Beyond the outbreaks: The enduring psychological burden of recurrent symptomatic genital herpes - A prospective cohort study.

Abstract

BackgroundGenital herpes, primarily caused by herpes simplex virus type 2 (HSV-2), is a chronic sexually transmitted infection with significant psychosocial implications. While cross-sectional studies have documented elevated depression, anxiety, and stigma among affected individuals, longitudinal data on the psychological burden of recurrent outbreaks remain scarce. In this study, recurrent genital herpes was defined as laboratory-confirmed HSV-2 infection with ≥2 symptomatic recurrences in the preceding year, and diagnosis was confirmed using polymerase chain reaction (PCR) from lesion swabs and/or type-specific serology at the initial episode; subsequent recurrences were diagnosed clinically with virological confirmation in a subset.ObjectivesThis study aimed to prospectively evaluate the longitudinal psychological burden of recurrent genital herpes, including depression, anxiety, stigma, and quality of life (QoL), and to identify modifiable risk factors influencing these outcomes.MethodsA prospective cohort study was conducted at a tertiary healthcare center in Punjab from January 2023 to December 2024. Participants included 100 adults with recurrent HSV-2 (≥2 outbreaks/year) and 100 matched controls. Clinical and psychological outcomes were assessed at baseline, 6, 12, and 24 months using validated tools such as the Hospital Anxiety and Depression Scale (HADS), STIGMA Scale for Herpes, and Herpes Quality of Life (HQoL) Questionnaire. Data on suppressive versus episodic antiviral therapy use, adherence measured by both self-report (MMAS-8) and pharmacy refill records, and relationship status (single, partnered, or in a serodiscordant relationship) were also collected. Statistical analyses included repeated measures ANOVA and multivariate regression.ResultsParticipants with recurrent HSV-2 exhibited higher baseline depression (29% vs 8%, p < .001) and anxiety (mean HADS: 11.2 vs 7.5, p < .001) compared to controls. Over 12 months, stigma (STIGMA mean: 38.2 vs 22.7, p < .001) and sexual distress (FSDS mean: 24.1 vs 15.8, p < .001) remained elevated in cases. Frequent outbreaks (≥5/year), low antiviral adherence, female gender, being in a serodiscordant relationship, and lack of social support independently predicted worse psychological outcomes (p < .01). Social support (MSPSS ≥60) was associated with improved QoL (p = .003).ConclusionsRecurrent genital herpes imposes a persistent psychological burden, particularly among individuals with frequent outbreaks, those in serodiscordant relationships and inadequate social support. Asymptomatic HSV-2-positive individuals and those on effective suppressive therapy demonstrated lower anxiety and stigma scores, suggesting a protective role of virological control. Integrated care models combining antiviral therapy with mental health interventions are needed to address stigma, gender disparities, and QoL impairments in this population.