The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Sexually Transmitted Infections (Impact Factor: 3.4). 05/2006; 82(2):154-7; discussion 157-8. DOI: 10.1136/sti.2005.016311
Source: PubMed
ABSTRACT
To evaluate the impact of a positive herpes simplex virus type 2 (HSV-2) serological test on psychosocial functioning among people with no known history of genital herpes.
Individuals (age 14-30 years) without a history of genital herpes were recruited from an urban university setting and sexually transmitted diseases (STD), primary care, and adolescent clinics. Participants completed a questionnaire addressing psychological functioning, psychosocial adjustment, and perceived quality of sex and were offered free HSV-2 antibody testing. 33 HSV-2 positive people and 60 HSV-2 negative people demographically matched from the same source of recruitment were re-evaluated at a 3 month follow up visit. HSV-2 positive participants also completed a genital herpes quality of life (GHQOL) measure.
Of the 33 who were HSV-2 seropositive, four did not recall their diagnosis. In comparing those who were HSV-2 positive with those who were negative, repeated measures analysis of variance indicated there were no significant differences over time on any of the measures. None the less, many HSV-2 positive individuals indicated that the diagnosis had a notable impact on their quality of life. Also, among the HSV-2 positive people, lower GHQOL at the 3 month follow up was predicted by higher interpersonal sensitivity (r = -0.44, p<0.05), lower social support (r = 0.40, p<0.05), and quality of sex (r = 0.62, p<0.01) at baseline.
A diagnosis of asymptomatic HSV-2 infection does not appear to cause significant lasting psychological difficulties. Those for whom the diagnosis had the greatest impact were interpersonally vulnerable before the diagnosis. These results suggest that assessment of interpersonal distress may be important to include as part of pretest and post-test counselling.

Full-text

Available from: Gregory Zimet
HERPES
The psychosocial impact of serological diagnosis of
asymptomatic herpes simplex virus type 2 infection
S L Rosenthal, G D Zimet, J S Leichliter, L R Stanberry, K H Fife, W Tu, D I Bernstein
...............................................................................................................................
See linked commentary on
p 157
See end of article for
authors’ affiliations
.......................
Correspondence to:
Susan Rosenthal, PhD,
Department of Pediatrics,
University of Texas
Medical Branch, 301
University Boulevard,
Galveston, TX 77555,
USA; slrosent@utmb.edu
Accepted for publication
15 September 2005
.......................
Sex Transm Infect 2006;82:154–158. doi: 10.1136/sti.2005.016311
Objectives: To evaluate the impact of a positive herpes simplex virus type 2 (HSV-2) serological test on
psychosocial functioning among people with no known history of genital herpes.
Methods: Individuals (age 14–30 years) without a history of genital herpes were recruited from an urban
university setting and sexually transmitted diseases (STD), primary care, and adolescent clinics.
Participants completed a questionnaire addressing psychological functioning, psychosocial adjustment,
and perceived quality of sex and were offered free HSV-2 antibody testing. 33 HSV-2 positive people and
60 HSV-2 negative people demographically matched from the same source of recruitment were re-
evaluated at a 3 month follow up visit. HSV-2 positive participants also completed a genital herpes quality
of life (GHQOL) measure.
Results: Of the 33 who were HSV-2 seropositive, four did not recall their diagnosis. In comparing those
who were HSV-2 positive with those who were negative, repeated measures analysis of variance indicated
there were no significant differences over time on any of the measures. None the less, many HSV-2
positive individuals indicated that the diagnosis had a notable impact on their quality of life. Also, among
the HSV-2 positive people, lower GHQOL at the 3 month follow up was predicted by higher interpersonal
sensitivity (r = 20.44, p,0.05), lower social support (r = 0.40, p,0.05), and quality of sex (r = 0.62,
p,0.01) at baseline.
Conclusions: A diagnosis of asymptomatic HSV-2 infection does not appear to cause significant lasting
psychological difficulties. Those for whom the diagnosis had the greatest impact were interpersonally
vulnerable before the diagnosis. These results suggest that assessment of interpersonal distress may be
important to include as part of pretest and post-test counselling.
T
he majority of people who are seropositive for herpes
simplex virus type 2 (HSV-2) do not report a history of
symptoms or an awareness that they are infected,
1
yet,
they can still transmit the infection.
