Objectives: To examine the seroprevalence and correlates of antibodies to herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), and to assess patients' knowledge and attitude towards genital herpes infection and its serotesting, before and after counselling. Methods: A cross sectional study among genitourinary medicine (GUM) clinic attenders in Coventry, a UK metropolitan city. Participants were asked to complete a self administered questionnaire before and after counselling. Patients were counselled before testing and after receiving the result. A commercially available enzyme immunoassay (EIA) was used to identify HSV-1 and HSV-2 antibodies (Gull/ Meridian EIA). Results: 223 patients participated in the study (97% of eligible patients). Overall, prevalence of HSV-2 antibody was 43/216 (20%) (19/103, 18% for males and 24/113 (21%) for females, p=0.61) while prevalence of HSV-1 antibody was 129/215 (60%) (60% for both sexes, p=0.91). In the multivariate analysis HSV-2 seropositivity was higher among black people and those with a history of genital herpes. HSV-1 seropositivity was independently associated with less education, increased years of sexual activity (between 14-25 years), and history of cold sores. The majority of patients wanted this serotesting to be available in the clinic (204/222 (92%) before and 216/218 (99%) after counselling, p=0.0003) and 97% accepted the test when offered. Only three patients regretted having the test and four patients contacted the department within 6 months of receiving the results for more counselling. Conclusion:The vast majority of the study population not only wanted to be tested, but accepted the test when offered. HSV-2 infection is common and largely unrecognised among our study population. The psychological impact of introducing type specific HSV serological testing in a clinical setting seems to be minimal. Counselling could improve patients' awareness of the infection and the acceptability of the test and its results. G enital herpes infection is the most common cause of genital ulceration, in both the developed world and in developing countries.1 2 The annual number of reported cases of genital herpes presenting to genitourinary medicine (GUM) clinics in England and Wales increased fourfold between 1976 and 1996. 3 In the United States, HSV-2 seroprevalence rose from 16% in 1978 to 22% in 1990. 4 5 Seroprevalence studies revealed that we diagnose only about 20% of patients with genital herpes and that the majority of these cases are unrecognised by both patients and clinicians.6 Clearly, undiagnosed genital herpes infections are the major factor in fuelling the genital herpes epidemic, as source partners in most transmission events are unaware that they have genital herpes. Patients shed the virus and transmit it even in the absence of clinical signs.7 Although the efficacy of transmission is higher at the time of lesions, most transmission has been shown to occur during periods of asymptomatic viral shedding. Accurate type specific serological tests c...

A case of granuloma annulare (GA) localised to the shaft of the penis is reported with a brief review of the current literature. We concluded that penile GA, although rare, should be considered in the diVerential diagnosis of granulomatous lesions of the penis and that histopathological examination of the lesion is essential for the diagnosis. (Sex Transm Inf 1999;75:186-187)

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