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What Does Your Doctor Know?

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Genital Herpes Testing for Patients with HIV

When it comes to HIV and HSV co-infection and testing practices, what does your doctor know? For those who are HIV-positive and think the answer is “everything,” a recent study suggests you may want to think again. Researchers recently assessed the testing knowledge and practices regarding HIV-HSV co-infection of providers with HIV-positive patients.

While numerous studies have documented the adverse consequences of HIV and HSV co-infection, studies on provider’s testing knowledge and practices regarding HIV-HSV co-infection are limited. Adverse consequences include but are not limited to frequent HSV-2 outbreaks, increased plasma HIV RNA levels, and increased transmission risk of HIV and/or HSV to uninfected sexual partners. Though these consequences may be limited with routine screening and treatment, clinical guidelines lack a recommendation. At best, there is a call for providers who provide HIV-positive patients care to consider routine HSV-2 blood testing in the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents1 and the Center for Disease Control and Prevention STD Treatment Guidelines.

So without a clear recommendation, what are providers doing? Results from the 102 providers who provide HIV-positive patient care and completed the 22-item online survey revealed various answers to this question. Close to a quarter (23%) of the survey respondents rarely or never tested HIV positive patients for HSV-2, while 65% indicated they usually or sometimes tested and 12% always tested.

As for providers’ knowledge related to HIV-HSV co-infection, most (90%) were knowledgeable that condoms may reduce the risk of acquiring and transmitting genital herpes. Similarly, most (92%) agreed with the statement “in some studies, genital herpes infection has been associated with increased risk for HIV acquisition and transmission.” Yet, the number of those that believed the majority of people with HIV-1 infection have genital herpes was thirty-five percent. Over a quarter (28%) indicated disagreement or uncertainty regarding whether most HIV-positive patients infected with genital herpes were asymptomatic.

When testing for HSV in patients without symptoms, a little over half of providers responding (52%) reported using serology test. Additionally, 19% indicated they use swabs or visual examination (24%) for screening asymptomatic patients. Regarding these results, Gilbert et al. noted this “suggests a lack of understanding of the frequent, truly subclinical presentation of genital herpes or a misunderstanding of the question.”

The study authors concluded with three clinical considerations worth quoting:

  • The majority of people living with HIV are coinfected with HSV-2, which may be asymptomatic.
  • All genital herpes diagnoses should be confirmed with serological tests.
  • Patients should be educated about genital herpes, including the information that (a) transmission occurs without symptoms, (b) condoms are effective in preventing transmission, and (c) antiviral medications are effective in preventing HSV symptoms and decreasing transmission to partners.

References
Gilbert L, Nanda J, Farley J, Mark H. Providers' Knowledge, Practices, and Barriers Related to Genital Herpes Testing for Patients With HIV. J Assoc Nurses AIDS Care. 2010 Mar 26. [Epub ahead of print]


1. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America).

 

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