Genital Herpes Has Mysteries for Physicians and Patients


EDMONTON, Alberta, Nov. 26 -- Neither patients nor the physicians they consult seem to be well informed about genital herpes, with diverging opinions about how the infection is transmitted and treated, a survey here revealed.
Action Points
Explain to patients who ask that patients with genital herpes and their physicians need to have a thorough and accurate discussion about the methods of virus transmission, risks to others, and appropriate treatment.
The general knowledge of family physicians and patients about genital herpes is "disappointing," Barbara Romanowski, M.D., of the University of Alberta, and colleagues reported online in Sexually Transmitted Infections.
Of special concern, physicians and patients underestimated the risk of transmission during periods of asymptomatic viral shedding. Patients estimated that a mean of 51% of patients are infected by a partner who does not have an outbreak at the time of contact, and doctors estimated that a mean 45% of cases are transmitted during periods of asymptomatic shedding (P0.001).
The actual figure reported in the literature is 70%, the authors said.
When patients were asked to indicate the possible sources of infection from a list of options, virtually all cited sexual contact (99%). However, some also considered toilet seats (19%), blood transfusions (18%), shaking hands (8%), and swimming pools or baths (6%) as potential sources.
Overall, only 65% got it right, identifying sexual transmission as the sole means of transmission.
The survey also explored the emotional impact of herpes infection, its transmission, and its management. Family physicians estimated the ongoing emotional impact of the viral infection to be higher than the patients did.
For their part, the patients were more distressed by recurrences and a more recent diagnosis, the investigators said.
More serious than the disconnect between what physicians and patients perceive was the fact that both doctors and patients underestimated the risk of transmission during asymptomatic viral shedding, they said.
The findings came from an online survey of 200 Canadian family physicians and 401 patients. The patients were recruited from a consumer panel of more than 165,000 Canadians, supplied by a market research company.
The physicians were recruited from an email database of 6,529 family doctors from the Canadian Medical Association Directory as well as doctors previously contacted by the marketing firm.
Where possible, the content of the doctor and patient questionnaires mirrored each another.
The physicians had been in practice for a mean 14.7 years. Of the physicians, 64% were men, and 68% practiced in a city with a population exceeding 100,000.
The mean patient age was 44.4 years and 60% were women. The average age at diagnosis was 31.2 years and the mean disease duration was 13.2 years. Of the patients, 22% had genital herpes for 20 or more years; 30% for 11 to 20 years; 25% for five to 10 years; 13% for two to four years; and the rest for a shorter time.
The patients reported that their diagnosis was made by a family physician for 74% and by a specialist for 19%.
In answer to questions about the emotional impact of the herpes infection, both physicians and patients acknowledged the stress of the infection, with 99% of the physicians considering the emotional impact high versus 89% of the patients. However, for the patients, distress increased significantly with the number of recurrences in the preceding year.
There was also substantial disparity in the reported use of antiviral therapy between doctors and patients. Physicians reported that 74% of their patients were taking medication, whereas only 29% of the patients reported use of antivirals.
Physicians reported discussing suppressive therapy with 59% of patients, whereas only 25% of patients recalled such a discussion.
Only 40% of patients were aware that daily antiviral therapy was available to reduce the risk of transmission, while the most compelling reason for a high interest in suppressive therapy for 62% of the patients was to reduce the frequency and severity of outbreaks rather than transmission risk.
Potential study limitations of the study include the sampling source, which may have included individuals more willing to discuss genital herpes and were more engaged in treatment, the researchers said.
Also, the online consumer panel was used because it provided an economical means of reaching a large sampling source with an anonymous atmosphere. Finally, internet research did not allow matching doctors and patients, they wrote.
Although physicians believe they are providing patients with choices on disease management, the message fails to reach many of their patients. Doctors must ensure that they are accurate and complete in their knowledge of genital herpes and adapt their communication style so that choices in disease management are truly shared with patients.
The challenge will be to educate both groups, with the goal of achieving optimal genital herpes management and standard of care as the norm, not the exception, Dr. Romanowski concluded.
This study was supported by GlaxoSmithKline Inc., Canada, maker of the herpes drug valacyclovir (Valtrex).
Dr. Romanowski reported that she is a consultant for GlaxoSmithKline and has received research funds and honoraria for speaking engagements from them. Co-authors Yola M. Zdanowicz and Steven T. Owens are employed by an independent market research company, Ipsos Reid, which supplied some of the patients and physicians for this study. They have received consulting fees from GlaxoSmithKline to conduct the fieldwork for this study as well as to consult on the methodology, analysis, and preparation of this journal article.Primary source: Sexually Transmitted InfectionsSource reference: Romanowski B, et al "In search of optimal genital herpes management and standard of care (INSIGHTS): doctors' and patients' perceptions of genital herpes"Sex Transm Infect 2007; DOI: 10.1136/sti.2007.027631.