Perceived stressors and coping responses in persons with recurrent genital herpes

Impact of primary and recurrent genital herpes on the quality of life of young people and adults: a mixed methods systematic review

OBJECTIVE

This review sought to identify the experiences of persons living with genital herpes and what interventions improve the health-related quality of life of young people and adults with primary or recurrent genital herpes.

INTRODUCTION

Genital herpes is commonly associated with psychosocial challenges. However, a growing body of evidence suggests that its impact can be ameliorated through pharmacological and psychosocial interventions.

INCLUSION CRITERIA

This review considered English- and German-language studies of community-dwelling males and females, of any ethnicity and geographical location, aged 15 years and older, who had primary or recurrent genital herpes. The quantitative component of the review included studies that reported on the virus' impact on patients' health-related quality of life and/or the efficacy of interventions in improving their health-related quality of life. Studies compared antiviral suppression therapies and psychological interventions with usual care or placebo, or against one another. The qualitative component of the review included studies that investigated the perceptions and experiences of young people and adults with genital herpes.

METHODS

Eleven databases were searched from January 1980 to March 2020. The JBI approach to mixed methods systematic reviews was followed at each stage of the review, and a convergent segregated approach to synthesis and integration was adopted.

RESULTS

A total of 31 publications covering 30 studies were deemed suitable for inclusion. Studies encompassed quantitative (n = 27, across 28 publications), qualitative (n = 1), and mixed methods (n = 2) designs. Critical appraisal scores were variable, particularly among the randomized controlled trials and the analytical cross-sectional studies. All studies were included regardless of methodological quality. The quantitative components identified that depression, illness concern, stress, anxiety, isolation, stigma, and a lowering of self-esteem, self-concept, self-confidence, and health-related quality of life may be experienced by both those newly diagnosed with genital herpes and those with recurrences. It was also identified that genital herpes can have an adverse effect on work or school, sexual relationships, and relationships with friends and family. Depression was found to significantly decrease after self-hypnosis and certain psychosocial interventions. Anxiety significantly decreased following pharmacological treatment, psychosocial interventions, and hypnosis. Psychosocial interventions significantly improved mood, and a self-help module with counseling significantly improved participants' satisfaction with intimate relationships and their self-esteem. Pharmacological treatment significantly improved health-related quality of life; however, there were no significant differences between different active treatment regimens. The qualitative component of the review led to the identification of two synthesized findings: "Disclosure of a diagnosis of genital herpes poses a dilemma for people who have the virus" and "A diagnosis of genital herpes has a significant emotional impact for the individual."Integration of quantitative and qualitative evidence revealed a consensus that a diagnosis of genital herpes has a significant emotional impact for individuals and that disclosure is stressful, affects relationships, and affects health-related quality of life; however, there is a lack of consensus regarding efficacy of different interventions.

CONCLUSIONS

Genital herpes can lead to extreme emotional, social, relational, and sexual distress, but there is insufficient knowledge concerning which interventions best improve health-related quality of life. More high-quality research is required.

Young women's beliefs regarding human papillomavirus

OBJECTIVE

To describe young women's perceptions of human papillomavirus (HPV) using the Common Sense Model and examine whether perceptions differ based on history of HPV diagnosis or sexually transmitted disease (STD) testing.

DESIGN

Cross-sectional, survey data.

SETTING

Four women's health clinics and one university classroom.

PARTICIPANTS

Three hundred and two women ages 18-24.

METHODS

Young women's beliefs regarding HPV were measured using the HPV Representations of Sexually Transmitted Diseases (RoSTD) survey.

RESULTS

Most survey respondents believed HPV diagnosis was likely to result in cancer and death. Negative beliefs about the psychosocial consequences of HPV diagnosis were common. Compared to those who had not been diagnosed with HPV (or had never received STD testing), young women with a history of HPV diagnosis or STD testing had less serious and more accurate beliefs about HPV.

