Herpes Simplex Virus

Pathophysiology:

  • Viral agent

  • Infection = lymphatic system → inguinal lymph node tenderness & edema

  • Reactivation causes recurrent lesions at original site of infection

Types:

HSV-1: lips, eyes, skin; cold sores, oral herpes

HSV-2: Genital, anal, perianal area; genitial herpes(fluid filled vessicles)

Etiology:

  • skin to skin or mucous membrane contact with active lesion or viral shedding

  • transmitted even if no visible sores present

  • HSV-2 can be transmitted via vaginal delivery

  • both types can cause oral or genital lesions

Clinical Manifestations:

  • inital infection self-limiting but virus remains FOR LIFE

  • Prodrome: tingling, itching, burning before outbreak

  • Lesions: fluid-filled vessicles(3-7 incubation); painless, rupture & form painful ulcers

  • Female sites: cervix(most common), vulva, vagina

  • Male sites: glans penis, foreskin, shaft

  • Extragenital: mouth, anus, perianal area

  • Reactivation triggers: infectious disease, emotional stress, immunosuppression, fever, UV exposure

  • Severe complications in HIV/AIDS patients: liver, adrenal gland, lung, & CNS necrosis

Risk factors:

  • multiple sexual partners

  • unprotected sex

  • immunocompromised staus

  • emotional or physical stress

  • history of other STIs

  • Female sex

Diagnosis:

  • cell culture from active lesion

  • Serology testing

  • PCR: most sensitive, atypical presentations

Priority Nursing Diagnosis:

  • Risk for infection spread

  • Acute pain

  • Deficient knowledge

Key nursing interventions:

  • Pain management(analgesics, sitz baths, ice packs to lesions), keep lesions clean & dry, wear loose fitting cotton underwear, assess for urinary retention

Medications:

  • acyclovir

  • valacyclovir

  • famiciclovir

Patient Teaching:

  • HSV lifelong - antiviral will suppress NOT CURE

  • Aymptomatic shedding occurs can transmit without visible sores

  • Avoid sexual contact during outbreaks

  • Condoms reduce but don’t eliminate risk