2
With the recent
availability of herpes type specific serological screening tests,
professionals have struggled with whom and in what setting
individuals should be screened,
3–8
including whether screen-
ing should become a routine part of sexually transmitted
disease (STD) screening in public and private settings. Given
that suppressive antiviral treatment and condoms both
reduce the risk of HSV-2 transmission, there are clear
potential benefits of individuals knowing their serostatus.
910
On the other hand, serological testing could have a negative
emotional impact of an HSV-2 diagnosis, which would
outweigh the benefits.
7
Relatively few studies have systematically examined the
psychological impact of a positive HSV-2 serology in adults
with no known history of genital herpes. Although vaccine
trials have diagnosed many asymptomatic infections, data
are not currently available about the impact of the diagnosis
for those individuals. Five recent studies reported no
substantial psychological morbidity after HSV-2 diagnosis,
11-15
although there is some evidence that a positive result can
lead to transient negative psychosocial reactions (for
example, confusion and distress), concerns about the
implications for romantic relationships, and fear of
transmitting the virus.
13 14
In this study, we measured a
wide range of psychosocial issues potentially associated with
reactions to HSV-2 diagnosis, including social adaptation,
relationship factors, herpes quality of life, and the more
traditional measures of psychological symptomatology (for
example, depression and anxiety). In addition, our research
included participants recruited from a variety of settings.
The present study had three aims. Firstly, we evaluated the
impact of a positive serological test on psychosocial function-
ing at 3 months post-diagnosis. Secondly, we assessed
genital herpes quality of life at 3 months. Finally, we
evaluated whether functioning before diagnosis predicted
subsequent herpes health related quality of life.
METHODS
Study population and procedure
Participants were recruited from four sites: an STD clinic and
two primary care medical clinics (treated as one site for
analysis) in Indianapolis, Indiana, and an adolescent health
clinic and a college student population in Cincinnati, Ohio.
These sites were chosen to represent a range of ages and level
of risk for sexually transmitted infections. The STD and adult
medical clinics serve urban and suburban neighbourhoods
within the city of Indianapolis. The catchment area for the
adolescent clinic is the greater Cincinnati area, and the
college draws students from Cincinnati, other parts of Ohio,
and nationally. Details about these study sites have been
previously reported.
16
In the adult sites, participants were 18–
30 years of age, whereas the adolescents ranged in age from
14–20 years. At the Indianapolis sites, potential participants
were recruited from clinic waiting rooms. At the Cincinnati
adolescent health clinic, healthcare providers identified
potential subjects through clinic records and through a
‘‘snowball’’ recruitment technique in which adolescents who
Abbreviations: ANOVA, analysis of variance; BSI, Brief Symptom
Inventory; GHQOL, genital herpes quality of life; HRQOL, herpes health
related quality of life; HSV, herpes simplex virus; MSPSS,
Multidimensional Scale of Perceived Social Support; STD, sexually
transmitted diseases
154
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participated identified other potential participants. College
students were recruited through advertisements. Eligibility
criteria included no known history of genital herpes and the
ability to read English. All subjects (and guardians for those
under 18 years) provided informed consent for participation
by signing a form that was approved by both local
institutional review boards and the Centers for Disease
Control and Prevention’s institutional review board.
We used a two step consent process in which subjects were
first recruited to complete a written questionnaire.
Indianapolis participants were compensated $15 for ques-
tionnaire completion. Given that Cincinnati subjects were not
recruited from clinic waiting rooms, they were compensated
$20 to account for the additional time and effort required for
participation. Step two of the consent process involved the
offer to all subjects of a free blood test for detection of HSV-2
antibody. Those under 18 years had to have parental consent
for the serological screening. No additional compensation
was provided to those subjects who agreed to undergo
testing.
Individuals who chose to be tested for HSV-2 returned in
2 weeks for their results. Participants who were positive and
a subset of those who were negative were asked to come back
in 3 months for a follow up questionnaire. At all sites, those
who returned to complete questionnaires at the 3 month
follow up appointment were compensated $20 for their time
and effort.
Measures
The questionnaire assessed sociodemographic characteristics
and included multiple psychosocial measures, described
below. With the exception of the herpes health related
quality of life (HRQOL) measure, all scales were administered
at baseline and at the 3 month follow up appointment. The
herpes HRQOL was only administered at follow up to those
who were HSV-2 positive.
General psychological adjustment was measured with the
following subscales from the Brief Symptom Inventory (BSI):
depression, anxiety, paranoia, hostility, and interpersonal
sensitivity (that is, feelings getting easily hurt).
