Hayley Mark

Performance of Focus ELISA Tests for HSV-1 and HSV-2 Antibodies Among University Students With No History of Genital Herpes

Objectives: To define the performance characteristics of the Focus ELISA HSV-1 and HSV-2 assay among 100 university students. Study Design: HSV-1 and HSV-2 Focus ELISA and Western Blot assays were performed on sera from university students who reported no history of genital herpes. Results: HSV-2 and HSV-1 seroprevalence by Western Blot were 3.4% and 48%, respectively. In this population, the positive predictive value of the Focus HSV-2 ELISA was 37.5%, the sensitivity was 100%, and specificity was 94.1%. The PPV of the Focus HSV-1 ELISA was 96.7%, the sensitivity was 69.0%, and the specificity was 97.8%. Conclusions: In this low-prevalence population, the positive predictive value of the Focus HSV-2 ELISA test was low. This finding, together with those reported elsewhere, indicates that caution is warranted when recommending HSV screening in low-prevalence or heterogeneous populations. Consideration should be given to raising the cutoff index value for defining a positive test result.

Sexually transmitted infection clinics as safety net providers: exploring the role of categorical sexually transmitted infection clinics in an era of health care reform.

Background For many individuals, the implementation of the US Affordable Care Act will involve a transition from public to private health care venues for sexually transmitted infection (STI) care and prevention. To anticipate challenges primary care providers may face and to inform the future role of publicly funded STI clinics, it is useful to consider their current functions. Methods Data collected by 40 STI clinics that are a part of the Sexually Transmitted Disease Surveillance Network were used to describe patient demographic and behavioral characteristics, STI diagnoses, and laboratory testing data in 2010 and 2011. Results A total of 608,536 clinic visits were made by 363,607 unique patients. Most patients (61.9%) were male; 21.9% of men reported sex with men (MSM). Roughly half of patients were 20 to 29 years old (47.1%) and non-Hispanic black (56.2%). There were 212,765 STI diagnoses (mostly nonreportable) that required clinical examinations. A high volume of chlamydia, gonorrhea, and HIV testing was performed (>350,000 tests); the prevalence was 11.5% for chlamydia, 5.8% for gonorrhea, 0.9% for HIV, and varied greatly by sex and MSM status. Among MSM with chlamydia or gonorrhea, 40.1% (1811/4448) of chlamydial and 46.2% (3370/7300) of gonococcal infections were detected at extragenital sites. Conclusions Sexually Transmitted Disease Surveillance Network clinics served populations with high STI rates. Given experience with diagnoses of both nonreportable and reportable STIs and extragenital chlamydia and gonorrhea testing, STI clinics comprise a critical specialty network in STI diagnosis, treatment, and prevention.

Sex with women as a risk factor for herpes simplex virus type 2 among young men who have sex with men in Baltimore

Background: Herpes simplex virus type 2 is common among MSM and is a risk factor for transmission of HIV. The findings of studies investigating the relationship between infection with HSV-2 and number of sex partners among MSM are inconsistent and rarely distinguish between male and female partners. Goal: To determine the prevalence and risk factors for infection with HSV-2, including the number and gender of sex partners, in a group of MSM in Baltimore, MD. Study: This was a cross-sectional study among young MSM in Baltimore. Results: Of the blood samples from 824 participants, 19.3% had HSV-2 antibodies. After adjusting for known HSV-2 correlates, independent predictors of HSV-2 seropositivity included HIV seropositivity, black race, older age, number of lifetime female sex partners, recent unprotected receptive anal intercourse with a man. Conclusions: This study suggests that female sex partners may be an important source of HSV-2 infection among young bisexual MSM. After adjusting for known HSV-2 correlates, the number of lifetime female but not male sex partners was independently associated with HSV-2. These results highlight the need for HSV-2 prevention and treatment efforts targeting MSM who also have sex with women. Future investigations of HSV-2 and sexual behavior among MSM need to distinguish between male and female sex partners.

Recruitment Strategies and Motivations for Sexually Transmitted Disease Testing among College Students.

Objective The authors evaluated procedures for recruiting college students for sexually transmitted disease (STD) testing as part of a research study examining the impact of HSV serologic testing. Participants A convenience sample of 100 students was drawn from students aged 18 to 35 years enrolled at one university in a mid- Atlantic state between September 2004 and March 2006. Methods: Six strategies were used to recruit students for participation in the study. Upon enrollment, participants were asked where they heard about the study. Students were also asked about their motivations for participation. Results: Findings show that a significant recruitment strategy involves targeting places where students seek health care. Other effective strategies include those where information is directly provided to individuals. Most students were motivated to participate because of a possible past exposure to herpes simplex virus 2. Conclusions: Targeting places where students seek health care and educating students about STDs are important strategies for recruiting students for STD testing.

Serologic screening for herpes simplex virus among university students: a pilot study.

Objective: The authors examined the feasibility of conducting serologic testing for the herpes simplex virus 2 (HSV-2) among university students and assessed the psychosocial impact of an HSV-2 diagnosis. Methods: The authors recruited a convenience sample of 100 students (aged 18-39 years) without a history of genital herpes from 1 university between September 2004 and March 2006. Participants received HSV-2 antibody testing by Focus ELISA and Western Blot assays and completed a questionnaire that addressed psychological functioning. Twenty-eight participants completed the questionnaire again at a 3-month follow-up visit. Results: The study revealed (1) low test-reliability in the student population, (2) that positive test results may cause a decline in psychological well-being, and (3) that substantial resources are required to support students with positive HSV-2 results. Conclusions: Test performance, psychological impact, and availability of resources for counseling students with positive diagnoses should be considered before implementing HSV testing programs.

