Review on the molecular epidemiology of sexually acquired hepatitis C virus infection in the Asia-Pacific region.

INTRODUCTION: Sexual acquisition has emerged as a transmission route for hepatitis C virus (HCV) of growing importance among human immunodeficiency virus (HIV)-positive populations. In Western countries, HCV epidemics have been increasingly detected among men who have sex with men (MSM). This review describes the molecular epidemiology of sexually acquired HCV infection in the Asia-Pacific region. METHODS: A systematic search was performed on PubMed in March 2019. Either abstract or full-text of each publication in the search results was screened for eligibility. Studies from different countries/cities involving eligible cases, who acquired HCV sexually with identified subtype, were synthesized for the evaluation of molecular epidemiology in the Asia-Pacific region. Two large-scale systematic reviews on the genotype distribution of HCV at a population level and among PWID were used as references for comparison. RESULTS AND DISCUSSION: Overall, 13 full-text articles with 549 subjects originating from nine countries/cities were reviewed. A total of five genotypes and 14 subtypes were identified, dominated by subtypes 1b (23.0%), 2a (19.1%) and 3a (29.5%). A majority of the infected cases occurred in HIV-positive MSM. In some places, notably Hong Kong, India and Indonesia, the predominant subtype in sexually acquired HCV infection in MSM was different from that circulating in the general population. Shared transmission networks between people who inject drugs (PWID) and MSM were shown in Australia and New Zealand, whereas overlapping risk elicited from a small number of subjects existed in Tokyo, Taipei and Guangxi. MSM-specific clusters were identified in Hong Kong, Taipei and Hubei. CONCLUSIONS: The distribution of sexually acquired HCV was sparsely scattered across countries/cities in the Asia-Pacific region. The threat of overlapping risk differed by locations, whereas transnational outbreaks remained uncommon. The paucity of information has hindered progress with comprehensive assessment in the Asia-Pacific region, where seroprevalence of HCV among HIV-positive MSM was relatively high.

Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners.

The incidence of new HIV infections in the United States continues to be greatest among men who have sex with men (MSM). MSM infected with HIV often seek seroconcordant sexual partners based on intent to limit psychosocial, legal, and health risks they perceive as higher with serodiscordant sexual partners. However, the rationales for limiting sexual relationships exclusively with other MSM infected with HIV may be rooted in misinformation or misperception. Thus, these clients may have a unique sexual health knowledge deficit that nurses, social workers, and other clinicians need to address to help them reduce risk. This article focuses on sexually related health risks that are distinct to MSM infected with HIV seroconcordant partners. Data on the most recent HIV-infection incidence rates in MSM in the United States is provided. Discussion concentrates on the risk these individuals may have in communicating and acquiring sexually transmitted diseases other than HIV, the risk of HIV superinfection, and how sexually transmitted diseases affect persons who are immunocompromised differently than those who are immunocompetent. Finally, recommendations for healthcare professionals who counsel MSM infected with HIV in sexual decision making is provided.

The changing face of women living with HIV in western Ukraine.

Ukraine has the second largest HIV epidemic in Eastern Europe/Central Asia. This study characterizes the demographics of HIV-infected women in the Lviv region of western Ukraine, patterns in their clinical presentation, and factors associated with delays in seeking care. A retrospective chart review was conducted of 622 HIV-infected women who registered for HIV treatment at the Lviv AIDS Center between 2008 and 2013. A total of 81.6% of women were infected through heterosexual transmission and the remaining 18.4% through intravenous drug use. Slightly less than half (45.4%) was between 26 and 35 years old. Slightly more than half (56.7%) listed their residence in a city, 22.6% in villages. One-third (30.0%) of all women presented with AIDS, and 37.7% presented with symptomatic conditions. Women diagnosed with HIV during antenatal care experienced a median delay of 34 days between diagnosis and registration, compared to 87.5 days for nonpregnant women tested in the context of intravenous drug use. Overall, HIV-infected women in western Ukraine experience time delays in care, and often present with advanced HIV disease and secondary complications. Linkage to care in a timely manner is a high priority and substantial challenge for women, particularly for intravenous drug users who may face stigma and other additional barriers.

High trait shame undermines the protective effects of prevalence knowledge on state shame following HPV/CIN diagnosis in women.