17
The BSI is
an instrument with demonstrated reliability and validity,
which asks respondents to indicate how much a problem
has bothered them in the past 7 days, ranging from ‘‘Not at
all’’ to ‘‘Extremely.’’ In our sample the five subscales
demonstrated good internal reliability (coefficient alphas
ranging from 0.74 to 0.88).
Perceived social support was evaluated with a six item
measure derived from the 12 item Multidimensional Scale
of Perceived Social Support (MSPSS; alpha = 0.87).
18
The
MSPSS evaluates an individual’s perception of interpersonal
support from three sources: family, friends, and a significant
other. Participants responded to each item using a five point
response scale ranging from ‘‘Strongly disagree’’ to ‘‘Strongly
agree.’’ The score was calculated as the mean value across the
six items, with higher scores indicative of greater perceived
social support.
Relationship quality was evaluated with a five item
measure that has been used in several previous research
projects (alpha = 0.94).
19 20
This scale, which used a five
point response scale, measured the degree of emotional
closeness and affiliation experienced in the individual’s
primary identified romantic relationship. The score was
calculated as the mean value across the five items, with
higher scores indicative of better relationship quality.
STD related stigma was measured with an 11 item true-
false scale adapted from an established measure (alpha =
0.69).
21
A total stigma score was calculated by summing
across the items so that a higher score was indicative of
greater feelings of stigma associated with an STD examina-
tion or diagnosis.
Perceived quality of sex was measured with seven items
(alpha = 0.96) and was developed for this project.
Participants answered each item with a five point response
scale ranging from ‘‘Strongly disagree’’ to ‘‘Strongly agree.’’
Quality of sex scale scores were calculated as the mean value
across the seven items, with a higher score indicative of
higher quality of sex.
Genital herpes HRQOL is a 20 item measure for which
reliability, content, and construct validity have been pre-
viously established.
22
It addresses issues such as feelings of
shame associated with having herpes and herpes making life
difficult (alpha = 0.95).
22
Participants responded to each
item using a four point response. The stem for each response
was variable (for example, difficult or worry) but always
ranged from ‘‘very’’ to ‘‘not at all.’’ A total herpes HRQOL
score was calculated by summing across items, with a higher
score indicative of a better HRQOL and fewer problems with
herpes. For purposes of individual item analysis, answers of
Table 1 Description of sample
Measure
Baseline 3 Month follow up
Negative
(n =60)
Positive
(n =33)
Negative
(n =60)
Positive
(n = 33)
Age* 21.8 (3.6) 24.2 (3.6)
% Female 87% 88%
% White 52% 48%
Site
% STD clinic 50% 46%
% Adult clinic 30% 33%
% University 13% 15%
% Adolescent 7% 6%
BSI scales*
Depression 1.60 (0.80) 1.76 (0.80) 1.49 (0.71) 1.78 (0.86)
Anxiety 1.49 (0.65) 1.65 (0.68) 1.44 (0.73) 1.64 (0.76)
Hostility 1.63 (0.70) 1.74 (0.87) 1.54 (0.67) 1.63 (0.69)
Paranoia 1.73 (0.74) 1.88 (0.80) 1.64 (0.76) 1.96 (0.81)
Interpersonal sensitivity 1.69 (0.81) 1.70 (0.84) 1.63 (0.80) 1.80 (0.98)
Social support* 4.25 (0.70) 4.00 (1.01) 4.18 (0.67) 3.97 (0.71)
Relationship quality* 4.33 (0.78) 4.01 (1.09) 4.31 (0.91) 4.23 (0.86)
STD related stigma* 1.41 (1.73) 1.75 (2.00) 1.33 (1.78) 1.45 (1.42)
Quality of sex* 4.07 (0.82) 4.11 (0.82) 4.15 (0.75) 4.13 (0.75)
*Values expressed as mean (SD).
No significant differences between groups on any measures.
Psychosocial impact of HSV-2 serological diagnosis 155
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‘‘very’’ or ‘‘quite’’ were considered to be indicative of
endorsing the experience.
Statistical methods
To evaluate the first specific aim, we used a 262 repeated
measures analysis of variance (ANOVA) to compare psycho-
social adjustment between HSV-2 positive and HSV-2
negative people from baseline to 3 month follow up. The
within subject factor was time (baseline; 3 months) and the
between subject factor was diagnostic group (HSV-2 positive;
HSV-2 negative). Dependent variables were the BSI sub-
scales, perceived social support, relationship quality, STD
related stigma, and quality of sex.
