Genital herpes counseling: Ethical considerations in confidentiality, disclosure, and psychosocial harm

Genital herpes is a common, recurrent, chronic sexually transmitted infection that is frequently encountered in dermatologic practice, and in which the psychosocial burden often exceeds the physical manifestations, as many affected individuals are asymptomatic or experience only mild symptoms. Shame, fear of rejection, anger, depression, and anxiety surrounding disclosure can diminish quality of life more than the physical manifestations of the herpes infection. These concerns are compounded by practical threats to confidentiality, especially for adolescents whose explanation-of-benefits statements are insured under a parent's plan. Using two cases, we examine the ethical tensions that a diagnosis of genital herpes can create for the dermatologist. In the first, a patient requests omission of the diagnosis from her record; in the second, the same patient declines to notify an identifiable partner. In genital herpes, ethical management requires balancing confidentiality against truthful documentation and the interests of identifiable partners, while attending to stigma, relational autonomy, truthfulness, beneficence, informed consent, and psychologic morbidity alongside antiviral therapy.