CONCLUSION

Young women tend to have misconceptions about HPV in addition to noteworthy concerns about the psychosocial consequences of HPV diagnosis. Clinical attention to young women's beliefs about HPV may provide direction for improving the delivery of patient-centered education and counseling about this exceedingly common illness.

Young women's Representations of Sexually Transmitted Diseases (RoSTD): a psychometric study

Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding sexual health behaviors. The purpose of this study was to develop and test the psychometric properties of the Representations of STDs (RoSTD) Scale. The RoSTD was developed to measure young women's representations of STDs, and it is intended to be used to measure beliefs about any of the seven most common STDs. Confirmatory factor analysis indicated a four-factor structure for the 40-item RoSTD: Future Perspective, Cause, Psychosocial Consequence, and Identity. Internal consistency for the subscales (measured for each of seven different STDs) ranged from .67 to .93 and 2-week test-retest correlations ranged from .69 to .90. The RoSTD shows evidence of reliability and validity in young women.

Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment

OBJECTIVES

To assess the emotional and psychosocial responses to a serological diagnosis of HSV-2 infection in individuals without previous history of genital herpes.

METHODS

24 individuals who had a positive HSV-2 serology by western blot and no clinical history of disease were recruited from four clinics (sexually transmitted disease, maternal and infant care, family medicine, and virology research) over a 10 month period. In-depth qualitative interviews were conducted to elicit an individual's responses to the HSV-2 diagnosis.

RESULTS

Three categories of themes were identified from the interviews. Short term emotional responses included surprise, denial, confusion, distress, sadness, disappointment, and relief to know. Short term psychosocial responses included fear of telling sex partners, anger at the source partner, guilt about acquiring or transmitting, and concern about transmitting to a child. Perceived ongoing responses included fear of telling future partners, concern about transmitting to a sex partner, feeling sexually undesirable, feeling socially stigmatised, feeling like "damaged goods," sex avoidance due to social responsibility, fear of transmitting to a newborn, and relationship concerns relating to the diagnosis.

CONCLUSIONS

Individuals exhibit strong emotional and psychosocial responses to a serological diagnosis of HSV-2 infection. Many of the negative responses may be time limited and influenced by factors that are potentially amenable to counselling.

A pilot study examining energy conservation for cancer treatment-related fatigue

The purpose of this pilot study was to examine the feasibility of conducting an energy conservation and activity management (ECAM) intervention for cancer treatment-related fatigue and describe patterns of cancer treatment-related fatigue for two groups undergoing active treatment, one receiving the ECAM intervention and a nonequivalent control group receiving standard care for cancer treatment-related fatigue. The ECAM group received 3 telephone sessions focusing on the provision of information about fatigue, development of an energy conservation plan, and evaluation of the plan's effectiveness. Data for the ECAM group were collected before treatment, at an expected fatigue high point during treatment, and an expected low point of fatigue after treatment. The nonequivalent control group lacked the pretreatment measure but had equivalent follow-up measurement points. The feasibility of conducting the ECAM intervention was supported by patient adherence in receiving all 3 sessions of the intervention and by their self-reports of its usefulness and plans to continue using ECAM skills. Patterns of fatigue differed for the ECAM study group and the nonequivalent control group, suggesting that the intervention moderates the expected rise in fatigue due to cancer therapy. A full-scale clinical trial is needed to evaluate the efficacy of the ECAM intervention.

Psychosocial outcomes in individuals living with genital herpes

Genital infection, a common chronic sexually transmitted infection, is associated with physical and psychosocial concerns. While recognizing that some patients are able to take advantage of medication to chronically suppress the virus, researchers have examined the role that stress and other variables play in the frequency of outbreaks a patient might experience. In this article, several theories are reviewed from the stress literature that relate to patients' experience with herpes: the adjustment issues associated with having herpes, the role of social support, and the issue of disclosure. These theories and their clinical implications are discussed within the context of nursing interventions.

