The effect of suppressive oral acyclovir on the psychological morbidity associated with recurrent genital herpes.

OBJECTIVES To assess the psychological impact of recurrent genital herpes and to determine if longterm acyclovir has any impact on this morbidity. SETTING AND SUBJECTS Patients with frequently recurring genital herpes attending a department of genitourinary medicine who were considered suitable for longterm acyclovir. METHODS Patients completed an 80 item, self-administered psychological questionnaire before starting acyclovir and every three months for one year. Treatment was then stopped and three months later a further questionnaire was completed. The questionnaire consisted of the General Health Questionnaire (GHQ); the Hospital Anxiety and Depression Questionnaire (HADQ); Illness Attitude Scales and Illness Concern. Data were analysed by McNemar's test for changes in proportions and by Wilcoxon's test for changes in scores. RESULTS 102 patients were recruited: 55 men, and 47 women. Eighty two (80%) patients completed three months treatment, 75 (74%) six months, 64 (63%) nine months and 61 (60%) a year. Fifty (49%) of the original 102 patients completed the three months post treatment follow up. At first visit 63% (64/102) were designated as GHQ "cases". Within three months this decreased to 26% (21/82). McNemar's test showed that 67% (34/51) of the patients who were initially classified as GHQ "cases" became "noncases" after three months (p < 0.0001). There was a significant decrease in the proportion of HAD anxiety cases from visit one to visit two (p < 0.0001) and a decrease in illness concern scores from visit one to visit two (p < 0.0001). All these decreases were maintained throughout the years treatment with acyclovir. CONCLUSIONS There is a substantial morbidity associated with frequently recurring genital herpes. However, acyclovir suppression significantly reduces illness concern and anxiety and is a useful addition to the treatment of this infection.