STD Quarterly: Missed opportunities: Family planners receive call to action for herpes screening
Despite availability of diagnostic tools, status awareness remains low
Do you provide routine screening for herpes? According to the American Social Health Association (ASHA) in Research Triangle Park, NC, at least 80% of people infected with genital herpes do not know that they have the sexually transmitted disease (STD), despite the availability of improved diagnostic tools that easily can detect the infection.
Improving awareness of herpes simplex virus (HSV) infection is important for several reasons, says Linda Alexander, PhD, FAAN, ASHA president and chief executive officer. "For example, accurate type-specific blood tests can help define the risk that a pregnant woman has for exposing her baby to herpes, particularly if she is newly infected during pregnancy," Alexander explains. "Additionally, HSV infection has increasingly been associated with the transmission and acquisition of HIV; likewise, studies have shown that genital herpes also can accelerate the course of an HIV infection."
ASHA recently was host for a herpes diagnostic summit in Seattle that brought together researchers, clinicians, and pharmaceutical companies in an effort to improve knowledge and use of available diagnostic tools. One of the action steps identified at the summit is to see that public health providers routinely screen HIV-positive and STD clinic patients for genital herpes.
Given the prevalence of the STD, patients need to know their HSV status, and type-specific serologic blood testing should be used for diagnosis, says Anna Wald, MD, MPH, assistant professor at the University of Washington in Seattle. Wald is scheduled to present on HSV testing at the March 4-7, 2002, National STD Prevention Conference in San Diego.
"I think that if you’re dealing with an infection that affects almost one out of four people, you need to ask the question Is it worth diagnosing?’" Wald states. "I happen to think it is, and type-specific testing is really the only way to do it."
Why know HSV status?
Compared to other diseases/conditions, HSV is not always seen by health care providers as important, says Alexander.
"Medically, HSV isn’t viewed to be a serious condition, [such as] untreated chlamydia; however, the devastating psychosocial repercussions that often result from herpes diagnoses warrant appropriate attention," Alexander observes. "Because is it so difficult to estimate and quantify things such as days of lost work and the emotional toll that results from herpes, the virus is often trivialized and not seen as important."
Genital herpes often goes misdiagnosed through use of inaccurate tests, says Alexander. There is a high rate of false-positives with older tests, and a considerable amount of frustration arises from patients’ inability to obtain accurate tests, she states.
3 blood tests recommended
The Herpes Resource Center, operated by ASHA, recommends three blood tests for type-specific diagnosis.
The Herpes Western Blot, available from the University of Washington, is considered the research "gold standard." Blood must be drawn for the test; result time can take about two weeks. (Contraceptive Technology Update reported on HSV tests in the article "Get a handle on herpes" in its August 2000 STD Quarterly insert.)
Focus Technologies of Herndon, VA (formerly MRL Diagnostics) offers HerpeSelect ELISA and Immunoblot test kits. Both detect specific antibodies to serotypes 1 or 2. Result time can take one to two weeks. The Food and Drug Administration (FDA) granted approval for the ELISA kit in February 2000; the immunoblot kit was approved in April 2000. Blood must be drawn for both tests.
The POCkit Rapid Test from Diagnology of Research Triangle Park, NC, detects HSV-2 only; however, it only requires a finger prick, and results are available in fewer than 10 minutes. It received FDA approval in August 1999.
Provide information
Herpes treatment can be time-consuming for providers, since patients have many questions and are often in need of emotional support, Alexander notes.
"In today’s world of managed care, health care providers just don’t have the time to invest for what is medically viewed to be a recurrent skin condition," she contends.
Providers should look to alternative ways of counseling patients, as opposed to just not testing them, says Wald. University of Washington researchers have experimented with an interactive, computer-based program to educate patients about genital herpes and found it an effective tool.1 However, most providers have not implemented similar counseling programs, she observes.
Resource center offers hotline
ASHA offers many resources for herpes information. The Herpes Resource Center provides accurate information and appropriate referrals through its National Herpes Hotline [(919) 361-8488] Monday through Friday, 9 a.m. to 7 p.m., ET. Visitors to the Herpes Resource Center’s on-line presence on the ASHA web site (www.ashastd.org/hrc) can participate in the Herpes Chat Room, available Monday through Friday, 4-6 p.m. ET. Visitors can chat freely and anonymously; a Herpes Resource Center staff member is on hand to answer questions and keep conversations on track. The Resource Center also works with herpes support groups found in 38 states and abroad, and publishes a newsletter, the helper. (See "Web Watch" in this issue for additional resources.)
It can’t happen to me’
According to a nationwide survey released in April 2001, nearly 80% of Americans are unaware of genital herpes’ widespread prevalence, and 65% say that they are "not at all" concerned about contracting the disease.2 These figures reaffirm the common attitude that "it can’t happen to me," and contrast sharply with the real-incidence figures of the STD.
Genital herpes now affects one in five Americans over the age of 12, says Alexander. The time for provider to act is now, she believes.
"When effective tests are available, they play a critical role in the STD prevention process," states Alexander. "We have the tools, now we have to put them to use."
References
- Bensen C, Stern J, Skinner E, et al. An interactive, computer-based program to educate patients about genital herpes. Sex Transm Dis 1999; 26:364-368.
- Novartis Pharmaceuticals. New Survey Shows Most Americans Are "Not At All" Concerned With Contracting Genital Herpes. Press release. April 17, 2001.
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