Human papillomavirus (HPV), and the related, cervical intraepithelial neoplasia (CIN), are common yet poorly understood physical conditions. The diagnosis of HPV often elicits shame and guilt, which in turn may undermine psychological and physical health. The current study compared shame and guilt responses to diagnosis among two groups: women diagnosed with HPV/CIN and women diagnosed with Epstein-Barr Virus (EBV/IM). Eighty women recently diagnosed with HPV/CIN or EBV/IM completed measures of shame- and guilt-proneness, shame and guilt following diagnosis, and disease knowledge including prevalence estimates (HPV and EBV, respectively). HPV/CIN (vs. EBV/IM) predicted more diagnosis-related shame and guilt. Estimates of high prevalence interacted with diagnosis and shame-proneness to predict diagnosis-related shame. Simple slope analyses indicated that in women with HPV/CIN reporting low-to-average shame-proneness, high prevalence estimates reduced diagnosis-related shame; however, women high in shame-proneness experienced high diagnosis-related shame regardless of more accurate prevalence estimates. Women high in shame-proneness appear to be particularly vulnerable to HPV-related shame even when they are aware that it is very common.

Perceived Risk of Human Papillomavirus Infection and Cervical Cancer among Adolescent Women in Taiwan.

PURPOSE: High-risk types of human papillomavirus (HPV) are a critical etiologic factor behind cervical cancer. Adolescents are a vulnerable group for HPV infection. However, the literature on adolescent women for HPV infection and cervical cancer is limited. This study was to investigate HPV-related knowledge and perceived risk of HPV infection and cervical cancer among Taiwanese adolescent women in order to assess intervention strategies for prevention of cervical cancer and maintenance of reproductive health. METHODS: A descriptive cross-sectional study design was implemented. There were 610 adolescent women from three colleges in Southern Taiwan who participated in this study. Data were collected using an anonymous self-administered questionnaire survey. RESULTS: The results showed that the percentage of appropriate answers to HPV-related knowledge questions was only 36.8%, and smoking as the leading cause of cervical cancer received the lowest mean score for appropriate answers among the HPV-related knowledge items. The perceived risk of HPV infection and cervical cancer were moderate, with relatively lower susceptibility to infection with HPV than to cervical cancer (p < .001). Only 11.5% of the participants reported that they had received information about HPV vaccination from healthcare professionals. CONCLUSIONS: Participants lacked a comprehensive understanding of cervical cancer prevention and were not aware of their susceptibility to HPV infection. Adolescent women rarely obtained HPV-related information from healthcare professionals. Appropriate education strategies should be developed and conducted by healthcare professionals to reduce the risk of cervical cancer threat from adolescence.

Perceived Risk of Human Papillomavirus Infection and Cervical Cancer among Adolescent Women in Taiwan

PURPOSE: High-risk types of human papillomavirus (HPV) are a critical etiologic factor behind cervical cancer. Adolescents are a vulnerable group for HPV infection. However, the literature on adolescent women for HPV infection and cervical cancer is limited. This study was to investigate HPV-related knowledge and perceived risk of HPV infection and cervical cancer among Taiwanese adolescent women in order to assess intervention strategies for prevention of cervical cancer and maintenance of reproductive health. METHODS: A descriptive cross-sectional study design was implemented. There were 610 adolescent women from three colleges in Southern Taiwan who participated in this study. Data were collected using an anonymous self-administered questionnaire survey. RESULTS: The results showed that the percentage of appropriate answers to HPV-related knowledge questions was only 36.8%, and smoking as the leading cause of cervical cancer received the lowest mean score for appropriate answers among the HPV-related knowledge items. The perceived risk of HPV infection and cervical cancer were moderate, with relatively lower susceptibility to infection with HPV than to cervical cancer (P < .001). Only 11.5% of the participants reported that they had received information about HPV vaccination from healthcare professionals. CONCLUSIONS: Participants lacked a comprehensive understanding of cervical cancer prevention and were not aware of their susceptibility to HPV infection. Adolescent women rarely obtained HPV-related information from healthcare professionals. Appropriate education strategies should be developed and conducted by healthcare professionals to reduce the risk of cervical cancer threat from adolescence.