The second set of analyses involved an examination of
genital herpes HRQOL among those who had tested positive
for HSV-2 by calculating the percentage of individuals who
endorsed each item. Pearson product moment correlations
were used to evaluate the relation of HRQOL to potential
baseline predictors and current level of functioning (specific
aim 3).
RESULTS
There were 1199 sexually experienced subjects enrolled in the
study, of whom 820 (68%) accepted HSV-2 serological
screening. Of those
820 participants, 149 (18%) were positive, ranging from 7%
positives among the adolescents to 26% among the STD clinic
patients. Overall, 72% returned for their results; 62% of the
HSV-2 positive (n = 93) and 74% of the HSV-2 negative
returned (n = 496). Thirty three of the HSV-2 positive
individuals returned for 3 month follow up (four did not
recall their diagnosis). At each site, following a positive
result, the next two negative subjects at that site were asked
to return for a follow up visit in 3 months; 121 HSV-2
negative individuals returned for 3 month follow up. The
HSV-2 negatives were matched nearly 2 to 1 to the 33 HSV-2
positive within recruitment site based on gender and race
(white/non-white). The 60 HSV-2 negative individuals
included in the analyses were more likely to be female
(p.0.01) and non-white (p,0.01) than the 61 HSV-2
negative individuals who were excluded. This set of findings
is a natural outcome of the process of matching negative to
positive participants. The included and excluded groups were
not significantly different on any baseline or follow up
measures, with the exception of STD stigma at 3 months, in
which the excluded group had higher scores (mean = 2.3)
than the included group (mean = 1.3, p,0.05). (See table 1
for descriptive data on the HSV-2 positive and included
negative samples at baseline.)
Nine repeated measures ANOVAs were carried out to
compare those who were diagnosed as HSV-2 positive with
those who were negative with regard to depression, anxiety,
paranoia, hostility, interpersonal sensitivity and STD related
stigma, and levels of social support, relationship quality, and
quality of sex at 3 months post-diagnosis. There were no
statistically significant main effects for time or for diagnostic
group. Of specific relevance to questions about the impact of
a genital herpes diagnosis, there also were no statistically
significant time by group interaction effects. (See table 1 for
the mean values of the dependent measures at baseline and
3 month follow up.)
The four individuals who did not recall their HSV-2
diagnosis were not included in the analyses involving the
genital herpes HRQOL, as it was not relevant to them.
Although the analyses above indicated no significant
negative impact of the HSV-2 diagnosis on psychosocial
functioning, a number of individual HRQOL items were
endorsed frequently as being either quite or very difficult
problems, including ‘‘It is difficult to forget that I have
herpes’’ (endorsed by 63%) and ‘‘I worry about giving herpes
to someone’’ (endorsed by 56%). Table 2 lists the most
frequently endorsed items (30% or more) and the least
frequently endorsed items (15% or less).
Greater baseline interpersonal sensitivity (r = 20.44,
p,0.05), lower sexual satisfaction (r = 0.62, p,0.01), and
lower social support (r = 0.40, p,0.05) were associated with
poorer HRQOL at 3 month follow up. Lower baseline
relationship quality was similarly associated with poorer
HRQOL (r = 0.41, p = 0.07), but this correlation may not have
been statistically significant because of missing data.
Baseline measures of depression, anxiety, hostility, paranoia,
and STD related stigma were not statistically significant
predictors of HRQOL (p = 0.47 to p = 0.13).
DISCUSSION
Until recently, little research has been conducted on the
psychological sequelae of a genital herpes diagnosis. Care
providers’ impressions are often based on those few patients
who are quite distressed or very demanding of the care
provider’s time. In addition, the impact of an asymptomatic
infection may be different from that of a symptomatic
infection. It has been suggested that the recurrences
themselves may be associated with altered mood states,
and that the pain and discomfort of the disease may be an
important aspect of the psychological stress.
23
Thus, it is
important to examine the psychological impact of asympto-
matic infections independently from the impact on those
individuals with clinical disease.
The finding that there was no sustained impact on
psychological adjustment at 3 months supports previous
findings.
11–15
However, many individuals did report an impact
on their quality of life specific to herpes, particularly those
who were more interpersonally distressed before screening, a
finding consistent with a study that demonstrated general
psychosocial functioning was related to the impact of an STI
diagnosis on adolescents, not the particular STI.
