Infectious Diseases in Obstetrics and Gynecology women because 1 participant enrolled but prematurely with- drew before providing evaluable data on the questionnaires or willingness to be tested. 3.2. Willingness to Be Tested for HSV-2. At Visit 1, 134 of 303 participants (44%) were willing to be tested for HSV-1/HSV- 2 and provided a blood sample (Willing/Tested Subgroup), and 169 (56%) were unwilling to be tested (Unwilling Subgroup). Although 249 of 303 participants (82%) initially indicated that they were willing to be tested, 115 (38% of the sample) changed from willing to unwilling and did not provide blood samples at Visit 1. Participants had to go to another location to get their blood drawn, and it was not part of their routine prenatal blood workup. These 115 participants were included in the Unwilling Subgroup. Of the participants initially unwilling to be tested, only 2 changed from being unwilling to being willing after counseling at Visit 1. The number of patients never willing to be tested was 52. The Willing/Tested Subgroup did not diﬀer from the Unwilling Subgroup with respect to most demographic vari- ables or sexual history (Table 1). However, those willing to be tested were more likely than those unwilling to be tested to be married (65% versus 54%) and to have private/employer- provided health insurance (89% versus 79%) (P < .05 for frequency distributions of responses for marital status and insurance type) (Table 1). In both the Unwilling Subgroup and the 52 patients never willing to be tested, the most common reason for choosing not to be tested was not being at risk for genital herpes (Table 2). In both the Unwilling Subgroup and the group of participants who changed from being willing to being unwilling, the most common reasons for choosing not to be tested were not being at risk for genital herpes, being tested is too personal, and concern about what will be done with the results (data not shown). Proportionally more participants who changed from willing to unwilling than participants in the Unwilling Subgroup as a whole cited these reasons for not wanting to be tested (% participants who strongly agreed/agreed: 85% versus 90% for not at risk, 53% versus 63% for being tested is too personal, and 51% versus 60% for concern about what will be done with the results) (diﬀerences not statistically tested). The frequency distribution of reasons for choosing not to be tested did not diﬀer as a function of whether participants were asked about testing before or after they received counseling (data not shown). 3.3. HSV Seroprevalence. Of the 134 participants in the Willing/Tested Subgroup, 27 (20%) were HSV-2 seropositive and 81 (60%) were HSV-1 seropositive (Table 3). The percentages of participants testing both HSV-1 and HSV-2 positive, both HSV-1 and HSV-2 negative, HSV-1 positive and HSV-2 negative, and HSV-1 negative and HSV-2 positive were 11%, 31%, 49%, and 9%, respectively (Table 3). 3.4. Counseling. The median time commitment for counsel- ing the blood draw on Visit 1 for participants who consented to the blood draw was 30 minutes per participant (range 20 to 35 minutes). Counseling was provided by a nurse for 70% 5 of participants, by an obstetrician/gynecologist for 26%, and by another health care provider for 4%. Visit 1. Participants’ understanding of the information from counseling at Visit 1 was generally good (Table 4). The majority of participants answered each question correctly. Nevertheless, 15% of participants incorrectly answered that you cannot spread herpes to your newborn at the time of delivery. Results did not diﬀer between the Willing/Tested Subgroup and the Unwilling Subgroup (Table 4) or between the latter subgroups and those who changed from willing to unwilling to be tested (data not shown). Nearly all participants (≥99%) indicated that they were satisﬁed or very satisﬁed with each of the probed aspects of counseling. Results did not diﬀer between the Willing/Tested Subgroup and the Unwilling Subgroup. Visit 2. Participants’ understanding of counseling infor- mation from Visit 2 was generally good regardless of serostatus (Table 4). The majority of participants answered each question correctly. Among participants who were HSV-2 seropositive, 100% agreed that it is important to use medicine to treat herpes during pregnancy, and all were willing to take a medicine during the last 4 weeks of pregnancy to treat herpes. Nearly all participants (≥99%) indicated that they were satisﬁed or very satisﬁed with each of the probed aspects of counseling. 4. Discussion Previous studies involving patient surveys suggest that pregnant women perceive the value of prenatal screening for genital herpes and are willing to be tested [21, 22]. This study extends previous ﬁndings by being the ﬁrst to determine whether participants who express a willingness to be tested also agree to provide a blood sample for serologic testing, to assess barriers to testing, and to assess demographic and clinical correlates of willingness and unwillingness to be tested. In this study conducted in a US obstetrics/gynecology ambulatory unit, 44% of 303 women who were given the opportunity to be tested for HSV-1/HSV-2 agreed to be tested and provided a blood sample at their ﬁrst prenatal visit. These women agreed to be tested and provided a blood sample prior to receiving any counseling or other information from the practice about genital or neonatal herpes; they were simply asked whether they would be willing to have a blood test to determine if they were infected with the virus that causes genital herpes or the virus that causes cold sores. Among the 56% of participants unwilling to be tested for HSV, the most common reasons for being unwilling to be tested were not being at risk for genital herpes (85%), being tested is too personal (53%), and concern about what will be done with the results (51%). Substantial proportions of this Unwilling Subgroup also cited other reasons for being unwilling including test would take too much time (34%), do not want to know results (31%), fear of results (27%), having to tell my partner (24%), and no beneﬁt