Gender differences for the predictors of depression in young adults with genital herpes

Genital herpes is a chronic, stigmatizing, sexually transmitted disease (STD), which is increasing despite efforts to control its spread. Depression is commonly reported among people diagnosed with genital herpes and differences in depression by gender have been reported. Therefore, the purpose of this study was to identify gender differences in the predictors of depression in young adults with genital herpes by secondary analyses of baseline data from a randomized clinical trial (RCT). For the RCT, young adults (193 females, 59 males) with genital herpes were recruited from newspaper advertisements. Participants completed questionnaires measuring illness burden, attitudes toward herpes, stress symptoms, mood states, depression, self-concealment, self-disclosure, substance use, and demographics. Univariate analyses and multiple regression techniques were used to identify variables predictive of depression in this sample. In women, increased anger, decreased vigor, increased confusion, a negative attitude toward herpes, self-concealment, and stress symptoms from genital herpes predicted more depression (R2 = 0.63). In men, increased depression was predicted by increased anger, a negative attitude toward herpes, and a decreased willingness to share personal information with a stranger (R2 = 0.51). Findings suggest that future psychoeducational interventions should address anger as a predictor of depression in this population. Gender-specific interventions need to be developed in order to assist young adults who are living with genital herpes.

Self-disclosure of HPV infection to sexual partners

Disclosure decisions of persons with genital HPV infection were examined. The research questions focused on relationships among knowledge of transmission, beliefs about the obligation to disclose knowledge of HPV infection to sexual partners, factors that influence the disclosure decision, and evaluations of the decision. Participants were 92 persons diagnosed with HPV 6 months prior to data collection. Sixty-three women and 29 men whose average age was 23.1 years constituted the sample. A subset of 48 persons provided detailed information about their reasons for disclosing or not disclosing knowledge of HPV and subsequent evaluation of their behavior. Knowledge of HPV transmission was adequate; however, there was no relationship between transmission knowledge and disclosure beliefs. Participants tended to disclose the presence of HPV to partners at point of diagnosis, but not to new partners 6 months later. Both disclosers and non-+disclosers felt positively about their decision. Possible changes in clinical interventions for persons with HPV infection are discussed.

Effects of psycho-educational interventions on sexual health risks and psycho-social adaptation in young adults with genital herpes

The purpose of this study was to test the outcomes of group psycho-educational intervention (PEI) led by nurses on sexual health risks (knowledge, behaviour, disease burden) and psycho-social adaptation (depression, mood states, self-efficacy) in young adults with the chronic disease, genital herpes. Two hundred and fifty-two young adults with symptomatic genital herpes participated in a randomized controlled trial (RCT). The intervention was participation in a three-session group PEI facilitated by a nurse in the community. Participants completed questionnaires measuring sexual health risks (herpes knowledge, sexual risk behaviour, disease burden of patterns of recurrences of outbreaks of the disease), and psycho-social adaptation (depression using the Beck Depression Inventory [BDI], mood states using the Profile of Mood States [POMS], and feelings of self-efficacy for protection from sexually transmitted diseases [PSTD]) at induction into the study, and at 3 and 6 months. Participants were mainly employed, Caucasian, single women in their twenties (X = 27.1 years, SD = 4.3), with some college education; 23% of the sample were men. After controlling for baseline knowledge about genital herpes, the experimental group had significantly more knowledge than the control group at 3 and 6 months' post-intervention. They also reported using condoms and spermicides to prevent the spread of genital herpes more often than did the control group. The implications for nurses in the community include the following: (a) PEI is an intervention that can be used by nurses in the community with a high-risk population; (b) group intervention is a viable treatment for people with a highly stigmatized, chronic sexually transmitted disease (STD); and (c) further testing of the use of PEI by nurses in the community with other high-risk populations is needed.

Psychological factors in recurrent genital herpes

OBJECTIVES

To review recent research into psychological aspects of genital herpes and assess possible implications for clinical practice.

