Psychological adjustment among women living with 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.

College students' use of technology to communicate with romantic partners about sexual health issues

OBJECTIVE

To examine college students' technology-assisted sexual communication perceptions and practices alongside their beliefs about the effectiveness of face-to-face (F-t-F) sexual communication.

PARTICIPANTS

144 college students at a private university in the Northeast, U.S., completed a survey in October 2016.

METHOD

A cross-sectional online survey examined how college students use text messaging and private social media messaging to communicate with romantic partners about sexual health issues.

RESULTS

Students who have communicated with romantic partners via technology reported being likely to do so again in the future, to perceive the effectiveness of technology-assisted sexual communication to be comparable to F-t-F sexual communication, and to be confident in their ability to initiate sexual communication with romantic partners via F-t-F communication.

CONCLUSIONS

College students may see text messaging and social media messaging as useful for sexual communication, which has important implications for college health professionals who wish to promote frequent, effective sexual communication.

Health-related quality of life of young people and adults with primary or recurrent episodes of genital herpes: a mixed methods systematic review protocol

REVIEW QUESTION

The review questions are:The specific objectives are:This mixed methods review seeks to develop an aggregated synthesis of quantitative and qualitative data on the HRQOL implications of genital herpes for the individual in order to derive conclusions and recommendations for clinical practice and policy decision making.

Genital herpes stigma: Toward the Measurement and Validation of a highly prevalent yet hidden public health problem

Despite its highly prevalent and stigmatizing nature, genital herpes has received little attention from stigma researchers relative to other sexually transmitted infections. This limitation is of great relevance to researchers and practitioners in both clinical and healthcare settings, given that stigma can cause psychological distress and hinder disclosure to sexual partners, hence contributing to the spread of genital herpes. The present research developed and examined the psychometric properties of a quantitative measure of genital herpes stigma. Two hundred individuals diagnosed with genital herpes recruited through online genital herpes support groups completed a survey containing 37 items adapted from the HIV Stigma Scale, questions about demographic and herpes-related characteristics, and measures of relevant psychosocial variables. A confirmatory factor analysis yielded an 18-item scale with four factors: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. All subscales demonstrated good internal consistency, with Cronbach alphas ranging from 0.74 to 0.87. Construct validity was supported by correlations with relevant psychosocial variables, including negative affect, rumination, and perceived social support. As a psychometrically sound assessment tool, the Genital Herpes Stigma Scale can be used in both clinical and research settings to facilitate future efforts to alleviate the negative psychological consequences of this incurable viral infection.

Herpes simplex virus: 'to disclose or not to disclose.' An exploration of the multi-disciplinary team's role in advising patients about disclosure when diagnosed with genital herpes simplex virus

The first UK prosecution for genital herpes simplex virus (HSV) transmission in 2011 attracted strong criticism from medical experts. To address the dearth of research on the topic, this study aimed to explore the nature of advice given to patients by the multidisciplinary team (MDT) in the West of Scotland on HSV disclosure to partners. Ten semi-structured interviews with members of the MDT were conducted and the interviews were analysed using Burnard's Thematic Content Analysis. Four themes emerged which explored practitioners' knowledge of HSV and their feelings regarding the emotional aspects of the diagnosis on clients including the challenges of discussing disclosure. Within this framework, participants' attitudes to the legal prosecution were also surveyed. This study revealed that participants had good knowledge about HSV. Furthermore, participants believed disclosure to be the patient's choice and had not altered their practice to advise disclosure to all partners in accordance with local protocol. However, there was a general consensus that disclosure was not required due to the prevalence of HSV and prevalence was used to dissipate emotional reactions to HSV diagnosis.

Predictors of the Sexual Well-being of Individuals Diagnosed with Herpes and Human Papillomavirus

Research suggests that having a sexually transmitted infection (STI) such as genital herpes and human papillomavirus (HPV) can negatively affect sexual well-being. However, there is little research examining factors associated with poorer sexual well-being among individuals with a STI. This study investigated the extent to which stigma experiences, individual characteristics, and STI characteristics were associated with multiple aspects of sexual well-being among individuals diagnosed with herpes and/or HPV. Participants were an average of 36 years old (SD = 11.58) and included 188 individuals with herpes and/or HPV who completed measures of sexual activity, sexual problems, and sexual cognitive-affective factors. The results showed that experiences of stigmatization were the most important predictors of sexual well-being. Participants who perceived were stigmatized by others as well as those who internalized negative social attitudes to a greater extent reported poorer sexual well-being across all dimensions, over and above individual and STI characteristics. The implications of these findings for sexual health professionals are discussed.

"I have human papillomavirus": An analysis of illness narratives from the Experience Project

PURPOSE

Human papillomavirus (HPV) is the most common sexually transmitted virus worldwide. Our purpose was to examine people's experiences with HPV using narratives posted on a website entitled, Experience Project.

METHOD

We conducted a content analysis of 127 HPV narratives to identify stigma, emotion-focused and problem-focused coping, and misinformation.

RESULTS

Negative self-image was the most commonly identified type of stigma. There were more instances of problem-focused than emotion-focused coping. Sources of confusion were mostly about HPV treatment and side effects/symptoms.