Internet y conducta sexual de riesgo para VIH/SIDA en jóvenes / Internet and sexual risk behavior for HIV/AIDS in young people

Objetivo: Determinar si el uso de material sexual en línea influye en la conducta sexual de riesgo para VIH/SIDA en los jóvenes universitarios. Se utilizaron conceptos de la Teoría Cognitiva Social. Método: Diseño descriptivo correlacional, participaron 200 jóvenes universitarios, seleccionados por muestreo aleatorio sistemático (k = 11). Resultados: Los jóvenes que usaron material sexual en línea en medios ricos para masturbarse (r = .34), excitarse (rs = .29), estimularse (rs = .29), buscar una aventura (rs = .30), conocer gente (r = 27), imágenes (rs = .14) y cibersexo (r = .25) mostraron mayor conducta sexual de riesgo para VIH/SIDA (p< .01). El uso de material sexual en línea para masturbarse (Rs2 = 6.4%, F = 12.80, p < .001), buscar una aventura (R2 = 4.8%, F [1,189] = 9.56, p < .01), conocer gente (R2[1,189] = 5.9%, F = 11.88, p <.01) y tener cibersexo (R2 = 4.1%, F = 8.07, p < .01) presentó un efecto positivo y significativo en la conducta sexual de riesgo para VIH/SIDA. Conclusiones: El uso de material sexual en línea influye en la conducta sexual de riesgo para VIH/SIDA (AU)

Objective: To determine whether the use of online sexual material influences sexual risk behavior for HIV / AIDS in young university students. Concepts of Social Cognitive Theory were used. Methods: A descriptive correlational design, involving 200 university students selected by systematic random sampling (k = 11). Results: Young people who used sexual material online rich media to masturbation (r= 29), stimulation (rs = 29), adventure (rs = 30), meeting people (rs =.27), images (r =.17) and cybersex (rss =.25) showed greater sexual risk behavior for HIV / AIDS (p <.01). The use of sexual material online for masturbation (R2 = 6.4%, F [1,189] = 12.80, p <.001), seeking adventures (R2s =.34), arousal (r = 4.8%, F = 9.56, p<.01), meeting people (R2 = 5.9%, F [1,189] = 11.88, p <.01) and have cybersex (R =8.07, p <.01) had a significant positive effect on behavior sexual risk for HIV/AIDS. Conclusions: The use of online sexual material influences sexual risk behavior for HIV/AIDS (AU)

Male human papillomavirus vaccine acceptance is enhanced by a brief intervention that emphasizes both male-specific vaccine benefits and altruistic motives.

BACKGROUND: Although female human papillomavirus (HPV) vaccine acceptance has been widely studied, research on vaccine uptake among boys and men is needed. Male HPV vaccination can provide both individual and community-level benefit by offering recipients personal health protection while concurrently minimizing HPV transmission and ultimately providing female health protection. As such, male vaccine acceptance may be enhanced by emphasizing both altruistic motives (female health protection) and personal health benefits. METHODS: A university-based sample of young men completed computer-administered surveys and viewed informational interventions that varied in the inclusion or exclusion of altruistic motives and in the level of emphasis on male-specific HPV-related illnesses and vaccine benefits. Human papillomavirus vaccine acceptance was assessed immediately after intervention. RESULTS: Participants who received the intervention emphasizing both altruistic motives and male-specific information endorsed the greatest vaccine acceptance (mean [SD], 3.6 [1.0]). CONCLUSION: Provider and community-level interventions highlighting both altruistic motives and personal health vaccine benefits may enhance HPV vaccine uptake among young men.

Counseling reduces HPV persistence in coinfected couples.

