Psychosocial Well-Being and Quality of Life Among Women Newly Diagnosed With Genital Herpes

doi:10.1111/j.1552-6909.2009.01026.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 38, Issue 3, May–June 2009, Pages 320-326

https://doi.org/10.1111/j.1552-6909.2009.01026.x Get rights and content

ABSTRACT

Objective

To assess the psychosocial well-being and quality of life among women with a new genital herpes simplex virus diagnosis.

Design

Data were collected by a cross-sectional survey.

Participants

Eighty-three women diagnosed with genital herpes simplex virus by culture, visual exam and/or a description of symptoms within the last 3 months were recruited from primary health care clinics by their provider.

Measures

Participants completed the Hospital Anxiety and Depression Scale and the Recurrent Genital Herpes Quality of Life scale.

Results

Thirty-four percent of the women qualified as “clinical cases” for depression, and 64% were designated as “anxiety cases” based on Hospital Anxiety and Depression Scale scoring methods. A majority of participants reported feeling ashamed about having herpes and worried about having an outbreak or giving herpes to someone else.

Conclusions

Despite substantial progress toward understanding genital herpes simplex virus epidemiology and transmission, a diagnosis of genital herpes continues to cause considerable psychosocial morbidity and to impact quality of life. There is a dearth of good evidence on how best to intervene to minimize the psychological impact of a diagnosis. Experts recommend addressing both the medical and psychological aspects of infection by providing antiviral therapy, written material, and resources.

Section snippets

Study Design

This was a cross-sectional study of 101 individuals who had been diagnosed with genital HSV in the past 4 months. Each respondent was asked to provide demographic information and complete the Hospital Anxiety and Depression Scale (HADS) and Recurrent Genital Herpes Quality of Life (RGHQOL) instrument at one point in time. No follow-up study was conducted.

Subjects and Procedure

In late 2006 and early 2007, e-mail invitations were sent from professional organizations to over 8,000 randomly selected physicians who were

Results

Thirty-four providers recruited one to three subjects each. Table 1 presents the sample characteristics of the subjects. More than two thirds were between the ages of 15 and 34 years old and the majority was White. Most (76%) diagnoses included a visual exam and/or culture, and 60.5% of women planned to use either daily suppressive or episodic therapy to treat their infection.

Anxiety and depression were common in this population with 33.8% defined as HADS cases on the depression subscale and

Discussion and Conclusions

The findings from this study suggested that despite an increased understanding about the frequency of occurrence of HSV-2 and the availability of treatment to limit symptoms and transmission, the impact of a genital herpes diagnosis for women with symptoms has not lessened. This study reinforces the results of a 1993 study of patients with recurrent genital HSV, in which 14% of the subjects were defined as HADS depression cases at the first visit following a genital herpes diagnosis and 60%

Limitations

The findings in this study should be interpreted in the context of several limitations. First, this was a cross-sectional, descriptive study using a convenience sample. The depression and anxiety noted in these participants could be related to other factors such as premorbid functioning (e.g., interpersonal distress before screening) (Rosenthal et al., 2006). In addition, frequency, painfulness, and duration (severity) of physical symptoms for each patient were not measured, which may influence

Conclusions

As a major source of primary care around the world, nurses are frequently the providers who diagnose genital HSV. This study indicates that despite substantial progress in our understanding of genital HSV epidemiology and transmission, a diagnosis of genital HSV through clinical symptoms continues to cause psychosocial morbidity and impact on quality of life. There is a lack of systematic evidence about how best to counsel and reduce psychological morbidity in women with genital herpes,

Acknowledgments

Funded by GlaxoSmithKline. The authors thank Mitch Herndon, American Social Health Association Scientific Advisory Committee, and Aimee Gallager.

