Note Do Protective Behaviors Follow the Experience of Testing Positive for Herpes Simplex Type 2? RICHARD A. CROSBY, PHD,* SARA HEAD, MPH,† RALPH J. DICLEMENTE, PHD,† BETH MEYERSON, PHD,‡ AND ADEWALE TROUTMAN, MD§ Objective: To test the hypothesis that individuals attending a sexu- ally transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). Methods: Recruitment (N  360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manu- factured by Biokit (Lexington, MA) and they completed a self-admin- istered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). Results: Of those completing follow-up, 43.4% (n  111) tested positive for HSV-2 at enrollment. Significant differences between par- ticipants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex part- ners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P  0.037) and nonsteady partners at follow-up (P  0.017). However, repeated measures anal- yses yielded only 1 significant group  time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. Conclusions: Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against fur- ther acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serosta- tus may not be sufficient to motivate the adoption of safer sex behav- iors among this population. IN THE UNITED STATES, herpes simplex virus 2 (HSV-2) remains the primary cause of genital herpes and prevalence is estimated at 17%. 1 HSV-2 is associated with neonatal herpes and transmission of human immunodeficiency virus (HIV). 2,3 The ad- vent of type-specific rapid testing for HSV-2 has led to research investigating psychosocial sequelae of testing positive, with results indicating only short-lived consequences. 4–8 The next question is whether persons newly diagnosed with HSV-2 will adopt behav- iors protective against further acquisition and transmission of sexually transmitted diseases (STDs). Literature investigating be- havior change after HIV counseling and testing has led to variable and inconclusive results. 9 –12 The most recent review found re- duced risky sexual behavior after HIV counseling and testing among persons newly diagnosed with HIV but not among persons testing negative for HIV. 12 Although recent evidence suggests that people are less likely to acquire HSV-2 from partners who disclose their positive status, 13 disclosure may not be normative in all populations. An important, but understudied, question is whether patients may engage in risk management after diagnosis with HSV-2 (meaning they adopt protective behaviors in response to the diagnosis). Accordingly, the purpose of this study was to determine whether protective behaviors follow the experience of testing positive for HSV-2. Methods Study Sample Patients (18 years old) were recruited from an STD clinic located in the southern United States. Nurses referred potentially eligible patients to the research assistant. Eligibility requirements were 1) not previously diagnosed with HSV-2; 2) speaking En- glish; 3) sexually active in the past 3 months; and 4) willingness to be tested for HSV-2. Of 381 patients referred, 360 (94.5%) were eligible, agreed to participate, and provided written informed con- The authors gratefully acknowledge the assistance of the Clinic Director (Deborah Snow) and the clinic staff members. Supported by Glaxo Smith-Kline (to R.A.C). Correspondence: Richard Crosby, PhD, College of Public Health, 121 Washington Avenue, Lexington, KY 40506-0003. E-mail: crosby@uky. edu. Received for publication October 10, 2007, and accepted March 16, 2008. From the *Department of Health Behavior, University of Kentucky College of Public Health, Lexington, Kentucky; †Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; ‡Policy Resource Group, LLC Indianapolis, Indiana; and §Louisville Metropolitan Health Department, Louisville, Kentucky Sexually Transmitted Diseases, September 2008, Vol. 35, No. 9, p.787–790 DOI: 10.1097/OLQ.0b013e318177a068 Copyright © 2008, American Sexually Transmitted Diseases Association All rights reserved. 787