INTRODUCTION: Human papillomavirus (HPV) infection is a very common sexually transmitted disease. A variable concordance and clearance time between partners of infected heterosexual couples have been shown. AIM: Aims of this study were evaluation of prevalent sites of HPV infection, frequency, genotype concordance, and course of viral infection in counseled and non-counseled infected heterosexual couples. METHODS: Prospective, controlled study among 74 consecutive HPV-infected heterosexual couples seeking their first medical intervention for sexually transmitted infections. MAIN OUTCOME MEASURES: HPV detection and genotyping were performed at enrollment and during 24 months follow-up by polymerase chain reaction and INNO-LiPA assay in samples obtained from both partners. Samples were collected in males from coronal sulcus, urethra, semen, and oropharynx, and from cervix and oropharynx in females. Moreover, HPV fluorescence in situ hybridization was analyzed on semen samples. RESULTS: The study was completed by 49 couples. The specific HPV-type concordance among infected couples was 69.4%. Among couples who declared performing oral sex, oropharyngeal infection was 22.7% of couples, and was more prevalent in females than males (18.1% and 4.5%, respectively). Thereafter, couples were randomly divided in two groups: a control group of 24 couples followed up for HPV-related lesions, and an experimental group counseled of 25 couples followed up for HPV-related lesions and counseled to avoid known risk factors for HPV infection. In patients who received counseling, the number of infected sites diminished faster during the follow-up and a higher number of couples had clearance. Only in the counseled group were there no infected couples at the end of the 24-month follow-up period. CONCLUSIONS: This study confirms that HPV infection affects many sites in both males and females and shows a significant prevalence of oropharyngeal infection in couples performing oral sex. Targeted counseling in heterosexual couples appears to reduce the number of infected sites and to speed up viral clearance.

The sexual health consultation as a moral occasion.

Sexually transmitted infections (STIs) are socially constructed as more 'dirty' than other gynaecological conditions. This article analyses women's accounts of interactions with clinicians, subsequent to a diagnosis of genital herpes simplex virus or human papilloma virus. Women conceptualised consultations as a 'moral event,' different from other consultations. This moral component is highlighted drawing on Foucault's notion of 'the confessional.' Additionally, Douglas' anthropological construction of 'dirt' is used to consider why these consultations are 'confessional' experiences. Email interviews were conducted with 26 women diagnosed with a viral STI and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Findings indicated that discourses of morality shape sexual health consultations. Five themes were identified in relation to the moral 'work' in clinical consultations about a viral STI diagnosis: the particular 'dirtiness' of viral STIs, clinicians as moral agents, the 'non-judgmental' clinician, women juggling truth-telling and risk and clinicians prescribing moral work. Clinicians support and educate women more effectively if they recognise subjective, moral aspects of sexual health consultations rather than assuming that effective clinical teaching is rational, scientific and non-judgmental.

Association of injecting drug use and late enrolment in HIV medical care in Odessa Region, Ukraine.

OBJECTIVES: Late entry of HIV-positive persons into specialized care is a significant challenge to limiting the spread of the HIV epidemic. In 2008-2010, only 54% of 108,116 persons who tested HIV positive enrolled in care at AIDS Centers in Ukraine, and almost half of new AIDS cases are found in patients with first-time HIV diagnoses. We aimed to identify factors associated with delayed enrolment in HIV care in Odessa Region, Ukraine. METHODS: We conducted a retrospective data analysis of patients who enrolled in HIV care in 1995-2010, comparing patients on the basis of the reported route of HIV transmission (injecting drug use or sexual transmission). The nonparametric Mann-Whitney U-test was used to compare the groups. RESULTS: During the period analysed, the delay in enrolment in HIV care among people who inject drugs (PWID) in Odessa Region was longer than that among people infected via sexual transmission. The mean delay in enrolment in care among PWID increased over time for men and women; their mean age at the time of enrolment also gradually increased. Urban residents accounted for the majority of HIV cases, with some growth in the proportion of rural residents. CONCLUSIONS: People who acquired HIV via injecting drug use showed later enrolment in HIV care compared with people infected via sexual transmission. There is an urgent need to improve HIV counselling and referral services, taking into account differences in the behaviour of drug-using and non-drug-using populations.

Diagnostic classification, viral sexually transmitted infections and discourses of femininity: limits of normalisation to erase stigma.

Clinicians in the field of women's sexual health typically classify the two most common viral sexually transmitted infections (STIs), the human papilloma virus and the herpes simplex virus, as relatively innocuous infections. Teaching interventions include 'normalising' adult sexual activity and the epidemiological ordinariness of infection. Normalising is intended to disarm the potential stigma of the diagnosis. In this study, in-depth email interviews were conducted with 26 women with a viral STI diagnosis and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Normalising is contextualised as an example of the workings of western philosophical thought whereby dualistic classifications privilege certain terms and subordinate other terms. In this instance, the relative medical normalcy of viral STIs is given primacy compared to the social abnormality experienced by women. Although these viral STIs infect women and men, this research concentrates on women's learning about viral STIs. For women, beliefs about femininity, sexuality, health, morality and responsibility influence effects of a viral STI diagnosis. These discourses are clinically significant because beliefs that specifically link to ideas about how to be a woman are overlooked when clinicians devise educational interventions.