24
Therefore,
individuals who are already vulnerable with regard to their
sexual and interpersonal experiences appear to be most
impacted by an HSV diagnosis. While the most vulnerable
individuals had the greatest psychological difficulties, many
of the participants experienced quality of life problems
specific to herpes. The more frequently endorsed items
appeared to be focused on the emotional associations with
being infected (for example, shame, depression, anger), and
Table 2 Genital herpes health related quality of life
(HRQOL): most and least endorsed items
Most endorsed items % Endorsed as
‘‘very’’ or ‘‘quite’’
It is difficult to forget that I have herpes 63%
I worry about giving herpes to someone 56%
I worry about people I know finding out I have
herpes
48%
I feel insecure about personal (intimate)
relationships because of herpes
30%
I get depressed about having herpes 30%
I feel angry about having herpes 30%
I worry that people will reject me if they know I
have herpes
30%
Least endorsed items % Endorsing as
‘‘very’’ or ‘‘quite’’
Herpes is affecting my sex life 15%
Because of herpes, I become tense when
someone touches me
15%
I find it difficult to live with herpes 11%
Herpes makes it difficult for me to plan ahead 7%
I feel isolated from other people because of
herpes
7%
Herpes is making my life miserable 4%
156 Rosenthal, Zimet, Leichliter, et al
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Page 3
on interpersonal consequences such as having to tell others
or rejection. These findings highlight the importance of
anticipating and addressing concerns of patients newly
diagnosed with herpes or HSV-2 infection.
The results of this study should be interpreted in the
context of the limited ethnic and regional diversity, and the
limited ability to examine gender differences. In addition,
when considering implementing screening programmes, it is
important to note that there was a high loss to follow up
between the testing and the time results were provided (30%
loss overall and 37% loss among those that were HSV-2
positive). The fact that these individuals did not find out
about their test results may be related to the fact that testing
was not being done as part of a clinical examination or in
response to symptoms. The availability of a point of care test
would change the need for follow up appointments and, thus,
more individuals might learn of their results. There was an
additional loss to follow up between the individuals learning
of their positive results and the 3 month follow up assess-
ment (64%). This may represent those who were too
distressed to return, but it is also likely that it represents
those who did not find the results significant enough to
warrant a return visit. Understanding these two points of loss
to follow up will be important for interventions that are
planning to use screening as a tool to foster behavioural
change.
This study points to the importance of understanding the
psychological impact of herpes infections in the context of
pre-morbid functioning. Without baseline assessments, it is
possible that the individuals for whom there is the most
impact would not be identified. The major impact was on
quality of life specific to herpes; thus, future research could
assess specific interventions that might reduce the extent of
this distress. Finally, this and other studies do not support
the notion that herpes screening programmes should not be
implemented because of the psychological costs to indivi-
duals. Other reasons such as the cost of the screening and the
sensitivity/specificity of the test in particular populations
should continue to be considered.
CONTRIBUTORS
SLR, GDZ, JSL, LRS, KHF, DIB participated in the design and
conceptualization of the project; WT and GDZ analysed the data; SLR
and GDZ wrote the initial manuscript; and all authors provided
substantive edits to the final version of the manuscript.
Authors’ affiliations
.....................
S L Rosenthal, L R Stanberry, University of Texas Medical Branch,
Galveston, TX, USA
G D Zimet, K H Fife, W Tu, Indiana University School of Medicine,
Indianapolis, IN, USA
J S Leichliter, Centers for Disease Control & Prevention, Atlanta, GA,
USA
D I Bernstein, Cincinnati Children’s Hospital Medical Center, Cincinnati,
OH, USA
This work was supported by a cooperative agreement from the Centers
for Disease Control and Prevention (# UR6/CCU517826).
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Key messages
N
There was little sustained psychological distress among
those who were diagnosed with asymptomatic HSV-2
infection
N
The diagnosis may have some specific herpes quality of
life impacts such as worries about transmission or of
others learning of the diagnosis
N
Psychologically vulnerable individuals were at the most
risk for an impact on herpes specific quality of life
..............
COMMENTARY
..............
The perception that both condom usage and antivirals can
potentially modify the risk of transmission has led some to
advocate the routine screening of asymptomatic individuals.
