# Presentation: 055535

## FACTORS INFLUENCING THE ACCEPTANCE OF HSV 2 ANTIBODY TESTING AMONG ADOLESCENTS AND YOUNG ADULTS 

**K.H. Fife****1****, W. Tu****1****, D.I. Bernstein****2****, R. Brady****2****, F. Biro****2****, L. Stanberry****3****, S. Rosenthal****3****, K. Stone****4****, J. Leichliter****4****, and G.D. Zimet****1**
**1****Indiana University School of Medicine, Indianapolis, IN, ****2****Children’s Hospital Medical Center, Cincinnati, OH, ****3****University of Texas Medical Branch, Galveston, TX, and ****4****Centers for Disease Control and Prevention, Atlanta, GA**** **

## BACKGROUND

**The seroprevalence of HSV 2 antibody among US adults is 21.9%**
**Most seropositive individuals shed HSV 2 from the genital tract**
**Fewer than 10% of seropositives have a clinical history of genital herpes**
**“****Asymptomatic” HSV 2 antibody positive individuals may play an important role in ongoing transmission of HSV 2**

## BACKGROUND

**Older HSV serologic tests were not truly type-specific**
**Recently introduced tests have made type-specific HSV antibody testing possible**
**There have been no studies of which patients will desire or accept HSV antibody testing**

## STUDY OBJECTIVES

**To determine the factors associated with acceptance or refusal of HSV 2 antibody testing in:**
**STD clinic attendees (age 18-30)**
**Primary care clinic attendees (age 18-30)**
**College students (age 18-30)**
**Adolescent clinic attendees (age 14-19)**

## METHODS

**Subjects at each of the 4 clinical sites with no history of genital herpes were asked to complete a questionnaire about their knowledge and attitudes about herpes and other STDs as well as personal behavior**
**After completing the questionnaire, subjects were offered free HSV 2 antibody testing**
**Acceptance or refusal of HSV 2 testing was correlated with questionnaire responses**

## FACTORS EVALUATED IN LOGISTIC REGRESSION ANALYSIS 1

**Demographics**
**Knowledge of genital herpes (GH)**
**Perception of severity of GH**
**Perception of vulnerability to GH**
**Perceived benefits of testing for GH**
**Perceived impact of GH on life**

## FACTORS EVALUATED IN LOGISTIC REGRESSION ANALYSIS 2

**Fear of blood drawing**
**Perceived stigma of STDs**
**Presence of genital symptoms like GH**
**Number of sexual partners**
**History of STD**
**Condom use**
**Perceived test characteristics**

## DEFINITIONS

**Vulnerability to genital herpes was measured by 4 questions related to self-perceived fear of and likelihood of genital herpes infection**
**Fear of needles was measured by 3 questions related to perceived pain and anxiety about blood drawing**

## RESULTS 1

**At the time of analysis, 520 subjects were enrolled**
**64% of subjects were female, 36% male**
**58% were Caucasian, 34% African American, 8% other**
**Complete data were available on 452 subjects**

## RESULTS 2

**HSV 2 testing was accepted by 60.6% of subjects (274/452)**
**Overall seropositivity rate was 15% (41/274)**

| Clinic | STD n=56 | PC   n=68 | Coll. n=77 | Adol. n=73 |
| --- | --- | --- | --- | --- |
| # HSV 2 (%) | 15 (26.8) | 17 (25.0) | 8 (10.4) | 1 (1.4) |

## RESULTS OF MULTIPLE LOGISTIC REGRESSION ANALYSIS 1

| Parameter | Odds ratio | 95% CI |
| --- | --- | --- |
| Female gender | 2.2 | 1.3, 3.8 |
| 2 partners in last 6 mo. | 3.8 | 1.7, 8.4 |
| h/o STD | 7.4* | 1.6, 33.6 |
| Vulnerability | 1.2 | 1.1, 1.3 |

***Possible interaction with clinic site**

## RESULTS OF MULTIPLE LOGISTIC REGRESSION ANALYSIS 2

**Increased age correlated with test acceptance, but the effect varied with clinic site**
**The only negative correlation with test acceptance was fear of needles (odds ratio 0.92, 95% CI 0.86, 0.99)**

## CONCLUSIONS 1

**There is interest in HSV 2 antibody testing among adolescents and young adults in a variety of clinical settings**
**The factors that predict test acceptance overlap with those that place individuals at risk for acquiring genital herpes**
**Self-perceived vulnerability predicted acceptance independent of number of partners or STD history**

## CONCLUSIONS 2

**Knowledge about genital herpes did not predict test acceptance**
**The presence of genital symptoms suggestive of herpes did not predict test acceptance**
**Fear of needles may be a deterrent to HSV 2 testing in some individuals**

## IMPLICATIONS

**Free HSV 2 antibody testing would be accepted by many individuals at risk for genital herpes**
**The psychological impact of a positive HSV 2 antibody test in an asymptomatic individual has not been measured, but could be significant**

## ACKNOWLEDGEMENTS

**The authors would like to thank the following individuals for assistance in the conduct and analysis of this study:**
**Judi Bell, Timothy Breen, Lisa Brockman, Sara Hanson, Laura Pace, Gretchen Ricketts, Stanley Taylor, Sue Waddell, Michelle Woodard, and Jingwei Wu**
**We would also like to thank Dr. J. Dennis Fortenberry for input into the study design**