There are two types of herpes simplex virus (HSV), type 1 and type 2. Herpes simplex virus-1 causes infection above the waist, such as “cold sores” that occur on the mouth. This type may occur in the genital area as a result of oral-genital sexual practices. After the initial infection, the virus is dormant, but the patient is a carrier and likely to have recurrent infections. Events that trigger recurrences are sun exposure, fever, menses, stress, or lack of sleep.
Herpes simplex virus-2 causes lesions in the genital area. In the primary episode, multiple, blister-like, painful vesicles erupt on the vulva, perineum, cervix, or perianal area within 3 to 5 days after the initial exposure. The virus then becomes dormant and resides in the nerve ganglia of the affected area. Repeated outbreaks can happen at any time, but most patients have less severe regular recurrences that are more likely to occur during menses, pregnancy, or times of illness and stress. The more severe the primary outbreak, the more frequent the recurring infections. In the United States, 22% of the adult population has herpes simplex virus-2, and 1.7 million new cases are diagnosed each year.
Active herpes simplex virus is associated with spontaneous abortion in the first trimester of pregnancy and an increased risk of preterm labor after 20 weeks’ gestation. If a patient has active herpes around the time of the estimated date of delivery, cesarean section is the preferred method of delivery. Infected infants can develop the following signs and symptoms after an incubation period of 2 to 12 days: fever, hypothermia, jaundice, seizures, poor feeding, and vesicular skin lesions.
To cause an infection, herpes simplex virus needs to come into direct contact with the genitals, mouth, eyes, open sores, or cracks in the skin. herpes simplex virus-2 is sexually transmitted through contact with an infected person. Pregnant women can transmit the herpes virus to the fetus, especially during a primary outbreak. Transmission can occur when the membranes rupture or during a vaginal delivery, but transplacental transmission is extremely rare. Asymptomatic transmission is very uncommon.
Nursing care plan assessment and physical examination
If the patient has an oral lesion, ask about a sore throat, increased salivation, anorexia, and mouth pain. During a primary episode, the patient may experience flulike symptoms, such as fever, malaise, and enlarged lymph nodes. If the lesion is not a primary one, the patient usually does not have any systemic complaints but may complain of a tingling, itching, or painful sensation at the site of the lesion. If the patient has a genital lesion, obtain a detailed summary of his or her sexual activity, including number of partners, use of barrier protection and birth control measures, participation in oral or anal intercourse, and previous (if any) history of sexually transmitted diseases (STDs). Inquire about any burning with urination, dysuria, dyspareunia, pruritus, fever, chills, headache, and general malaise. On some occasions, the patient may be asymptomatic or have such mild symptoms that the outbreak goes unnoticed.
Inspect the lips and the oral and pharyngeal mucosa for lesions and inflammation. The lesion may appear as a red, swollen vesicle, or if it has ruptured, it is ulcer-like with yellow crusting. Palpation of the lymph nodes in the neck may reveal cervical adenopathy. Take the patient’s temperature. Inspect the genitalia for fluid-filled vesicles, or if the vesicles have ruptured, note an edematous, erythematous oozing ulcer with a yellow center. Examine the cervix by using a speculum, and inspect the walls of the vagina. Inspect the patient’s perianal skin and the labia and vulva or penis and foreskin carefully to identify all lesions; note any abnormal discharge.
Ask the patient about sexual practices, partners, and birth control methods. Assess the patient’s knowledge of STDs and their implications. Assess the patient’s ability to cope with having an STD. The diagnosis of an STD can be very upsetting to a woman or man who believes she or he was involved in a monogamous relationship. Tell patients that an outbreak of genital herpes simplex virus may have had its origins even 20 to 30 years before the outbreak.
Nursing care plan primary nursing diagnosis: Anxiety related to a knowledge deficit of cause, treatment, and prevention of herpes simplex virus.
Nursing care plan intervention and treatment plan
Since herpes simplex virus is not curable, treatment focuses on relieving the symptoms. The drug of choice to treat a primary infection of herpes simplex virus-1 and -2 is acyclovir. Instruct the patient to take all medication ordered, even if symptoms recede before the medication is used up. For comfort during the outbreak, patients may take prescribed analgesics or use warm soaks with Epsom salts or sitz baths. Lesions can be cleaned with Betadine. Encourage patients to wear loose clothing and cotton underwear and to avoid ointments that contain cortisone and petroleum because they slow healing and promote the growth of the virus. Encourage exercise, good nutrition, and stress reduction to decrease the number of recurrent outbreaks.
Inform patients that the risk of acquiring human immunodeficiency virus (HIV) is double that for herpes simplex virus-2–infected persons. Help the patient understand that this is a minor problem with which she or he will be inconvenienced from time to time. Adherence to strict guidelines when active lesions are present allows the patient to have a normal sexual relationship. Healthcare workers with active herpes are prohibited from working with immunosuppressed patients or in a nursery setting because of the complications that result in the neonate if HSV transmission occurs.
Nursing care plan discharge and home health care guidelines
Be sure the patient understands the correct dosage, route, and time of the medication, as well as the importance of taking all prescribed medication, even if the symptoms subside. Review events that trigger outbreaks; emphasize the importance of avoiding contact with the lesion in preventing transmission. Teach the female patient that a potential long-term complication is the development of cervical cancer; yearly Papanicolaou tests are critical.