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Nursing Care Plan | NCP Genital Herpes

Genital herpes is a sexually transmitted disease (STD) caused by a virus group that may also cause cold sores in the mouth. It is contagious and can be spread by carriers—persons who are infected with the virus but have no symptoms of the disease. As many as 80–90 percent of people infected by the herpes virus are asymptomatic carriers.

Genital herpes is a sexually transmitted viral infection whose most noticeable symptom is blisters or open sores on the skin of the genitals. It is caused by the herpes simplex virus (HSV), which has two forms, known as HSV-1 and HSV-2. HSV-1 is familiar to many people as the virus that causes cold sores around the outside of the mouth; it is responsible for some cases of genital herpes as well. HSV-2 causes most cases of genital herpes; it is spread by mouth-to-genital or genital-to-genital contact. HSV is shed from visible sores, blisters, or a rash during outbreaks of genital herpes, but can also be shed from the affected area between outbreaks of symptoms. HSV can be transmitted even when the infected person has no symptoms; in other words, a sexual partner without obvious genital sores or blisters can still transmit the illness. People without noticeable symptoms may actually contribute more to the spread of genital herpes than those with active sores.

More than some other sexually transmitted diseases (STDs), herpes can be a source of severe emotional distress to people infected with it. These feelings—particularly fear of rejection—are largely related to the fact that unlike such STDs as chlamydia and gonorrhea, genital herpes presently has no permanent cure. This fact means that anyone who is in a sexual relationship with an infected person runs some risk of being infected themselves even when the partner is being treated for HSV infection. Some people do choose to end relationships with infected partners rather than run this risk.

Genital herpes is an extremely common infection among sexually active adults around the world. The rate has been increasing in most developed countries in recent years although it has recently decreased in the United States. According to the Centers for Disease Control and Prevention (CDC), there are between 45 and 50 million people infected in the United States, with an estimated one million new infections every year. About one in every five sexually active adolescents and adults are infected with HSV. Women are about twice as likely to be infected with herpes by having sex with men than men are to get the infection from a woman. Some groups of people are at greater risk than others of being infected with genital herpes. High-risk groups in the United States include:
• Young adults of either sex.
• People who have unprotected sex or do not use barrier methods of birth control (condoms or diaphragms).
• Homosexual men, particularly those who are HIV-positive or abuse drugs or alcohol.
• People living in large cities.
• People with low income or little education.
• People who use cocaine.
• People who have a large number of sexual partners.

Nursing Care Plan Signs and Symptoms
Genital herpes is caused by herpes simplex virus (HSV). It may be caused by either HSV-1, which also causes cold sores around the mouth, or primarily by HSV-2. People who have never had cold sores may have a prodrome, or period when they have some warning symptoms of the disease. The prodrome of genital herpes may be marked by flu-like symptoms, including loss of appetite, fever, and a general unwell feeling. Some people feel pain, itching, burning, or a tingling sensation in the areas where the blisters of herpes erupt several days later. Although genital herpes is usually transmitted by mouth-to-skin contact or sexual activity, it can also be transmitted by a pregnant woman to her baby during childbirth. If a woman has active genital herpes at the end of her term, the baby is usually delivered by cesarean section. Fortunately, infection of a baby from a woman with herpes infection is rare. There have also been cases of HSV transmission through skin-to-skin contact in such sports as wrestling or rugby.

After the prodromal period, infected people of either sex typically notice what are often repeated eruptions of small aching blisters (between onequarter and one-half in size) filled with clear yellowish fluid on the genitals, around the rectum, or covering nearby areas of skin. The blisters typically occur in clusters or crops. The blisters then break, leaving shallow open sores that are very painful. These sores eventually crust over and slowly heal over a period of two to four weeks. The patient’s lymph glands may also become sore and swollen. Both men and women may experience pain when urinating, and women may notice a vaginal discharge.

After a person is infected with HSV, the virus hides within nerve cells, making it difficult for the immune system to find and destroy it. The virus remains in the body, so that symptoms can reappear at any time. Recurrences of genital herpes can be triggered by a number of factors. The most common triggers, however, are emotional stress; menstruation (in women); inadequate sleep and fatigue; another illness; a surgical procedure; and irritation of the skin from clothing or athletic gear.

Nursing Care Plan Diagnosis
The diagnosis of genital herpes is often delayed, particularly if the person has had only mild symptoms that can be mistaken for those of another disease. Herpes can be detected by a blood test or by a laboratory culture made from fluid or a tissue scraping from a blister or sore. A tissue culture generally takes several days to give results. Many people who do have symptoms of genital herpes are also infected with HIV, gonorrhea, syphilis, or other STDs. It is now common for doctors to test patients for these other diseases to make sure which disease is causing the patient’s symptoms and that all the STDs that are present are being treated.

Treatment for genital herpes consists of one of several antiviral medications taken by mouth to lower the risk of relapses, to lower the risk of spreading herpes, and to heal sores and blisters more rapidly. The most common medications prescribed for herpes are Valtrex, Famvir, and Zovirax. These drugs do not, however, cure the disease. They are usually prescribed for a period of seven to ten days for the first outbreak and five days for recurrences; however, patients who have frequent outbreaks may be able to control them only by taking an antiviral drug every day.

There is no cure for genital herpes. Although the majority of infected persons may never have noticeable symptoms, those who do may have recurrent outbreaks as long as forty years after the initial infection. Eighty-five percent of people with symptomatic genital herpes have recurrences— sometimes as many as six to ten each year. Recurrent herpes infections in men are generally milder and shorter in duration than those in women.

Genital herpes can be prevented in several ways:
• Abstaining from sexual intercourse or limiting intercourse to one partner who is free of sexually transmitted diseases.
• Not having sex with high-risk partners.
• Infected persons should not have sex at all when they have blisters or sores anywhere on the body or in the mouth. Even the use of a condom does not prevent the spread of herpes when someone has genital sores or blisters because not all sores will be covered by the condom.
• Using latex condoms every time during sex when sores or blisters are not present.
• Avoiding the use of drugs (particularly cocaine) and alcohol, which can impair good judgment.
• Having sexual partners tested or treated for herpes before having sexual relations.

The Future
The number of new herpes infections is likely to continue to rise worldwide, if only because the majority of infected persons are carriers rather than having obvious symptoms of the disease. One possible treatment that might reduce the risk of symptomatic herpes in women is a vaccine against HSV-2 called Herpevac, which was being tested by the National Institutes of Health (NIH) as of 2008. Results so far indicate that the vaccine would not help everyone; it does not prevent genital herpes in men, and it works only in women who have never been exposed to HSV-1. The partial success of Herpevac does, however, encourage researchers to continue working on vaccines against genital herpes.
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