Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Is suspicion of genital herpes infection associated with avoiding sex? A clinic-based study

Richard A. Crosby A D , Sara Head A , Gregory Moore B and Adewale Troutman C

A College of Public Health, University of Kentucky, Lexington, KY 40506, USA.

B University Health Service, University of Kentucky, Lexington, KY 40506, USA.

C Louisville Metropolitan Health Department, 400 East Gray Street, PO Box 1704, Louisville, KY 40201, USA.

D Corresponding author. Email:

Sexual Health 5(3) 279-283
Submitted: 10 January 2008  Accepted: 15 May 2008   Published: 6 August 2008


Objective: The present study tested the research hypothesis that sexually transmissible disease (STD) clinic patients suspecting genital herpes infection would be more likely than their ‘non-suspecting’ counterparts to abstain from sex to avoid transmission of a perceived STD. Methods: Recruitment (n = 351) occurred in a publicly-funded STD clinic located in a metropolitan area of the southern USA. Participants were tested for herpes simplex virus type 2 (HSV-2) using a rapid test manufactured by Biokit (Lexington, MA, USA) and they completed a self-administered questionnaire (using a 3-month recall period). Results: Well over one-third (38.7%) of those indicating suspicion also indicated avoiding sex with steady partners because of concerns about STDs as compared with 28.0% among those not indicating suspicion (prevalence ratio = 1.38; 95% CI = 1.02–1.87, P = 0.036). The relationship between suspicion and avoiding sex with non-steady partners was not significant (P = 0.720). The relationship with steady partners only applied to people who were female (P = 0.013), single (P = 0.017), reported symptoms of genital herpes (P = 0.003), perceived that genital herpes would have a strong negative influence on their sex life (P = 0.0001), and who subsequently tested positive for HSV-2 (P = 0.012). Conclusions: Among STD clinic attendees, suspicion of genital herpes infection may translate into partner protective behaviour, but only for a minority of people and only with respect to sex with steady partners. Clinic-based and community-based education programs may benefit public health by teaching people (especially single women) how to effectively recognise symptoms of primary genital herpes infections. Reversing the often prevailing ethic of genital herpes as a ‘community secret’ will clearly be a challenge to these education programs.

Additional keywords: genital herpes, sexual behaviour, sexually transmissible diseases, symptoms.


[1]  Fleming DT McQuillan GM Johnson RE Nahmias AJ Aral SO Lee FK et al 1997 Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 337 1105 11 doi:10.1056/NEJM199710163371601

[2]  Corey L Handsfield HH 2000 Genital herpes and public health: addressing a global problem. JAMA 283 791 4 doi:10.1001/jama.283.6.791

[3]  Lafferty WE Downey L Celum C Wald A 2000 Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis 181 1454 7 doi:10.1086/315395

[4]  Xu F Sternberg MR Kottiri BJ McQuillan GM Lee FK Nahmias AJ et al 2006 Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 296 964 73 doi:10.1001/jama.296.8.964

[5]  Ribes JA Steele AD Seabolt JP Baker DJ 2001 Six-year study of the incidence of herpes in genital and nongenital cultures in a central Kentucky medical center patient population. J Clin Microbiol 39 3321 5 doi:10.1128/JCM.39.9.3321-3325.2001

[6]  Roberts CM Pfister JR Spear SJ 2003 Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 30 797 800 doi:10.1097/01.OLQ.0000092387.58746.C7

[7]  Melville J Sniffen S Crosby R Salazar L Whittington W Dithmer-Schreck D et al 2003 Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment. Sex Transm Infect 79 280 5 doi:10.1136/sti.79.4.280

[8]  Meyer JL Crosby RA Whittington WLH Carrell D Ashley-Morrow R Meier AS et al 2005 The psychosocial impact of serological herpes simplex type 2 testing in an urban HIV clinic. Sex Transm Infect 81 309 15 doi:10.1136/sti.2004.012146

[9]  Miyai T Turner KR Kent CK Klausner J 2004 The psychosocial impact of testing individuals with no history of genital herpes for herpes simplex virus type 2. Sex Transm Dis 31 517 21 doi:10.1097/01.olq.0000137901.71284.6b

[10]  Rosenthal SL Zimet GD Leichliter JS Stanberry LR Fife KH Tu W et al 2006 The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection. Sex Transm Infect 82 154 7 doi:10.1136/sti.2005.016311

[11]  Smith A Denham I Keogh L Jacobs D McHarg V Marceglia A et al 2000 Psychosocial impact of type-specific herpes simplex serological testing on asymptomatic sexual health clinic attendees. Int J STD AIDS 11 15 20 doi:10.1258/0956462001914841

[12]  Richards J Scholes D Caka S Drolette L Magaret AM Yarbro P et al 2007 HSV-2 serologic testing in an HMO population: uptake and psychosocial sequelae. Sex Transm Dis 34 718 25

[13]  Brown ZA Gardella C Wald A Morrow RA Corey L 2005 Genital herpes complicating pregnancy. Obstet Gynecol 106 845 56

[14]  Blower S Ma L 2004 Calculating the contribution of herpes simplex virus type 2 epidemics to increasing HIV incidence: treatment implications. Clin Infect Dis 39 S240 7

[15]  Duffus WA Mermin J Bunnell R Byers RH Odongo G Ekwaru P et al 2005 Chronic herpes simplex virus type-2 infection and HIV viral load. Int J STD AIDS 16 733 5 doi:10.1258/095646205774763298

[16]  Renzi C Douglas JM Foster M Critchlow CW Ashley-Morrow R Buchbinder SP et al 2003 Herpes simplex virus type 2 infection as a risk factor for human immunodeficiency virus acquisition in men who have sex with men. J Infect Dis 187 19 25 doi:10.1086/345867

[17]  Wald A Link K 2002 Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. J Infect Dis 185 45 52 doi:10.1086/338231

[18]  Corey L 1994 The current trend in genital herpes. Progress in prevention. Sex Transm Dis 21 S38 44

[19]  Wald A Krantz E Selke S Lairson E Morrow RA Zeh J 2006 Knowledge of partners’ genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis 194 42 52

[20]  Alexander L Naisbett B 2002 Patient and physician partnerships in managing genital herpes. J Infect Dis 186 S57 65 doi:10.1086/342964

[21]  Patel R Boselli F Cairo I Barnett G Price M Wulf HC 2001 Patients’ perspectives on the burden of recurrent genital herpes. Int J STD AIDS 12 640 5 doi:10.1258/0956462011923859

[22]  Patel R Tyring S Strand A Price MJ Grant DM 1999 Impact of suppressive antiviral therapy on the health related quality of life of patients with recurrent genital herpes infection. Sex Transm Infect 75 398 402

[23]  Spencer B Leplege A Ecosse E 1999 Recurrent genital herpes and quality of life in France. Qual Life Res 8 365 71

[24]  Ashley RL Wald A Eagleton M 2000 Premarket evaluation of the POCkit HSV-2 type-specific serologic test in culture-documented cases of genital herpes simplex virus type 2. Sex Transm Dis 27 266 71 doi:10.1097/00007435-200005000-00005

[25]  Corey L Wald A Sacks SL Tyring SK Warren T Douglas JM Jr et al 2004 Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes. Obstet Gynecol Surv 59 260 1 doi:10.1097/01.OGX.0000120171.49986.31

Export Citation Cited By (2)