Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)

Hey there, it’s Meg! Welcome to our lesson on Herpes Simplex Virus, or genital herpes. Let’s go ahead and get started.

So what is Herpes Simplex Virus? Herpes Simplex Virus can cause cold sores as well as genital herpes. When we’re talking about HSV-1, that is when it’s going to cause cold sores, like we see here. For the case of this lesson, we will be referring pretty much only to HSV-2, which is going to cause genital herpes, the sexually transmitted infection we’re going to talk about today.

So like other STIs, it spreads by sexual contact and it is most often found in the genital, rectal, and oral cavities. I also want you to remember throughout this lesson that herpes is a virus so it is not curable, but it is manageable with the right medications.

Let’s talk first about genital herpes outbreaks. When I talk about outbreaks, which is the technical term, I’m talking about the onset of sores within the patient. I’m not talking necessarily about the spread to other patients. I’m talking just about the patient having sores.

Let’s talk more about outbreaks and herpes simplex infection in general.It is more common in females, unfortunately for us ladies. The genital herpes outbreak period is when the patient is most contagious, but I also want you to remember that the patient is still contagious even if they don’t have active sores. The onset of a genital herpes outbreak from infection is about two to 12 days, which makes it actually one of the shortest incubation periods. The first time they have an outbreak, it can last up to 30 days. Over time, as the patient is on medication and the body continues to fight it off, these periods will get shorter and they will become less severe. I also want you to understand that a patient who has a genital herpes outbreak who is delivering a child is likely to need a c-section because it can spread to an infant during childbirth, and this is very, very dangerous.

All right, so let’s talk both about risk factors and infection prevention, because understanding one helps us mitigate the other. First, like other sexually transmitted diseases, having multiple sexual partners, starting sexual activity at a young age, and having unprotected sex are of course risk factors. Much like other STDs as well, patients with HIV and cancer are also at a higher likelihood of contracting any infection. When we talk about infection prevention, safe sex is key, so I’m going to write that down for you guys. Safe sex, it makes a difference. However, in the case of herpes, condoms are unfortunately not 100% effective, they’re actually around 50% effective. However, we do need to tell our patients that condoms are still heavily encouraged because when condoms aren’t 100% an effective, it’s because the patient has sores outside of the region that condoms cover. So if the patient has sores on their penis, for example, it would still be very much beneficial for them to use condoms and that should still be encouraged. The only way to 100% ensure that a patient does not get herpes is to avoid having sex with infected individuals. However, we know that’s very difficult, but we do need to coach our patient on the risks so that they understand the risks that it presents to them as well as their partners. Because of this, this patient education component cannot be underestimated, it is so important. And- it’s important to be available to answer your patient’s questions once they have this diagnosis.

Let’s talk about treatment now. So like any other virus, there is no cure for genital herpes. However, these two medications are antivirals, and they do help to decrease both the frequency as well as the severity of outbreaks, so they are still very much encouraged even though they’re not a cure. Over time, these outbreaks will also decrease in severity and frequency as the body forms specialty antibodies. Once the patient is infected with herpes, it helps to decrease the occurrence over time as well. The human body is truly amazing. I do want you to remember, however, that even if a patient is on an antiviral, or they’ve had herpes for a long time and the outbreaks are occurring less frequently, the patient is still very much contagious.

Let’s talk more about patient education, because the diagnosis of herpes is truly a very scary diagnosis for a patient to receive. There is a large stigma associated with genital herpes, so helping to support and educate your patient will help to ease some of those anxieties. Patients do need to understand that it is highly contagious, even when they’re asymptomatic, so I’m going to write that down for you guys. Because that is so incredibly important, even when asymptomatic, safe sex practices are going to be our next step and they can help to protect patients’ partners, even though those condoms only decrease risk by 50%. Again, the only way to 100% guarantee a patient doesn’t get herpes is to abstain from sex completely. However, if your your partner is in a monogamous relationship, it does help to abstain from sex at least during outbreaks to give them the best chance of not passing it on to their partner. Does that make sense? If your patient is going to have sex with their partner, coaching them that abstaining during an outbreak will help to protect their partner the best.

Now, let’s talk about risks for pregnancy because this is incredibly important, and this is something that a lot of times delivering mothers struggle with because mothers sometimes have a preference for delivering vaginally. However, if the patient has an outbreak, there’s really going to be very few occurrences where the patient does not get a c section, just because passing herpes onto an infant can result in death. It is truly something that needs to be taken seriously.

And then finally, managing outbreaks. Not only are we coaching our patients on the transmission to others, but we need to coach them on how to treat the sores. They need to keep the area clean and dry, and that will help to facilitate the healing process.

Okay, so let’s review some priority nursing concepts for a patient with herpes simplex virus. First of all, of course, this affects the patient’s sexuality because not only is it sexually transmitted, but it can also affect their sexual relationship with their partner. And then of course, this affects infection prevention and health promotion, because educating patients helps to decrease the spread of herpes simplex virus between sexual partners.

So let’s once again go over some key points. Let’s remember, herpes simplex virus is sexually transmitted to the mouth, vagina, rectum, and penis most often. It isn’t curable because it’s a virus, but it is treatable. So, treating our patients is really going to improve their quality of life, and it’s going to decrease the risk of spreading to others over time. And finally, it is contagious even when it’s asymptomatic. So safe sex, as always, is going to be the way to go. Okay folks, that’s all for our lesson on herpes simplex virus. Check out the attached resources to learn more. Now, go out and be your best self today, and as always, happy nursing.