Herpes Simplex

 is an infection caused by HSV (herpes simplex virus). This virus affects the external genitalia, anal
region, mucosal surfaces, and skin in other parts of the body.

Etiologic Agent
 herpes simplex virus, also known as HSV, is an infection that causes herpes.
 HSV-1: primarily causes oral herpes, and is generally responsible for cold sores and fever blisters
around the mouth and on the face.
 HSV-2: primarily causes genital herpes, and is generally responsible for genital herpes outbreaks.

Mode of Transmission
 HSV-1 can be contracted from general interactions such as:
 oral-to-oral contact to cause oral herpes infection, via contact with the HSV-1 virus in
sores, saliva, and surfaces in or around the mouth. 
 eating from the same utensils
 sharing lip balm
 kissing
 HSV-2 is the main cause of genital herpes, which can also be caused by herpes simplex virus type 1
(HSV-1).
 -usually transmitted by sexual contact but can be passed to an infancy during childbirth

Incubation Period- 2-12 days

Period of Communicability
 Secretion of virus in the saliva may occur for up to 7 weeks after recovery from stomatitis.
 Patients with primary genital lesions are infective for 7–10 days.
 Those with recurrent disease are infectious for 4–7 days with each episode
Pathogenesis
 The transmission of herpes simplex virus (HSV) infection is dependent upon intimate, personal
contact of a susceptible seronegative individual with someone excreting HSV. Virus must come in
contact with mucosal surfaces or abraded skin for infection to be initiated. With viral replication at
the site of primary infection, either an intact virion or, more simply, the capsid is transported
retrograde by neurons to the dorsal root ganglia where, after another round of viral replication,
latency is established. The more severe the primary infection, as reflected by the size, number, and
extent of lesions, the more likely it is that recurrences will ensue. Although replication sometimes
leads to disease and, infrequently, results in life-threatening infection (e.g., encephalitis), the host-
virus interaction leading to latency predominates. After latency is established, a proper stimulus
causes reactivation; virus becomes evident at mucocutaneous sites, appearing as skin vesicles or
mucosal ulcers.

Clinical Manifestation
 HSV 1
 painful blisters or open sores called ulcers in or around the mouth.
 Sores on the lips are commonly referred to as “cold sores.”
 tingling, itching or burning sensation around their mouth, before the appearance of sores.
 the blisters or ulcers can periodically reccur...
 genital herpes is characterized by 1 or more genital or anal blisters or ulcers.

 HSV 2
For Women
 tingling, itching and pain in the genital area
 eruption of smalls pustules and vesicles
 excruciating painful to touch
 dyspareunia
 dysuria
 urine retention

For men
  Urethritis
 lesion of the penis and scrotum
 rectal and perianal infections are possible with anal contact

 Systemic Symptoms
 fever
 headache
 malaise
 muscle ach
 lymphadenopathy

Diagnostic Test
 Standard viral culture: Tube culture isolation is the traditional gold standard for HSV detection
and the reference method against which all other tests are measured
 Antigen detection. Viral antigen detection may be a suitable alternative to culture for smaller
laboratories in which the expense of maintaining cell lines is unwarranted. 
 Tzanck smears-HSV infection causes typical cytopathic changes in genital epithelial cells
 Electron microscopy-Direct examination of vesicle fluid or other clinical material by electron
microscopy for the diagnosis of HSV is limited by the fact that viral morphology cannot be used to
distinguish HSV from other herpes viruses 
 Virus DNA detection-Viral DNA may be detected by hybridization techniques using radiolabelled
or biotinylated probes
 Indirect serological test-The detection of antibodies to HSV allows for diagnosis when other
virological methods cannot be performed or yield negative results

Treatment Modalities
 Antiviral medications-these drugs decrease the frequency of recurrences, shorten the duration of
the active lesion, reduce the number of new active lesions, formed and decrease vital shedding
with primary infections
 acyclovir
 famciclovir
 valacyclovir

Nursing Management
 Pain killers like ibuprofen can reduce pain and fever.
 Anti-viral drugs like acyclovir, valacyclovir, famciclovir, and penciclovir. If used correctly, they
may speed up the healing time of a recurrent infection
 Topical application of antiviral creams can also help in healing outbreak of infection. They do not
get rid of the herpes simplex virus or prevent future outbreaks of cold sores occurring.

Prevention and Control

 Try to avoid direct physical contact with other people.
 Don’t share any items that can pass the virus around, such as cups, towels, silverware, clothing,
makeup, or lip balm.
 They should also abstain from oral sex, to avoid transmitting herpes to the genitals of a sexual
partner.
 Wash your hands thoroughly and apply medication with cotton swabs to reduce contact with
sores.
 The consistent and correct use of condoms can help to prevent the spread of genital herpes.