Knowledge of sexually transmitted HPV infection, genitoanal warts, cancer and their prevention among young females after vaccine introduction in Germany.

BACKGROUND: Sexually transmitted human papillomavirus (HPV) high-risk types cause carcinoma and low-risk types lead to warts of genitoanal area. Since the HPV vaccine has been introduced, awareness of HPV infection, prevention and health-related behaviour have not been studied in a large sample of young women in Germany. OBJECTIVES: Assessment of awareness and health-related behaviour regarding HPV infection and prevention among young German females. METHODS: In 2010, a postal cross-sectional survey was conducted with a random representative sample size (n = 2000) of females aged 19-35 attending Germany's largest (comprehensive) university, which was designed to obtain data about socio-demographics, the awareness of sexually transmitted HPV, genitoanal neoplasms and their prevention, HPV vaccine, immunisation and cervical cancer screening. RESULTS: Of the 547 (27.3%) participants, 69.1% had heard of HPV, 62.5% were aware of the vaccine, 14.4% were vaccinated and 6.9% reported a history of sexually transmitted infection, including HPV (2.7%). The HPV-related knowledge among those who had heard of it was high (75.1-99.7%), except of that HPV affects men (52.9%) and HPV's causative role in genital (54.2%) and anal (35.6%) warts, and smoking (11.3%) as an HPV risk factor. The lower HPV knowledge score (

A survey of risk behaviour for contracting HIV among adult psychiatric patients. A South African study - Part 1.

OBJECTIVE: Various studies have reported increased prevalence of HIV infection among psychiatric patients. Psychiatric patients are under-evaluated in terms of their HIV risk behaviour. The study sought to establish the prevalence of HIV risk behaviour and determine the association between risk behaviour and demographic and clinical variables. METHOD: Participants were 113 consenting adult in-patients. A structured interview was conducted with each participant. A total risk behaviour score was calculated. From the risk score, three risk behaviour categories were identified: 0 = no risk; 1 to 3 = medium risk; 4 to 9 = high risk. Associations between HIV risk behaviour and demographic and clinical variables were analysed. RESULTS: Of the 113 participants, 68% were men and 32% women. The mean age was 38. Forty-five per cent were sexually active and 48% fell into the "no-risk group", 29% in the "medium-risk" group, and 23% in the "high-risk" group. Female patients with a history of treatment for sexually transmitted disease and a diagnosis of personality disorder were associated with being sexually abused. Having multiple sex partners was associated with diagnoses of substance-related disorders and cognitive disorders. Sex with someone known for less than 24 hours was associated with long-term hospitalisation and diagnoses of cognitive and personality disorders. CONCLUSION: The study confirmed that mentally ill patients are vulnerable and may be victimised. The study also suggests that mental illness may impair appreciation of consequences and lead to high-risk behaviour for contracting HIV. Special care should be taken to protect female patients in psychiatric institutions.

Social-cognitive predictors of intention to vaccinate against the human papillomavirus in college-age women.

This study examined social-cognitive predictors of college-age women's intentions to obtain the human papillomavirus (HPV) vaccine using the Health Belief Model (HBM) and Theory of Planned Behavior (TBP) as theoretical guides. Questionnaire data were collected from 143 women at a Midwestern university. Among the HBM variables, perceived susceptibility to HPV, perceived benefits of the vaccine, and self-efficacy to obtain the vaccine were significant predictors. Among the TPB variables, positive attitudes toward the vaccine and beliefs that important others would support vaccination predicted intentions. A model with all HBM and TPB variables explained nearly 60% of the variance in intentions. Comparison of the theories suggests that the TPB is a better predictor of intentions than the HBM. Results suggest that targeting personal beliefs about the vaccine, and increasing acceptance for the vaccine among social network members, may increase vaccination intentions among college-age women.

[Factors associated with Human Papillomavirus related stigma, shame, and intent of HPV test].