CONCLUSIONS

These findings have implications for how nurses and other health professionals can care for individuals living with HPV. Based on these findings, it would be beneficial for clinics/providers to implement on-line forums where myths about HPV can be debunked and accurate information provided. Both patients and the public need to be better informed about HPV, in order to decrease the negative stigma that can create a mental burden for individuals with HPV.

Associations between individual and relationship characteristics and genital herpes disclosure

Disclosure is often a challenge for individuals living with genital herpes. This study explores determinants of genital herpes disclosure with one's most recent sexual partner using an online questionnaire (n = 93). The majority of participants reported (80.4%) disclosure. Among non-disclosers, fear of negative partner reactions was the primary reason for non-disclosure. Age, relationship commitment, time in relationship, and expectations of partner's reaction were statistically significant predictors at the bivariate level. Reaction expectations and relationship commitment remained significant in the multivariate logistic regression model. Findings indicate that future disclosure research should focus on relationship context and managing negative expectations to increase disclosure.

Reducing the stigma of herpes simplex virus infection: lessons from an online video contest

BACKGROUND

Herpes simplex virus (HSV) is one of the most common sexually transmisible infections worldwide. HSV-associated stigma negatively impacts emotional and sexual health, suggesting a need for novel approaches to reducing stigma. The aims of this study were to describe the range of destigmatising strategies used by the public in brief online videos, and to describe videos that were successful or unsuccessful in creating a destigmatising message.

METHODS

A thematic content analysis was performed on 103 publicly produced YouTube videos designed to destigmatise HSV infection for an Australian online contest.

RESULTS

Five destigmatising strategies were identified: providing information, normalising through familiarity, promoting disclosure, negating a negative perception and expressing moral indignation. Most videos employed multiple strategies. Regarding the degree of destigmatisation achieved, videos were coded as unsuccessful, successful, mixed or neutral. Unsuccessful and successful videos often employed the same strategies, but differed in their ability to balance positive and negative messages about HSV and to manage affective content. Some videos were successful despite not providing information about HSV. Mixed videos were appreciated differently in different contexts, and the use of humour was especially problematic. Neutral videos tended to exclusively provide information while avoiding affective content.

CONCLUSIONS

Efforts to reduce HSV-associated stigma may be unsuccessful and may even perpetuate stigma. Special attention must be paid to balance and to affective content, specifically humour, when attempting to convey a destigmatising message. Doing so may help reduce the role stigma plays as a barrier to appropriate care for patients with HSV infection.

Sharing experiences and social support requests in an Internet forum for patients with systemic lupus erythematosus

Internet forums represent a useful but understudied resource to understand psychosocial aspects of living with systemic lupus erythematosus. This study was aimed to describe the demand/supply of social support through the Internet in relation with the description of personal illness experiences. All the posts (118) from an Italian forum for systemic lupus erythematosus patients were collected and analyzed combining qualitative content analysis with statistical textual analysis. The results showed different purposes for posts: starting new relationships, seeking information, receiving emotional support, and giving a contribution. Lexical analysis identified three ways of describing patients' experiences. Discussion focuses on the relationship between the requested/offered support and systemic lupus erythematosus experiences.

Alexithymia and low cooperativeness are associated with suicide attempts in male military personnel with adjustment disorder: a case-control study

Subpopulations of patients with adjustment disorder are at increased risk for suicide. The current study investigated whether personality traits, including alexithymia, temperament, and character, are associated with an increased risk of suicide in individuals with adjustment disorder. Age- and sex-matched patients meeting the diagnostic and statistical manual of mental disorders (DSM-IV) criteria for adjustment disorder with (n=92) and without (n=92) a history of suicide attempts were recruited for the present study. Ninety-two healthy individuals who did not meet diagnostic criteria for Axis I or II diagnoses were used as controls. The Toronto alexithymia scale-20 (TAS-20) and the temperament and character inventory (TCI) were used to assess personality traits. Significantly higher total and subscale scores on the TAS-20, including on the difficulty-identifying-feelings (DIF) and difficulty-describing-feelings (DDF) subscales, and lower scores on the TCI cooperativeness subscale were noted in adjustment-disorder patients with previous suicide attempts. In the multivariate regression analysis, high DDF and DIF and low cooperativeness increased the risk of suicide attempts in adjustment-disorder patients. A subsequent path analysis revealed that high DDF had a direct effect on suicide attempts, whereas high DIF had an indirect effect on suicide attempts via low cooperativeness.

Temperament and character of young male conscripts with adjustment disorder: a case-control study

Personality is an important clinical factor for successful adjustment in stressful situations. The aim of this study was to examine possible differences in temperament and character dimensions between patients with adjustment disorder with depressed mood and healthy controls. Among the young male conscripts, 86 subjects with adjustment disorder with depressed mood and 86 healthy controls were included. The mean scores in the 7 dimensions and 25 subscales of the Temperament and Character Inventory were compared between the patients with adjustment disorder with depressed mood and the control group by an independent t-test. The patients with adjustment disorder with depressed mood had significantly higher scores on harm-avoidance and lower scores on self-directedness, cooperativeness, and self-transcendence than did the controls. There were no differences in novelty seeking, reward dependence, and persistence in temperament between the two groups. The results of this study suggest that the personality traits of the subjects with adjustment disorder with depressed mood would make them vulnerable to stressful situations and less skilled in coping with conscription.