnostic tests drops greatly when prevalence is low, resulting in a potentially high rate of false positives.…”