METHODS

Review of all papers in the field on Medline 1985-96.

RESULTS

Much attention has been paid to possible links between stress and recurrent genital herpes. There is no convincing evidence that stress in itself causes recurrences. It may be that recurrences are preceded by a prodromal period of altered mood. Patients with recurrences show considerable stress as a result of the disease, although most individuals eventually adjust psychologically. The impact of social support on adjustment remains unclear. The little evidence available suggests that antiviral treatments can help adjustment and the effects may perhaps outlast the period of active treatment.

CONCLUSIONS

Existing research gives some clues to optimal patient management but there is a need for future research to focus much more clearly on clinical issues, particularly on means of alleviating psychological distress and on the impact of antivirals.

Orgasm without organisms: science or propaganda?

The worldwide epidemic of sexually transmitted diseases (STDs) presents a major public health challenge to medical practitioners and educators as they seek to implement preventive educational strategies in the adolescent population. The serious consequences of many STDs and the insufficient impact of condom promotion in this high-risk group have led to increasing recognition that sexual intercourse is medically unwise for young adolescents. As a result of this recognition, some educators have proposed that adolescent sexuality education focus on the explicit teaching of noncoital sexual activities, sometimes called outercourse. This paper explores the emergence of this educational strategy, the assertion that noncoital sexual activities will positively impact the rising incidence of STDs and unplanned pregnancy in teenagers, and the hypothetical benefits of adolescent noncoital sex.

Measuring health-related quality of life in persons with genital herpes

A disease-specific measure was needed for use in an international clinical trial to evaluate an investigational drug for genital herpes. A new measure was developed initially in the UK and translated and adapted for use in France, Italy, Germany, Denmark, Spain and the USA. This paper describes the translation and adaptation of the USA measure. It also describes the assessment of internal consistency, reproducibility, content validity, and construct validity (convergent and discriminant) of the measure. Two outcome measures of the final genital herpes-specific measure were developed: (1) a 21-item symptoms subscale; and (2) a 20-item HRQOL subscale. Each measure was scored and analyzed separately; the psychometric testing discussed in this paper refers to the HRQOL subscale only. The internal consistency of the HRQOL subscale is high (r = 0.93), as is the reproducibility measured with a two week interval (r = 0.85). Convergent validity is moderate to high. (Fleming Self-Regard subscale, r = 0.48; SF-36 Social Functioning dimension r = 0.59; SF-36 Mental Health dimension r = 0.50). The number of herpes outbreaks in the past year was a significant predictor of scores on the HRQOL subscale (0-1 outbreaks, mean = 82.1; 2+ outbreaks, mean = 72.1, p = 0.058) suggesting discriminant validity. The measure is currently in a phase III clinical trial including anti-viral therapy where the question of responsiveness can be addressed.

Sexually transmitted diseases: current and emerging concerns

Sexually transmitted diseases (STDs) are epidemic today, with the highest prevalence being among adolescents and young adults. If any decrease in incidence is to occur, nurses must make a determined effort to identify at-risk individuals and groups and empower them through teaching and counseling about strategies of primary and secondary prevention. Current and emerging concerns that make prevention of STDs difficult include such problems as the huge reservoir of infected individuals with no symptoms, the synergy between STDs and human immunodeficiency virus infections, and the particular vulnerability of women to STDs based on their biology. A holistic approach to care that is sensitive to the age, race, culture, and core group characteristics is essential for effective prevention efforts.

Genital human papillomavirus infection: common but not trivial

One of the most prevalent sexually transmitted diseases is genital human papillomavirus (HPV) infection. Because of its potentially serious consequences for women, HPV infection is receiving a significant amount of attention from researchers and clinicians. We summarize the research and clinical literature on HPV infection. The nature of the virus, the prevalence of HPV infection, and modes of transmission are discussed. Both the physiological and psychological consequences of the infection are explored. Perspectives on treatment are examined, and suggestions for psychoeducational interventions are offered.