A PROSPECTIVE-STUDY OF THE PSYCHOLOGICAL IMPACT ON PATIENTS WITH A 1ST EPISODE OF GENITAL HERPES

Objectives-To assess the psychological impact of first episode of geni tal herpes, and to determine whether this changes over time. Setting a nd subjects-The Departments of Genitourinary Medicine (GUM), and Derma tology, Middlesex Hospital London. The study group consisted of patien ts attending the department of GUM with a clinically proven first epis ode of genital herpes. Two control groups were recruited; firstly pati ents without herpes attending the GUM Department and secondly patients attending the Dermatology Department out patients with chronic dermat oses. Methods-Patients and controls completed an 87 item, self-adminis tered psychological questionnaire at 3 monthly intervals for a year. T he questionnaire consisted of the General Health Questionnaire (GHQ); the Hospital Anxiety and Depression Questionnaire (HADQ); Illness Atti tude Scales Illness Concern. Patients were also asked questions about their sexual behaviour. Results-Ninety one patients (68 women, 23 men) with genital herpes, 61 GUM controls (42 women, 19 men) and 56 dermat ology controls (36 women, 20 men) participated. There were no statisti cally significant demographic differences between patients and control s. At first visit the proportion of patients classified as ''cases'') by the GHQ (GHQ cases) were similar for primary herpes patients 62% (5 6/91) and Dermatology controls 52% (29/56) while a significantly small er proportion of GUM controls 34% (21/61) were classified as GHQ cases . The primary herpes group were significantly more concerned about the ir illness than either the GUM controls or the Dermatology controls (p < 0.002). The proportion of primary herpes patients classified as ''c ases'' by the GHQ reduced significantly over the initial three month p eriod with 67% of patients classified as ''cases'' at their first visi t becoming ''noncases'' after three months (p < 0.0001). Also 50% of t hose classified as ''cases'' at first visit by the HADQ became ''nonca ses'' after the initial three months (p = 0.007). The illness concern scores also decreased significantly from visit one to visit two (means 14.7 vs. 12.3; p < 0.0001). Conclusion-The diagnosis of a first episo de of genital herpes has a profound emotional effect on patients. If t hey do not have recurrent episodes, their emotional state improves. Fo r those who do have recurrences, the level of anxiety and concern rema ins as high as at the time of their first diagnosis. Clinicians must b e sensitive to the emotional impact such a diagnosis may bring.