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Nursing Guide to Genital Herpes: Nursing Diagnosis, Interventions, & Care Plans

Updated On 5 Minute Read

Definition 

Genital herpes is a treatable, but incurable, chronic sexually transmitted infection (STI). This common condition is caused by herpes simplex virus HSV-1 or HSV-2, both of which establish latency in nerve ganglia and reactivate periodically due to internal or external stimuli (Centers for Disease Control and Prevention [CDC], 2024). HSV-1 increasingly contributes to genital infections, particularly through oral-genital transmission, while HSV-2 remains predominantly associated with genital herpes.

Etiology 

  • Transmission:
    • Direct mucosal contact during sexual activity (oral, anal, or vaginal)
    • Asymptomatic viral shedding
    • Non-sexual transmission during childhood (HSV-1)

Diagnostic Criteria 

  • Physical Exam: Observation of lesions (blisters, ulcers, scabs) and swollen lymph nodes during outbreaks
  • Laboratory Tests (Kaye, 2024):
    • Polymerase chain reaction (PCR) Testing: The most sensitive method for detecting HSV DNA
    • Viral Culture: Useful for active lesions but less sensitive
    • Serologic Testing: Detects HSV-1 and HSV-2 antibodies in asymptomatic or high-risk cases. Serology is particularly useful for screening pregnant individuals or determining asymptomatic infection risks.

Common Signs and Symptoms 

  • Initial Outbreak:
    • Painful blisters on the genitals, rectum, or nearby areas
    • Flu-like symptoms such as fever, muscle aches, or swollen lymph nodes
  • Recurrent Episodes:
    • Milder, shorter, often preceded by tingling or itching

Red Flags 

  • Severe systemic symptoms, such as high fever, severe sacral neuralgia, urinary retention, or constipation, may indicate disseminated HSV.
  • Immunocompromised individuals are at increased risk for widespread or severe infection.
  • Active lesions during pregnancy may indicate neonatal herpes risk.

Potential Complications 

  • Neonatal herpes (Kaye, 2024):
    • This is a life-threatening condition caused by transmission during delivery; risk is higher with primary maternal infection due to lack of maternal antibodies.
    • Preventive strategies, including cesarean delivery, are crucial for managing high-risk pregnancies.
    • Neonatal HSV infection is a potentially fatal infection.
  • Co-infection with the human immunodeficiency virus (HIV) (CDC, 2024):
    • HSV increases susceptibility to HIV by providing entry points for the virus through mucosal breaks and increased immune cell presence in affected areas.
Frequently Asked Question

How Long Can You Have Herpes Without Knowing?

Herpes simplex virus can remain undetected for months, years, or even a lifetime, which is important for nurses to recognize when assessing patients or providing sexual health education. Many individuals never develop noticeable symptoms, while others experience mild manifestations such as a small bump, slight irritation, or slight discomfort, often mistaking them for common conditions like ingrown hairs, razor burn, yeast infections, or nonspecific dermatitis. 

Because the initial outbreak may occur long after the initial infection, patients are often surprised to learn that a seemingly “new” diagnosis may actually reflect an infection acquired many years earlier.

Treatments 

Pharmacological 

  • First episode (Kaye, 2024):
    • Acyclovir 400 milligrams (mg) three times daily for 7 to 10 days
    • Valacyclovir 1 gram (g) twice daily for 7 to 10 days
    • Famciclovir 250 mg three times daily for 7 to 10 days
  • Recurrent episodes: Shorter-duration episodic therapy with the same antivirals
  • Suppressive therapy (American Academy of Dermatology Association, 2024): Daily antivirals to reduce recurrence and transmission
  • Severe cases: Intravenous (IV) acyclovir for complications like disseminated infection

Non-Pharmacological 

  • Pain relief: Sitz baths, topical agents
  • Stress reduction to minimize recurrence triggers

Surgical 

Cesarean delivery for individuals with active lesions during labor

Nursing Management 

Assessment and Interventions

Managing Active Lesions 

  • Keep lesions clean and dry.
  • Administer prescribed antivirals and monitor for side effects.
  • Educate individuals to avoid contact with lesions to prevent autoinoculation.

Symptom Management 

  • Administer prescribed antivirals and monitor for adverse effects like nausea or rash.
  • Document symptom progression and effectiveness of treatment.

Transmission Prevention 

  • Teach proper condom use, while acknowledging its limitations.
  • Discuss the benefits of suppressive therapy in reducing asymptomatic shedding.

Psychosocial and Cultural Considerations

Psychosocial Support

  • Discuss the emotional impact of living with a chronic condition and provide coping strategies.
  • Offer referrals to local or online support groups to manage stigma.
  • Teach strategies for discussing genital herpes with partners.

Cultural Considerations 

  • Tailor education and communication to individual cultural beliefs about sexual health.
  • Address misconceptions about HSV transmission and management respectfully.

Home Management 

Self-Care for Genital Herpes 

  • Take prescribed antivirals consistently and set reminders for adherence.
  • Wash the affected area with mild soap, pat dry, and avoid scented products.
  • Maintain a journal to track triggers like stress or illness and adapt routines to reduce recurrence.
  • Wear loose, breathable clothing, such as cotton underwear, to minimize irritation.
  • Educate on reactivation triggers such as fever, stress, hormonal changes, and immune suppression.

Safety Measures & Precautions 

  • Wash hands thoroughly after touching lesions; avoid touching eyes to prevent ocular infection.
  • Refrain from sexual activity during outbreaks; use condoms during asymptomatic periods, while acknowledging their limitations.
  • Avoid sharing personal items such as towels or razors during outbreaks.
  • Caregivers assisting with lesion care should wear gloves and wash their hands immediately after removing them.

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Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2028

Course Contributor 

The content for this course was created by Tameka N. Warren, MSN, RN, CLC. 

Tameka N. Warren, MSN, RN, CLC, earned her Bachelor and Master of Science in Nursing degrees from Indiana University School of Nursing at IUPUI, and her Associate of Science in Nursing from Ivy Tech College. She has over 16 years of nursing experience in public health, regulation, home health, education, maternal child community health, and long-term care environments. Tameka served as a Public Health Nurse Surveyor (Home Health & Hospice) certified by the Centers for Medicare & Medicaid Services, or CMS, a maternal and infant mortality advocate, an ALPP Certified Lactation Counselor, and an Adjunct Clinical Professor. Tameka’s passion is to serve the most vulnerable populations affected by health disparities and to inspire a new generation of nurses to do the same successfully. 

Resource 

References 

FAQs

Tameka Warren, MSN, RN, CLC

Tameka N. Warren, MSN, RN, CLC, earned her Bachelor and Master of Science in Nursing degrees from Indiana University School of Nursing at IUPUI, and her Associate of Science in Nursing from Ivy Tech College. She has over 16 years of nursing experience in public health, regulation, home health, education, maternal child community health, and long-term care environments. Tameka served as a Public Health Nurse Surveyor (Home Health & Hospice) certified by the Centers for Medicare & Medicaid Services, or CMS, a maternal and infant mortality advocate, an ALPP Certified Lactation Counselor, and an Adjunct Clinical Professor. Tameka’s passion is to serve the most vulnerable populations affected by health disparities and to inspire a new generation of nurses to do the same successfully.