What's new in sexually transmitted infection management: changes in the 2010 guidelines from the Centers for Disease Control and Prevention.

Screening, treatment, and follow-up of sexually transmitted infections (STIs) are an important part of the role of womens health care providers. Keeping abreast of new and changing treatment guidelines is crucial to providing competent care. The Sexually transmitted diseases treatment guidelines, produced every 4 years by the Centers for Disease Control and Prevention, summarize current evidence on prevention, diagnosis, and treatment of STIs. The purpose of this article is to review the changes in the 2010 guidelines from the previous 2006 guidelines. These changes include new diagnostic tests for bacterial vaginosis, Neisseria gonorrhoeae, and human papillomavirus; new treatment recommendations for bacterial vaginosis, gonorrhea, and genital warts; the increasing prevalence of antimicrobial-resistant N gonorrhoeae; new criteria for spinal fluid examination to evaluate for neurosyphilis; and the emergence of azithromycin-resistant Treponema pallidum.

A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV.

ObjectiveWomen living with HIV experience higher risk of cervical cancer, but screening rates in the United States are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervicovaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology (“Pap”) testing among women with HIV. Materials and MethodsThis was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women older than 18 years, with HIV infection, attending an HIV clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the womens perceived threat of developing cervical cancer. ResultsA total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences in comparing HPV-positive with HPV-negative women nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer. ConclusionsThe intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible.

Asymptomatic Sexually Active Adolescents and Young Adults Should Not Be Screened for Herpes Simplex Virus

Herpes simplex virus (HSV) types 1 and 2 are highly prevalent in the general population of the United States. The seroprevalence of HSV-2 and HSV-1 were 17% and 58%, respectively, in a cohort aged 14 to 49 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2004.1 Seroprevalence is substantially less among adolescents and young adults. Approximately 80% of infected individuals are unaware of their infection and the majority of infections are transmitted by these individuals.2 Type-specific serological assays for HSV became commercially available in 1999, making possible widescale screening for HSV-1 and HSV-2. However, the value of HSV screening is controversial. Proponents argue that on detection, asymptomatic carriers can be counseled to use prevention methods and, thus, reduce the possibility of transmission to uninfected partners. Opponents point out the possibility that large numbers of asymptomatic individuals may receive a diagnosis of a stigmatized, chronic infection, with substantial transmission potential, but there are no substantial data to support the effectiveness of HSV screening in changing sexual behaviors or preventing transmission. The important questions that a clinician must consider in determining the value of HSV screening among asymptomatic sexually active adolescents and young adults are derived from the Wilson and Jungner classic public health report3 on criteria for use of a screening test and include the following: (1) Is the disease an important public health problem? (2) Is an accurate screening test available and is it acceptable to the population? (3) Does screening improve health outcomes and symptoms or reduce transmission of disease? (4) Are the costs and risks of screening less than the benefits?

Cervical Cancer Screening in the Era of Human Papillomavirus Testing and Vaccination

Cervical cancer screening algorithms have changed with the introduction of testing for human papillomavirus (HPV) and better understanding of the natural history of HPV. This review was undertaken to present recent developments related to cervical cancer screening, with HPV testing as a focus. Specifically, guidelines now recommend initiating cervical cancer screening at age 21, stopping at age 65 to 70 if previous tests are normal, and screening no more than every 2 to 3 years. Human papillomavirus testing is now incorporated into guidelines for cervical cancer screening in the United States, with the major impact being the lengthening of recommended screening intervals. Primary screening with HPV testing, although not yet approved in the United States, may serve to increase access to care for the millions of underserved women worldwide who bear most of the burden of cervical cancer. Despite clear guidelines from authoritative sources, many clinicians (including midwives) overscreen women. In cervical cancer screening, as in many areas of womens health care, performing tests that are unlikely to result in useful information may lead to harm.

Psychosocial Impact of a Positive HSV‐2 Diagnosis on Adults with Unrecognized HSV‐2 Infection

OBJECTIVE To evaluate the current research on the psychosocial impact of a positive herpes simplex virus type 2 (HSV-2) diagnosis on asymptomatic adults. DESIGN AND SAMPLE A structured review of PubMed, CINAHL, and MEDLINE resulted in 8 articles published between 2000 and 2008. MEASURES Articles were included if they investigated psychosocial reactions to HSV serological testing, including asymptomatic individuals, and used measurement instruments with adequate psychometric properties. RESULTS The studies included participants of various backgrounds, including individuals with a new HSV-2 diagnosis concurrently receiving human immunodeficiency virus treatment, students within a university setting, and an HMO population. Current research indicates that a diagnosis of HSV-2 does not result in persistent psychosocial morbidity. However, studies that assessed for more nuanced reactions noted an impact on quality of life related to herpes. CONCLUSIONS Further research is needed to confirm these findings among varied populations, to explore quality of life following HSV screening, and to identify the characteristics that may make particular individuals more susceptible to adverse psychological consequences.