One barrier to wider screening is the possibility of causing
psychological harm to those who are asymptomatically
infected. Rosenthal et al
1
found no evidence that discovering
they were positive led to frank psychiatric symptoms in most
of their positive individuals. This is reassuring. However, the
authors point out that the positive individuals did report
some adverse psychological effects. Many reported, for
instance, that they were preoccupied with the disease or that
herpes made them depressed. This discrepancy raises the
important issue of what should be considered a significant
adverse psychological impact.
Psychosocial impact of HSV-2 serological diagnosis 157
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  • Source
    • "For example, HPV vaccination was launched with a price of around $360 per course in the US, but is now available through the Global Alliance for Vaccines and Immunization (GAVI) in low income countries for $4.50 [34]. The opportunity for tiered pricing is more apparent for the viral STIs, where a cure is not possible through current treatment, treatment of disease causes a burden on the system [32] and there is a psychosocial burden [35] "
    [Show abstract] [Hide abstract] ABSTRACT: Sexually transmitted diseases, a source of widespread morbidity and sometimes mortality, are caused by a diverse group of infections with a common route of transmission. Existing vaccines against hepatitis B virus (HBV) and human papilloma virus 16, 18, 6 and 11 are highly efficacious and cost effective. In reviewing the potential role for other vaccines against sexually transmitted infections (STIs) a series of questions needs to be addressed about the burden of disease, the potential characteristics of a new vaccine, and the impact of other interventions. These questions can be viewed in the light of the population dynamics of sexually transmitted infections as a group and how a vaccine can impact these dynamics. Mathematical models show the potential for substantial impact, especially if vaccines are widely used. To better make the case for sexually transmitted infection vaccines we need better data and analyses of the burden of disease, especially severe disease. However, cost effectiveness analyses using a wide range of assumptions show that STI vaccines would be cost effective and their development a worthwhile investment.
    Preview · Article · Mar 2014 · Vaccine
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    • "HSV is a very stigmatizing disease, in part due to the incurable nature of the virus. The psychological distress and psychosexual problems associated with a diagnosis of HSV infection and recurrent HSV infections have been well described in the literature, though there is some debate as to whether these are due to long term effects of HSV infection or whether some patients are predisposed to anxiety616263, Carney demonstrated that suppressive therapy for HSV can result in reduction in anxiety [64]. As previously suggested, suppressive treatment in serodiscordant couples for HSV may not only increase the frequency of sex by reducing episodes of HSV, but also improve the psychological impact of HSV and concern regarding transmission, thereby improving sexual function. "
    [Show abstract] [Hide abstract] ABSTRACT: Infertility affects about 8% to 12% of couples, with male infertility being responsible for about 30% of cases. Sexually transmitted infections (STIs) are known to cause complications of pregnancy and are associated with tubal infertility in females, but the association with male fertility is still controversial. The prevalence of curable STIs has risen to an estimated 448 million a year with the number of people living with human immunodeficiency virus (HIV) at 34 million. This review looks at the evidence available to date, regarding the effect of STIs and male accessory gland infections on markers of male fertility and the evidence that STIs negatively affect sexual functioning, thus adversely affecting the ability to conceive. The review will also cover new developments in the use of medications and fertility treatments as an aid to conception in couples serodiscordant for HIV.
    Full-text · Article · Mar 2013 · Korean journal of urology
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    • "Additionally, maladaptive coping behavior, such as abusing substances, prior to diagnosis may affect how one responds after receiving the diagnosis (Mindel & Marks, 2005). Interestingly, if one is asymptomatic but seropositive for herpes, the psychological effects remit about six months after the initial diagnosis (Rosenthal et al., 2006 ). With suppressive medication , an individual's quality of life also improves, due in part to the reduction of symptoms (Brentjens, Yeung-Yue, Lee, & Tyring, 2003 ). "
    [Show abstract] [Hide abstract] ABSTRACT: This article reviews the psychological consequences of genital herpes infection through the lens of a recently proposed framework for conceptualizing concealable stigmas. We incorporate research on identity, stigma, and the connection between psychological and physical health to outline how negative stigma-related psychological consequences perpetuate distress associated with genital herpes. Our review of the research suggests a model linking negative affect and poor coping to frequent recurrences of genital herpes outbreaks. Frequent outbreaks, in turn, increase the salience of the stigma, reinforcing a stigmatized self-schema, thereby creating negative psychological consequences, continuing the cycle. We conclude by discussing the implications of this model for future research and mental health treatment.
    Full-text · Article · Jan 2011 · Journal of Health Psychology
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