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Sexually transmitted infections (STIs) are an ongoing global health challenge, contributing to significant morbidity and mortality. Globally, nearly 1 million new curable STIs are diagnosed every day (Rowley et al., 2019). In 2016 alone, there were 127.2 million new diagnoses of Chlamydia trachomatis, 86.9 million diagnoses of Neisseria gonorrhoeae, 156 million diagnoses of Trichomonas vaginalis, and 6.3 million new diagnoses of syphilis among 15–49-year-old men and women (Rowley et al., 2019). In the U.S., adolescents and young adults remain heavily impacted by STIs, with an estimated half of new infections occurring in youth ages 15–25 years old (Satterwhite et al., 2013). Given the heavy burden of these STIs in adolescents and young adults, the focus of this chapter is on youth ages 13–24 years and the STIs most prevalent in this age group: C. trachomatis (chlamydia), N. gonorrhoeae (gonorrhea), Trichomonas vaginalis (trichomonas), syphilis, and genital herpes simplex virus (HSV; herpes). Numerous biological, psychological/behavioral, and social factors serve as risk and protective factors for STIs among youth and are discussed below. Although this chapter will not address human immunodeficiency virus (HIV) infection, it is important to note that both bacterial and viral STIs increase the transmission and acquisition of HIV infection (Centers for Disease Control and Prevention, 2021).
Frequency of depressive symptoms among female migrant workers in China: associations with acculturation, discrimination, and reproductive health
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Importantly, because all of the participants in this study are women, gender-based discrimination in the workplace, that includes unpleasantness in social encounters and verbal disrespect, may be contributing to feelings of interpersonal discrimination. Finally, although a history of reproductive health conditions has been shown to increase risk of significant depressive symptoms,32–34 the incidence of these conditions was very low in this sample. The low rate may be explained by age, as the mean age for this sample is 34 years, which is considered a generally healthy age group.48
Depression has been associated with numerous adverse health conditions. This study sought to determine the frequency of significant depressive symptoms and whether or not acculturative stress, discrimination, and reproductive health conditions were risk factors for significant depressive symptoms in migrant working women in China.
The design of this study is cross-sectional.
Data were derived from a survey of female migrant workers at three employment sites in Changsha, China. The associations between acculturative stress, discrimination, reproductive health, and risk for significant depressive symptoms were obtained using F-tests for mean differences, correlations, ordinary least squares regression, and logistic regression analysis.
Between March and June 2017, 232 eligible female participants completed the survey among whom the median age was 34.36 years (standard error 0.43) and 25.58% reported significant depressive symptoms. Significant depressive symptoms were associated with higher education (F-test, P = .006), all four acculturative stress factors (r = 0.15 to r = 0.29), both institutional and interpersonal discrimination (r = 0.29, r = 0.35), age (r = − 0.13), and self-rated health (r = − 0.19). In multivariate regression analysis of depression scale scores, interpersonal discrimination was the strongest predictor (beta = 0.238, P = .002) among the nine factors identified in bivariate analysis. None of the other predictors (age, self-rated health, education, acculturative stress, and institutional discrimination) showed significant associations with the depression scale. Similar results were obtained for a multivariate logistic regression analysis of a clinically important threshold for depression (<10 versus ≥ 10 on the depression scale). Only interpersonal discrimination significantly distinguished between clinical depression categories (odds ratio = 2.607 per unit change in the index, P = .001).
Migrant women workers in China appear to be at risk for significant depressive symptoms, and interpersonal discrimination appears to be an important risk factor in this setting. Acculturative stress and institutional discrimination may also be relevant risk factors, as suggested in our bivariate analysis, but in our sample, the correlations between the stress and discrimination factors are high enough to compromise identification of unique associations between acculturation stress and depression. Government, community and workplace education, and psychosocial services for migrant women are recommended.
Review of mathematical models of HSV-2 vaccination: Implications for vaccine development
2019, Vaccine
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In 2012, 417 million people aged 15–49 years were estimated to be infected with HSV-2, 64% of whom were women [1]. HSV-2 infection can cause recurrent painful genital lesions and is often associated with negative psychosocial effects such as shame, anxiety, and depression [2,3]. Although neonatal herpes from mother-to-child transmission is rare, it has high morbidity and mortality [4].
Development of a vaccine against herpes simplex virus type 2 (HSV-2), a life-long sexually-transmitted infection (STI), would be a major step forward in improving global sexual and reproductive health. In this review, we identified published literature of dynamic mathematical models assessing the impact of either prophylactic or therapeutic HSV-2 vaccination at the population level. We compared each study’s model structure and assumptions as well as predicted vaccination impact. We examined possible causes of heterogeneity across model predictions, key gaps, and the implications of these findings for future modelling efforts. Only eight modelling studies have assessed the potential public health impact of HSV-2 vaccination, with the majority focusing on impact of prophylactic vaccines. The studies showed that even an imperfect prophylactic HSV-2 vaccine could have an important public health impact on HSV-2 incidence, and could also impact HIV indirectly in high HIV prevalence settings. Therapeutic vaccines also may provide public health benefits, though they have been explored less extensively. However, there was substantial variation in predicted population-level impact for both types of vaccine, reflecting differences in assumptions between model scenarios. Importantly, many models did not account for heterogeneity in infection rates such as by age, sex and sexual activity. Future modelling work to inform decisions on HSV vaccine development and implementation should consider cost-effectiveness, account for additional HSV-2 sequelae such as neonatal transmission, and model greater heterogeneity in infection rates between individuals, more realistic vaccine deployment, and more thorough sensitivity and uncertainty analyses.
Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya
2018, Journal of Sexual Medicine
Citation Excerpt :
For comparison, the mean raw baseline SQoL-M score in our study was 59.2, much higher than scores derived from other relatively young and healthy male populations. In keeping with other studies,36,37 HSV-2 seropositivity was associated with decreased SQoL for females. Given the high seroprevalence of HSV-2, it would have improved understanding to assess frequency or severity of outbreaks and impact on SQoL, to help inform clinician recommendations for suppressive therapy and/or enhanced counseling.
Sexual quality of life (SQoL) is a critical component of sexual health and is understudied in Sub-Saharan African settings with endemic HIV and sexually transmitted infection (STI).
We sought to assess SQoL among heterosexual couples in Kisumu, Kenya, and how this was associated with HIV status, STIs, and sexual practices.
This was a prospective cohort study of community-recruited couples. SQoL, HIV status, herpes simplex virus (HSV)-2 status, bacterial vaginosis (BV), sexual practices, and sociodemographics were measured at baseline, 6 months, and 12 months. Multivariable linear regression with random intercept was fitted separately for females and males, accounting for partner characteristics.
SQoL was assessed with an 18-item female and 11-item male survey.
From April 2014 through July 2016, 252 couples were enrolled, and followed up through September 2017. At baseline, women were median age 23 years, 10% HIV positive, 53% HSV-2 seropositive, and 22% with BV. At baseline men were median age 26 years, 12% HIV positive, 47% HSV-2 seropositive, and 56% circumcised. Mean SQoL was higher for men (88) than women (78), with consistent scores over time. In multivariable analysis (P < .05 each), SQoL Questionnaire—Female (SQoL-F) score was reduced with: male partner report that sex felt rougher than he would have liked (9.5-point decrease), female HSV-2 seropositivity (5.15-point decrease), female reported having dry vaginal sex (5.27-point decrease); among women with BV, SQoL-F score declined with recent sexual activity (8.27-point decrease) and increasing age (0.75-point decrease per 1 year increase in age). Age and recent sex did not affect SQoL-F for women without BV. SQoL Questionnaire—Male score was decreased 4.99 points if male was employed, 4.52 points if male reported multiple recent sex partners, and 29.5 points for HIV positive men whose female partner reported having sex when not in the mood. Men’s SQoL increased by 0.84 points for each 1-U increase in female partner body mass index and 17.6 points for HIV positive men whose female partner reported recent sex with him.
Within sexual partnerships, men had greater SQoL than women, and the adverse impact of BV and STIs on SQoL was greater for women than men.
Research is needed to ensure relevant domains are measured in settings where measure of SQoL has not been validated, along with robust measures of physiologic and psychologic correlates.
More attention to SQoL as an outcome may strengthen interventions aimed at preventing HIV and STIs and improving sexual health holistically.
Mehta SD, Nordgren RK, Agingu W, et al. Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya. J Sex Med 2018;15:1446–1455.
Genital Herpes Beliefs: Implications for Sexual Health
2013, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
A likely reason for the strong beliefs about the negative psychosocial consequences is the significant stigma associated with HSV and other STDs.8 A number of studies corroborate the serious psychological impact of an HSV diagnosis.10,22,23 Given the relationship between daily distress, HSV shedding and frequency of outbreaks,24 interventions that address psychological implications of a new HSV diagnosis are warranted.
Genital herpes (HSV) is exceedingly common in the United States and women are disproportionally affected. This study aims to describe young women's beliefs about HSV and examine the correlates of those beliefs.
A 40-item Herpes Representation measure (HSV-RoSTD) and a demographic questionnaire were administered to a convenience sample of young women. Data analysis included descriptive statistics, t-tests and Pearson's correlations.
Four women's health clinics and one large state university.
302 women aged 18-24 years.
None.
Four dimensions of HSV representations (cause, identity, future perspective, and psychosocial consequences), age and STD testing history.
Nearly all (98%) believed that HSV would result in genital sores and 68% believed they could tell if their sexual partner had HSV. Most (89%) understood the longevity of HSV; however, 30% believed that they could take a pill to get rid of the infection, and 15% indicated that it was likely they would die from HSV. Negative beliefs about the psychosocial impact of HSV were common as 95% indicated they would be depressed and 90% indicated concern about sex and partner notification. Those who were younger and those who had never been tested for STDs believed a genital herpes infection is highly symptomatic. Finally, negative beliefs about the psychosocial consequences of HSV were associated with beliefs about HSV being symptomatic, having a negative impact on future health, and being associated with sexual risk behaviors.
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Epidemiology of herpes simplex virus type 1 and genital herpes in Australia and New Zealand: Systematic review, meta-analyses and meta-regressions
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RESEARCHPsychosocial Well-Being and Quality of Life Among Women Newly Diagnosed With Genital Herpes

