Magazine article Clinical Psychiatry News

Educate Patients about Asymptomatic Herpes

Magazine article Clinical Psychiatry News

Educate Patients about Asymptomatic Herpes

Article excerpt

BOSTON -- "Genital herpes is a recurrent, lifelong viral disease. This is the one thing that patients and clinicians don't like to say, but there's no way around" it, Laura J. Mulcahy said at a conference on contraceptive technology sponsored by Contemporary Forums.

Other difficult truths about infection with herpes simplex virus (HSV) type 2? The overwhelming majority of people infected with the virus don't know that they have it, and people with asymptomatic or unrecognized disease shed the virus intermittently in the genital tract, said Ms. Mulcahy, a certified family nurse practitioner who is assistant medical director of the STD Center for Excellence at Monte-fiore Medical Center in New York.

"When we ask patients prior to screening for HSV-2 if they have a history of genital herpes...about 90% of those who ultimately test positive for HSV-2 antibodies reported having no history or symptoms of the infection," she said. This under recognition can be attributed to the fact that the leading cause of HSV-2 infection is asymptomatic shedding of the virus.

"There is a misperception and some clinicians are still telling patients that the infection is spread only through [HSV-2] sores. This is absolutely not true. The virus can shed even when the skin looks normal, and that's when most infections occur," she said.

Patient education about asymptomatic disease is critical to an effective screening protocol. "When patients come in and have no symptoms, it means nothing to us," Ms. Mulcahy stressed. Patients who come in for STD screening are told that, "from this day forward, the fact that you or your partner have no symptoms means nothing; the fact that you and your partner look fine means nothing; and the fact that you or your partner had a negative screen 6 months ago, if you've had partners in the interim, means nothing," she said.

Another factor contributing to the high rate of unrecognized disease is that many patients who have been screened for STDs believe they have been tested for genital herpes. "A complete STD screen does not include testing for herpes. Clinicians don't always tell this to patients, so many patients believe they are being tested for everything. If their STD screen is negative, they assume that means they don't have herpes," said Ms. Mulcahy.

For this reason, "clinicians who don't routinely screen for herpes [as part of an STD screening protocol] must inform patients that they are not being tested and chart that in the patient record so there is no confusion," she added.

If a patient asks to be screened for HSV-2, there are several points that should be addressed before testing, she stressed:

* The absence of symptoms does not predict a negative screen. …

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