Introduction

Genital herpes is a sexually transmitted disease for which there is no absolute cure. Its frequency is increasing all over the world, with over 22% of women in the USA affected. One of the main reasons for it's spread is that there are often no symptoms, or no obviously recognizable symptoms, in many of those infected. However, once it's been diagnosed, the patient may feel ashamed, anxious, and depressed, as well as suffering a loss of self-esteem.

The early stages of genital herpes require help to get through the necessary period of adjustment. Counseling by a healthcare provider can supply this help. Scientists at the American Social Health Association (ASHA), Research Triangle Park, USA, have conducted a patient survey to find out what needs improving in the education and counseling of newly diagnosed patients. Here's a summary of their findings.

What the survey revealed

Genital herpes patients were identified from a TV advertisement campaign for valacyclovir, an antiviral treatment for herpes. Ten thousand of them were sent a questionnaire, and about 400 of them returned valid replies. These patients were mostly young (under 35), female (80%), single (60%), and living in a large city or suburb (55%).

The questionnaire enquired about how the diagnosis was made, how the patients were treated, and information about the education and counseling given. Over 80% of the patients were diagnosed by a lab test (a blood test or culture of a swab), either by a physician, a physician's assistant, or a nurse practitioner.

While just about all the patients received a prescription for treatment or for suppression of the symptoms, 23% reported that they received no counseling, and 40% said that their counseling at the first visit lasted less than 5 minutes.

More than half the patients felt that embarrassment was the main reason that counseling wasn't effective, although shortage of time and difficulty in understanding the complexities of the disease played a role, too. These complaints were across the board - gender, race, and age made no difference.

Less than half the patients had a follow-up visit within the first 6 months. This was unfortunate; nearly all the replies stated that the first 6 months after diagnosis was the most important time for education and counseling.

The healthcare providers covered the factual clinical topics well - how to use a condom properly, reducing the risk of infecting a partner, etc. The emotional or social aspects were less well handled; this should ideally include information to reduce shame, anxiety, and depression, such as the frequency of the disease, how it's transmitted, how an outbreak can be suppressed, and what to do during pregnancy.

Nearly all the patients sought additional information - from the Internet, toll-free phone numbers from TV ads, hotlines, books, magazines, library visits, or friends and family. In only about half the cases was information on such resources supplied by the healthcare provider.

Finally, the patients were asked: "What suggestions do you have for improving genital herpes education and counseling from healthcare providers?" The answers were: more information, more resources, and emotional support; one patient in 5 reported that their healthcare provider was 'not sympathetic'.

Comment

It seems clear that more needs to be done to help newly diagnosed patients with genital herpes. In particular, a sympathetic counselor should provide adequate factual information about the disease, as well as emotional support, with advice on the various health and social resources available. Follow-up visits should be scheduled, with enough time allocated to helping the patient become reintegrated into society. Management of genital herpes is a life-long project, at least until a complete cure is found.