ABSTRACT

Objective

Design

Participants

Measures

Results

Conclusions

Section snippets

Study Design

Subjects and Procedure

Results

Discussion and Conclusions

Limitations

Conclusions

Acknowledgments

Journal of Clinical Virology

Journal Clinical Virology

Journal Psychosomatic Research

Infectious Disease Clinics of North America

Genital herpes infection

International Journal of Epidemiology

A prospective study of the psychological impact on patients with first-episode of genital herpes

Genitourinary Medicine

The effect of suppressive oral acyclovir on the psychological morbidity associated with recurrent genital herpes

Genitourinary Medicine

Once-daily valacyclovir to reduce the risk of transmission of genital herpes

New England Journal of Medicine

The international development of the RGHQOL

Quality of Life Research

Changing epidemiology of herpes simplex virus type 1 infections

Herpes

Psychosocial impact of serological diagnosis of herpes simplex virus type 2

Sexually Transmitted Infections

The psychosocial impact of serological herpes simplex type 2 testing in an urban HIV clinic

Sexually Transmitted Infections

The psychosocial impact of testing individuals with no history of genital herpes for herpes simplex virus type 2

Sexually Transmitted Infections

The Hospital Anxiety and Depression Scale (HADS). Translation and validation study of the Iranian version

Health and Quality of Life

RESEARCH
Psychosocial Well-Being and Quality of Life Among Women Newly Diagnosed With Genital Herpes