ISSUES IN COUNSELLING
- Providing accurate up-to-date information in a non-judgmental way is key to assisting a person to understand and come to terms with herpes.
- The pyschological morbidity of a diagnosis often far outweighs physical symptoms.
- Recommended resource for patients www.herpes.org.nz or the Herpes Helpline tollfree 0508 11 12 13.
Genital herpes is a common and, medically speaking, usually a relatively minor condition in people who are sexually active. However, conditioning and social values contribute to individuals having a range of emotional responses when given a diagnosis of genital herpes.104-107
Emotions related to the diagnosis of genital herpes
- Some people cope well without any problems, however for others a diagnosis of genital herpes may be the most challenging health disruption they have experienced, given the stigma and societal conditioning associated with it.
- The diagnosis of genital herpes can provoke confusion and a grief reaction causing feelings such as guilt, anger, fear, shock, denial and a sense of injustice.
- Common concerns of patients relate to social stigma, transmission, fear of rejection upon telling potential sexual partners, and how herpes will affect their sex life and social activities.106, 108
- Patients with genital herpes are usually very concerned about the diagnosis, and its potential impact on their relationships.109,110
- The diagnosing clinician should address patient concerns at the first presentation, even if the patient is referred elsewhere for counselling.111
- Herpes Helpline tollfree 0508 11 12 13 provides counselling and education in both acute and non-acute situations.
- Not all patients will take up the offer of initial counselling and support. It is very important to advise all patients of resources as these are often accessed at a later date, for example, when establishing a new relationship or wanting to conceive. www.herpes.org.nz
Successful psychosocial management of genital herpes is time-intensive. The impact of the diagnosis is influenced by the person’s coping strategies, level of social support and underlying beliefs about sexuality and sexual health. A diagnosis of herpes can also trigger worries about:
- Acquisition of HIV or other STIs.
- They are seen as promiscuous and that the doctor has a low opinion of them.112
- In all cases (whether primary, non-primary or first symptomatic reactivation), the emotional consequences and perceived social stigma of the infection should be addressed. No matter the time since diagnosis, do not assume that another clinician has spoken with the person about genital herpes.109, 113
Patients’ concerns are predominantly about relational issues
- Fear of discovery – when and how to tell a partner
- Intimate relationships and sex life affected
- Social activities and lifestyle altered
- Social stigma of STI
- Condition is 'incurable'
- Fear of transmission or contagion
- Fear of disclosure and subsequent rejection
- Inaccurate online material may exacerbate above points
Reassure patients that they are not alone in having genital herpes. The NZ Herpes Foundation www.herpes.org.nz or Helpline tollfree 0508 11 12 13 provide specialist support, education and counselling, or refer for specialist counselling at the local sexual health clinic. Advise about reputable internet resources and stress that the online ‘cure’ claims are not scientifically supported.
The above section on counselling is based on internationally accepted standards of practice. Grade C