Associations between individual and relationship characteristics and genital herpes disclosure

Disclosure of Sexually Transmitted Infections to Sexual Partners: A Systematic Critical Literature Review

The purpose of this review was to systematically and critically evaluate the STI disclosure literature (excluding HIV disclosure literature), summarize limitations and omissions, and identify opportunities for future research. We used the Health Disclosure Decision-Making Model (DD-MM) as a guiding theoretical framework. Following PRISMA guidelines, database searches using key terms identified 387 possible articles, 32 of which ultimately met inclusion criteria for this review. Findings indicated that individuals with STIs experience a variety of negative feelings and emotions related to the prospect of disclosure. Reasons for disclosure included moral obligation, love for partner, and desire for support, whereas reasons to not disclose included fears about partner's reaction and response, fears of being rejected or broken up with, and beliefs about the lack of obligation. Disclosers used a variety of disclosure strategies, including priming messages, framing, and direct disclosure. Non-disclosers used strategies to pass as uninfected (i.e. passing), withdraw from relationships, and using outbreaks to time sexual activity. Among studies that examined disclosure timing, around half or fewer individuals disclosed or believed they should disclose prior to engaging in sexual activity. The findings indicated that relationship-related factors such as greater levels of commitment, relationship quality, length together, and feelings of closeness were important predictors of disclosure. Finally, some individuals experienced negative partner responses, whereas others experienced positive responses and relationship outcomes. Our review revealed that the experiences of receivers of STI disclosures are not well-represented in the literature. Implications for future research, education, and intervention are specified.

Exploring the psychosexual impact and disclosure experiences of women testing positive for high-risk cervical human papillomavirus

OBJECTIVES

To examine the psychosexual impact and disclosure experiences of women testing HPV-positive following cervical screening.

DESIGN

In-depth semi-structured interviews.

METHODS

Interviews were conducted with 21 women of screening age (i.e. those aged 24-65 years) in England who self-reported testing HPV-positive in the context of cervical screening in the last 12 months. Data were analysed using Framework Analysis.

RESULTS

The sexually transmitted nature of HPV, and aspects relating to the transmission of HPV and where their HPV infection had come from, had an impact on women's current, past and future interpersonal and sexual relationships. Most women had disclosed their HPV infection to others, however the factors influencing their decision, and others' reactions to disclosure differed. The magnitude and extent of psychosexual impact was influenced by how women conceptualized HPV, their understanding of key aspects of the virus, concerns about transmitting HPV and having a persistent HPV infection.

CONCLUSIONS

Increasing knowledge of key aspects of HPV, such as its high prevalence and spontaneous clearance, and the differences between HPV and other STIs, may increase women's understanding of their screening result and reduce any negative psychosexual consequences of testing HPV-positive. Referring to HPV as an infection that is passed on by skin-to-skin contact during sexual activity, rather than an STI, may help to lessen any psychosexual impact triggered by the STI label.

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.

Genital herpes - diagnosis, treatments, attitudes and response to disclosure amongst members of the UK Herpes Viruses Association

A diagnosis of genital herpes may result in psychological as well as physical morbidity. Many patients require on-going help and contact the Herpes Viruses Association (HVA), a UK patient support organisation. The HVA conducts occasional questionnaires relating to various issues surrounding herpes and this study reports on a survey conducted amongst members in 2015. The survey was done using SurveyMonkey and covered diagnosis/treatment, both allopathic and self-help, physical and psychological impact and disclosure to partners. Three hundred and fifty-eight women and 103 men completed the questionnaire. Male respondents were older than women (48.6 versus 42.9 years). The majority were first diagnosed in sexual health clinics. A high proportion had informed partners about the diagnosis and in 83% disclosure did not result in rejection. 57% were taking prophylaxis with more taking treatment episodically rather than continually; 11.3% sourced medications on-line. Alternative treatments were used commonly with Lomaherpan cream (Melissa officinalis), lidocaine ointment and a diet with reduced arginine and increased lysine the most frequent choices. Other alternative treatments included olive leaf extract, Eleuthercoccus senticosus and vitamin supplements. Women reported being troubled psychologically more than men. Neuropathic pain was reported by 80.4% of the women and 64.1% of the men. Although antiviral treatment is cheap and well-tolerated it is still being refused by some healthcare providers. There still appears to be a considerable degree of stigma experienced by patients which can be mitigated by support from patients' support groups such as the HVA.

Concerns about disclosing a high-risk cervical human papillomavirus (HPV) infection to a sexual partner: a systematic review and thematic synthesis

BACKGROUND

Human papillomavirus (HPV)-based cervical screening is now replacing cytology-based screening in several countries and many women in screening programmes will consequently receive HPV-positive results. Because of the sexually transmitted nature of HPV, receiving an HPV-positive result may raise questions about disclosing the infection to a sexual partner.

OBJECTIVE

To review the quantitative and qualitative literature exploring women's concerns about disclosing a high-risk cervical HPV infection to a sexual partner.

METHODS

We searched MEDLINE, PsycINFO, CINAHL Plus, Web of Science and EMBASE for studies reporting at least one disclosure-related outcome among women with high-risk HPV. We also searched the grey literature and carried out forward/backward citation searches. A narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies were conducted.

RESULTS

Thirteen articles met the inclusion criteria (12 qualitative, 1 quantitative). In the quantitative study, 60% of HPV-positive women felt disclosing an HPV result was 'risky'. Concerns about disclosing HPV to a sexual partner were influenced by the stigma that is associated with having an STI and uncertainty about how their partner would respond. Women questioned how, when and to whom they should disclose their HPV-positive status.

CONCLUSIONS

The studies included in this review provide rich information about the range of concerns women have, the reasons for these concerns, and the questions women have about disclosing HPV to sexual partners. As studies were predominantly qualitative, the prevalence of concerns is unclear.

'When it comes to HIV, that's when you find out the genuinity of that love': The experience of disclosing a HIV+ status to an intimate partner

Despite a medical discourse of the 'normalisation' of HIV, it remains a highly stigmatising condition and makes the issue of disclosing one's HIV status particularly complex. This article reports on the experience of 18 people living with HIV in the United Kingdom of disclosing their HIV+ status in arguably their most important relationship, their intimate partnership. Five main themes arose: disclosure as the battlefield, preparing psychologically to disclose, disclosure as a test of the partner's love, disclosure as an opportunity for the partner to know them more deeply and the renegotiation of the relationship narrative.

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.