PURPOSE: This study was conducted to examine the factors associated with HPV (Human Papillomavirus) related stigma, shame and intent to have HPV test among adult women. METHODS: Data were collected from December 1, 2009 to January 31, 2010, and participants were 324 women who visited an obstetric gynecologic clinic. They anticipated testing positive for HPV. Then HPV related stigma, shame, intent to have HPV testing and HPV knowledge were measured. Descriptive statistics, Mann-Whitney U test, Kruskal Wallis test and multivariate adjusted logistic regression were used for data analysis. RESULTS: The levels of stigma and shame were higher than average. Intent to have HPV test was high and HPV knowledge was low. Women who answered that HPV is not sexually transmitted had lower HPV stigma than did women who answered they didn't know (OR=0.20, 95%CI 0.06-0.68). Women with lower stigma showed lower intent to have HPV test than women with higher stigma (OR=0.46, 95%CI 0.26-0.82). CONCLUSION: Basic HPV information should be fully understood for women especially prior to HPV test. Normalizing HPV stigma is necessary for women who perceive HPV as sexually transmitted and women intending to have HPV test.

Social representations of human papillomavirus in Bogotá, Colombia.

Identifying DNA of Human papillomavirus (HPV) has been proposed as a new screening method for cervical cancer control. Conventionally, health education for screening programs is based on scientific information without considering any community cognitive processes. We examine HPV social representations of 124 men and women from diverse educational status living in Bogotá, Colombia. The social representation of HPV involves a series of figurative nuclei derived from meanings linked to scientific information. While women focused on symbols associated to contagion, men focused on its venereal character. Figurative nuclei also included long-term uncertainty, need or urgent treatment, and feelings of imminent death associated with cancer and chronic sexually transmitted infections. The social representation of HPV impeded many participants from clearly understanding written information about HPV transmission, clearance, and cancer risk; they are built into a framework of values, which must be deconstructed to allow women full participation in HPV screening programs.

Associations of sexual identity or same-sex behaviors with history of childhood sexual abuse and HIV/STI risk in the United States.

OBJECTIVE: To measure associations of childhood sexual abuse (CSA) with sexual orientation, behaviors, and attractions and HIV/sexually transmitted infection (STI) incidence in a nationally representative sample of men and women. METHODS: Data from the 2004-2005 Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed, including frequencies of CSA and HIV/STI incidence for 5 subgroups defined by sexual orientation based on identity and behaviors and attraction to the same sex or opposite sex. RESULTS: Overall, 14.9% of women and 5.2% of men reported CSA. Among women, bisexuals, lesbians, and heterosexuals with same-sex partners had 5.3 times, 3.4 times, and 2.9 times the odds, respectively, for CSA occurring sometimes/more frequently (vs. never) compared with heterosexuals not having same-sex partners or attractions. Among men, bisexuals, gay men, and heterosexuals with same-sex partners had 12.8 times, 9.5 times, and 7.9 times the odds, respectively, for CSA. Men and women sometimes or frequently abused had significant increases in odds for HIV/STI incidence compared with those not abused. Among women, sexual minorities had 3.8 times the odds and heterosexuals had 2.8 times the odds, whereas among men, sexual minorities had 4.2 times odds and heterosexuals had 1.5 times odds. CONCLUSIONS: Extraordinarily high rates of CSA were observed for sexual minorities, and sexual minorities were more likely to have incident HIV or STIs, in this U.S. population survey. Identifying the impact of CSA among heterosexuals and sexual minorities in the US is a crucial first step in examining the sequelae of CSA, including the potential mediators of mental health and substance abuse disorders in the relationship between CSA and sexual risk taking.

Psychological responses of women infected with cervical human papillomavirus: a qualitative study in Taiwan.

OBJECTIVE: To determine the psychological response of cervical human papillomavirus (HPV) infected women. MATERIALS AND METHODS: Twenty oncogenic or high-risk HPV infected cases were collected by purposive sampling, and a 2-hour in-depth interview was carried out with 20 women at a tertiary referring medical center. The interview content was analyzed using the qualitative method. Psychological responses included cognition, emotions, and behavior. RESULTS: Differences in psychological responses arose more from individual cognition and personality than from whether or not one was single or married. After learning of their infection, most patients searched the Internet for HPV information and for a reputable doctor. They cared about privacy in the outpatient clinic. Most patients had all kinds of negative feelings, principally involving fear, worry, and suspicion. The better a couple's relationship, the less these patients struggled to tell the truth (HPV infection). Patients often urged partners to check-up and advised friends for Pap smear tests. CONCLUSIONS: Most HPV infected women have many kinds of negative feelings. Psychological help for these women is necessary.