To the Editor: The recent article by Miyai and colleagues published in Sexually Transmitted Diseases1 adds important information to the discussion concerning routine screening of high-risk persons for asymptomatic herpes simplex virus type 2 (HSV-2) infection. Their study showed there was little psychosocial impact among a group of sexually transmitted disease (STD) clinic clients who requested HSV-2 screening and were found to be HSV-2-positive. One important caveat, as described in their discussion, is that these clients received “thorough pretest counseling… and among infected patients,… intensive posttest counseling and education,” services which would not likely be routinely available in a busy STD clinic. The availability of HSV-2 screening in STD clinics in the United States is unknown, but anecdotal evidence suggests that few STD clinics offer this service.2 Concerns about screening include the specificity (false-positivity) and cost of testing, cost of providing suppressive therapy, and importantly, the resources needed to provide effective counseling in a time-efficient manner.3 In San Diego county, we conducted an anonymous self-administered questionnaire survey of STD clinic clients to determine if clients wanted herpes screening knowing that, if positive, changes in sexual practice would be needed. We also asked clients if they would pay some amount toward the cost of this test. During the survey period (December 20, 2000–January 23, 2001), 920 clients (>90% response rate) completed the one-page questionnaire and 69% responded to an initial question that they would want testing if it was available (Table 1). On the reverse side of the questionnaire, we provided information about safe sexual behavior practices that would be recommended if they tested positive. We then asked again (posteducation question) if they wanted HSV-2 testing and 72% responded “yes” (small changes in both directions between the two questions). The desire for testing (posteducation question) varied little by gender or age, or by those who thought they possibly had genital herpes. However, clients who thought they had been possibly exposed to a sex partner with herpes were 20% more likely to want testing compared with those who did not think they had been exposed (84% [65 of 77] vs. 71% [576 of 809], rate ratio [RR] = 1.2, 95% confidence interval [CI], 1.1–1.3, P <0.02). More than 70% of the clients who wanted testing were willing to pay ≥$5.00 (≥$5 [71%], ≥$10 [42%], ≥$15 [29%], Table 1).TABLE 1: Sexually Transmitted Disease Clinic Clients’ Acceptance of Herpes Simplex Virus Type 2 (HSV-2) Screening, San Diego, California, 2001This survey adds to the small but growing body of data indicating that STD clinic clients want to be tested for HSV-2 infection.4,5 Studies have shown that HSV-2 prevalence may be ≥40% among STD clinic clients.6 Our study showed that learning about the need to adopt safe sexual practices if infected had little impact on the decision process. In addition, clients appeared willing to pay some amount for testing. The resources needed to provide effective counseling in an HSV screening program can be a formidable challenge. The list of educational and counseling points that need to be covered is long and complex7,8 and may require ≥2 counseling sessions.8 One evaluation in England reported that posttest counseling for all clients tested averaged 9.8 minutes (range, 1–20 minutes.) per client and posed a “considerable burden” on clinic operations.9 More empiric data from STD clinics where HSV-2 screening is offered are needed to determine the counseling resources, screening and treatment costs, and other impact on STD clinic services—information that can guide other STD clinic managers in deciding how to best offer this important screening service.