2 pregnancy [11–15] while others discourage it or do not practice routine testing on the basis of concerns such as the negative psychological impact of HSV testing and lack of cost-eﬀectiveness [9, 16–20]. The current prospective study was undertaken to evaluate pregnant women’s willingness to undergo HSV type-speciﬁc serologic testing, factors aﬀecting their willingness, and the feasibility of HSV serologic testing and counseling in an obstetrics/gynecology ambulatory unit. 2. Materials and Methods 2.1. Sample. Pregnant women at least 18 years old and at 15 ± 3 weeks of gestation were eligible for the study if they did not have a known history of HSV-2 infection. All participants provided written informed consent. 2.2. Procedures. An institutional review board approved the protocol for this prospective study conducted at a single study center in the Department of Obstetrics and Gyne- cology and Reproductive Medicine Health Science Center at the State University of New York at Stony Brook (Stony Brook, NY, USA). The study included two oﬃce visits, Visit 1 (the ﬁrst prenatal visit; Figure 1) and Visit 2. At Visit 1, the study was described to patients. Patients were told that the study (1) involved their willingness to have a blood test to determine whether they were infected with the virus that causes genital herpes and the virus that causes cold sores and (2) would require a time commitment of approximately 1 hour at this visit and, possibly, an additional 20-minute oﬃce visit the next week. Those providing written informed consent to participate in the study were asked to complete a questionnaire on demographics and baseline clinical information. Blood was drawn for testing for HSV-1/HSV-2 from consenting participants via the FOCUS HerpeSelect 1 and 2 ELISA assay. Using a standardized script (the appendix), health care providers then counseled participants about genital herpes, its risks to the neonate, and the signiﬁcance of positive and negative serologic tests for genital herpes. These participants, the Willing/Tested Subgroup, were asked to complete two brief, self-administered questionnaires addressing their understanding of the information presented during counseling and their satisfaction with counsel- ing, respectively. Questionnaire items assessing participants’ understanding were declarative statements about herpes with response options of true or false. Questionnaire items assessing participants’ satisfaction with various aspects of counseling had response options of very satisﬁed, satisﬁed, neutral, dissatisﬁed, or very dissatisﬁed. Participants unwilling to be tested (the Unwilling Sub- group) were asked to complete a questionnaire addressing barriers to serologic testing. Questionnaire items, which corresponded to speciﬁc potential reasons for being unwill- ing to be tested, had multiple-choice response options: strongly disagree, disagree, agree, and strongly agree. Health care providers then counseled them about genital herpes with the same standardized script described above (the appendix). After they were counseled, participants were Infectious Diseases in Obstetrics and Gynecology again asked if they were willing to be tested. If they agreed and provided informed consent, they were given the blood test. If they remained unwilling to be tested, they were asked to complete the questionnaire addressing barriers to serologic testing again and to complete the two self- administered questionnaires addressing participants’ under- standing of the information presented during counseling and their satisfaction with counseling, respectively. At Visit 2, which occurred approximately 1 week after Visit 1, participants who were serologically tested at Visit 1 were counseled about the results of their test and encouraged to discuss the results with their partners. Participants who were HSV-2 seropositive were also provided with an educa- tional brochure on reducing risk of transmission of genital herpes and were asked if they were willing to take medicine to treat their herpes during pregnancy. Both seropositive and seronegative participants were given two self-administered questionnaires, adapted to participants’ serostatus, that addressed their understanding of the information presented during counseling and their satisfaction with counseling, respectively. 2.3. Measures and Data Analysis. The primary endpoint was the percentage of participants who expressed willingness to be tested for HSV-1 and HSV-2 and who provided a blood sample. Other endpoints included the percentages of participants in the Unwilling Subgroup expressing particular reasons for being unwilling to be tested, HSV-1 and HSV-2 seroprevalence among those who provided a blood sample, responses to questions on the counseling questionnaires in the Willing/Tested Subgroup compared with the Unwilling Subgroup, the percentage of HSV-2 seropositive participants willing to accept antiherpes therapy during pregnancy, health care providers’ ratings of the median time spent counseling participants, and the specialty of the health care provider who counseled participants. Some participants initially expressed a willingness to be tested for HSV but later became unwilling to be tested and declined to provide a blood sample. These participants were categorized as being unwilling to be tested and included in the Unwilling Subgroup. In post hoc summaries, reasons for not being tested and responses on the counseling questionnaires were summarized separately for the Unwilling Subgroup and the portion of this subgroup that changed from being willing to being unwilling. All data were summarized with descriptive statistics. In addition, the Willing/Tested Subgroup was compared with the Unwilling Subgroup on demographic variables and sexual history with chi-square or Fisher’s Exact tests and on responses to the counseling questionnaires with Fisher’s Exact tests. 3. Results 3.1. Sample. The sample comprised 304 women who con- sented to participate in the study. Demographics and baseline clinical characteristics are described in Table 1. Participants’ mean (SD) age was 29.3 (6.2) years. The majority (87%) of participants were white, 8% were black, and the remainder