Herpes Simplex Virus (HSV) Overview

Herpes Simplex Virus (HSV) Overview:

• A common viral infection that causes sores on the mouth, genitals, or other areas.
• HSV-1 and HSV-2 are the two types.
• Oral herpes, or cold sores, are commonly linked to HSV-1.
• Genital herpes is commonly linked to HSV-2.
• HSV-1 and HSV-2 can cause infections in the oral or genital area.
• It is spread through direct contact with someone who has the virus, either through sores or through asymptomatic shedding.
• Once infected, the virus remains for life and can reactivate, resulting in recurrent outbreaks.

Assessment Findings:

• Cold sores or fever blisters on or around the mouth are common symptoms of oral herpes (HSV-1).
• Genital herpes (HSV-2) manifests as painful blisters or sores on the genitals, buttocks, or inner thighs.
• Before sores appear, prodromal symptoms such as itching, tingling, or burning may occur.
• Individuals may experience pain, itching, and flu-like symptoms during an outbreak, including fever, headache, and body aches.
• Herpetic lesions are seen during physical examination; they are small, fluid-filled blisters that eventually rupture and crust over.
• Asymptomatic shedding occurs in some cases, indicating that people are contagious even when no sores are present.

Diagnostic Studies:

• Viral culture involves taking a sample from a sore and testing it for the presence of HSV.
• Polymerase chain reaction (PCR) is a more sensitive test that detects HSV DNA in a sample obtained from a sore or bodily fluid.
• Tzanck smear: a microscopic examination of cells extracted from a sore to detect HSV-related changes, but it is less sensitive than viral culture or PCR.
• Antibody tests are blood tests that detect HSV-1 and HSV-2 antibodies, and while they can establish if someone has been infected, even if they have no visible sores, they cannot determine the infection site.

Nursing Management:

• Correctly identify the differences between Herpes Simplex Virus 1 and 2
• Educate about antiviral medications like acyclovir, valacyclovir, and famciclovir to lessen the severity and length of outbreaks.
• Encourage medication use at the first sign of an outbreak or prodromal symptoms.
• Educate on proper hygiene to prevent the virus from spreading.
• Keep sores clean and dry.
• Avoid touching sores and wash hands thoroughly after touching them.
• Avoid sharing personal items like towels, razors, and lip balm to avoid transmission.
• Educate patients on safe sex practices.
• Encourage condom use during sexual activity to reduce the risk of transmission, but note that condoms do not completely eliminate the risk because shedding can still occur in areas not covered by a condom.
• When sores are present, people should avoid sexual activity.
• Discuss outbreak management strategies.
• Identify outbreak triggers such as stress, illness, sunlight, and menstruation.
• Counsel individuals on how to reduce stress and maintain a healthy lifestyle.
• Suggest over-the-counter pain relievers for pain and discomfort.
• Recommend topical creams or ointments to help sores heal and provide relief.
• Provide emotional support and counseling.
• Acknowledge the stigma of HSV and create a safe environment for patients to discuss their issues and feelings.
• Provide resources for support groups and counseling services.
• Encourage open communication with partners about HSV status.
• Discuss strategies for lowering the risk of HSV transmission to newborns.
• Advise pregnant women with HSV to notify their healthcare provider.
• If active lesions are present, a cesarean delivery may be indicated to prevent transmission to the baby during childbirth.

Potential Complications:

• Recurrent outbreaks: HSV remains in the body for life and can reactivate, causing recurrent outbreaks.
• Transmission to others: HSV can be transmitted through direct contact with someone who has the virus, even when there are no visible sores.
• Neonatal herpes: HSV can be transmitted from a mother to her baby during childbirth, causing serious complications for the newborn.
• Ocular herpes: HSV can cause infections of the eye, leading to corneal scarring and vision loss.
• Encephalitis or meningitis: In rare cases, HSV can spread to the brain, causing inflammation and neurological damage.
• Disseminated infection: In individuals with weakened immune systems, HSV can spread throughout the body, causing a life-threatening infection.

Important Teaching Points:

• A common viral infection that causes sores on the mouth, genitals, or other areas of the body.
• HSV-1 and HSV-2 are the two types.
• HSV is spread through direct contact with an infected individual, whether through sores or asymptomatic shedding.
• Once infected, the virus remains for life and can reactivate, resulting in recurrent outbreaks.
• Antiviral medications can help to reduce the severity and duration of outbreaks.
• Proper hygiene and safe sex practices can help prevent the virus from spreading.
• Emotional support and counseling can assist people in dealing with the stigma and emotional issues associated with HSV.
• Pregnant women who have HSV should notify their healthcare provider to reduce the risk of transmission to their newborns.