Herpes Simplex Virus: To disclose or not to disclose.An exploration of the multi-disciplinary team’s role in

advising patients about disclosure when diagnosed with genital herpes simplex virus (HSV).

Pauline Caulfield

Advanced Nurse Practitioner

Sandyford Services

Glasgow CityCommunity Health PartnershipNorth West Sector

BackgroundBackground

Herpes Simplex Virus (HSV) – First UK prosecution for transmission 2011

Implications to clinical practice/protocols regarding the now legal issue of

disclosure – change in local protocol

The psychological morbidity and stigma associated with HSV is well documented

Factors affecting disclosure have been widely explored in literature

Gap in literature: what do the multidisciplinary team advise patients diagnosed with

HSV regarding disclosure?

AimAim

The overall aim of the study was to explore the nature of advice given to

patients by the multidisciplinary team regarding HSV disclosure to

partners.

ObjectiveObjective

To explore different staff group’s views on HSV disclosure and the

nature of advice they give to patients.

MethodsMethods DesignDesign

▪ Qualitative descriptive approach

SampleSample A Stratified Convenience sample of 10 members of the multidisciplinary team

Data Collection Data Collection 10 Semi-structured interviews were conducted in March 2014

Data AnalysisData Analysis Interviews were transcribed verbatim and analysed using Burnard’s Thematic Content

Analysis

FINDINGS THEME 1: FINDINGS THEME 1: HSV – The FactsHSV – The Facts

Physical Care/ManagementPhysical Care/Management

‘I would talk about the immediate symptomatic relief and treatment to

reduce the severity and duration of her lesions.’

(Participant 9)

Normalising HSVNormalising HSV

‘I often use the image of an iceberg. This is particularly useful when talking

about partners. The people with symptoms are the bit of the iceberg above

the water and the part of the population infected who never get symptoms

is the big chunk underneath.’ (Participant 2)

FINDINGS THEME 2: FINDINGS THEME 2: Stigma and Psychological Aspects of Stigma and Psychological Aspects of

HSVHSV

‘The Aftermath’The Aftermath’

‘It is definitely the one that brings the most tears…it is more the psychological

aspects of having HSV that we deal with rather than the physical symptoms.’  

(Participant 4)

‘The Future’The Future’

‘they become concerned about the future and if they will ever have a sexual

partner again cause they don’t want to transmit it to somebody else.’

(Participant 6)

FINDINGS THEME 3:FINDINGS THEME 3:The Challenge of DisclosureThe Challenge of Disclosure

Patient’s ChoicePatient’s Choice

‘Ultimately it is up to them. It is the patient’s choice. If patients choose not to tell

their partners, that is up to them.’

(Participant 3)

Casual Versus RegularCasual Versus Regular

‘I say I think it is up to you to gauge each relationship and each partner and

obviously if it is casual sex and it is a one off I think it is much less likely that

someone will be willing to do that.’

(Participant 5)

Lack of GuidanceLack of Guidance

‘I think we need some clear guidance as to what should form part of the

consultation about the partner notification aspects of HSV.’

(Participant 10)

FINDINGS THEME 4:FINDINGS THEME 4:

The Legal Case: Revenge not JusticeThe Legal Case: Revenge not Justice

• ‘I just wonder whether some of these cases are driven more by revenge and

that justice really isn’t well served by pursuing them.’

(Participant 10)

• ‘I think it is really sad and unfortunate that it got to court and there was a

successful prosecution.’

(Participant 4)

• ‘Makes no sense to me given the prevalence of herpes.

How could they prove it was him?’

(Participant 7)

DiscussionDiscussion

• Participants provided accurate information on HSV

• Disclosure more likely to occur to a regular partner

• General consensus disclosure not required due to the prevalence of HSV

• Participants believed disclosure to be the patient’s choice

• Participants not following local protocol on disclosure

Conclusions and RecommendationsConclusions and Recommendations

• Conclusions:Conclusions:

Participants believed that disclosure was the patient’s choice

Participants had not altered their practice to advise disclosure to all

partners in accordance with local protocol.

• Recommendations:Recommendations:

Clearer guidance on disclosure required to guide advice given and

ensure continuity of practice

Larger multi-centre study to assess current practice