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SEXUALLY

TRANSMITTED
DISEASES

SUBMITTED BY:
BSN – IV C2
CONTENTS
1. SYPHILLIS
2. GONORRHEA

3. HIV / AIDS
4. CHLAMYDIA
5. GENITAL HERPES

(CLICK ON THE TITLE TO VIEW


THE PRESENTATION)
Syphilis

 A complex STD that, if not treated, can


lead to blindness, paralysis, mental
illness, cardiovascular disease & death

 Often occurs w/ one or more other STDs


 Higher incidence in African Americans,


American Indians & Alaska Natives

 Penicillin has significantly reduced the


incidence of syphilis

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Syphilis: Pathophysiology

Spirochete bacteria, Treponema pallidum

ucous membranes or open skin to skin contact, sexual intercourse or blood transfusion

Period of incubation ensues

Enters the lymphatic system and blood stream and disseminates soon after contact
Chancre forms at the site of inoculation

Heals after 2-8 weeks

Secondary Stage

Individual with intact immune system

Enters the period of Latency


Inflammation and regional vasculopathy accounts for s/sx

After a period of latency four or more weeks

Enters the tertiary stage

focal granulomatous lesions known as GUMMAS affect organ system


Syphilis: PRIMARY Stage

 Primary: appearance of painless ulcer


called a chancre @ site of inoculation;
regional lymph nodes may be swollen;

 chancre appears 3-4 weeks after infectious


contact & disappears within 2-8weeks

 Chancre may go unnoticed in women

 Highly infectious during primary stage even


if no symptoms are present

Syphilis: Secondary Stage
 Symptoms of secondary syphilis appear
any time from 2 weeks to 6 months after
initial chancre disappears

 Symptoms include skin rash (especially on


palms of hands & soles of feet); mucus
patches in oral cavity; sore throat;
generalized lymphadenopathy; flat,
broad-based wart-like papules on labia,
anus or corner of mouth; flu-like
symptoms & alopecia

 These symptoms disappear within 2-6


weeks

Syphilis: Latency Period
 Usually NOT counted as a “stage”

 During this period of time there is no


symptoms; may last up to 50 years

 No symptoms are present & the disease is not


transmissible by sexual contact; it CAN be
spread by blood, however, during this time

 2/3 of the time the disease may not progress
any further

 This period may be much shorter in HIV


infected clients

Syphilis: Tertiary Stage
 Benign late syphilis: characterized by
localized infiltrating tumors called
gummas in skin, bones & liver; this form
of the tertiary stage usually responds
well to treatment

 Diffuse inflammatory response: involves
the CNS & cardiovascular system; can
still be treated but damage that has
already occurred is irreversible

Syphilis: Diagnostic Tests
 Diagnosis:
› VDRL (Venereal Disease Research Laboratory) &
RPR (Rapid plasma reagin) are tests done to
detect syphilis; these tests may be positive
about 4-6 weeks after infection

› FTA-ABS (fluorescent treponemal antibody
absorption); specific for the spirochete that
causes the disease; used to confirm the above
2 tests

› Immunofluorescent staining or dark-field
microscopy can be done to look for the
spirochete under a microcope after a smear is
taken from the chancre or a lymph node

Syphilis: Treatment
 Penicillin by a single IM injection is
treatment of choice for primary &
secondary syphilis

 If duration of disease is unknown the dose


is increased to 3 weekly injections

 If client is allergic to penicillin, oral


doxycycline (Vibramycin) may be given

Syphilis: Nursing Care

 Early symptoms resolve without


treatment but client is still infected
 Take all prescribed medication
 Refer all sexual partners for treatment
 Abstain from sexual contact for 1 month
after treatment
 Use a condom
 Emphasize need for follow-up testing at
3 & 6 months for clients w/ primary or
secondary; & at 6 & 12 months for
those with tertiary stage disease

GONNORHEA:
 is a common
sexually transmitted infection caused
by the bacterium Neisseria
gonorrhoeae (also called Gonococcus,
which is often abbreviated as "GC" by
clinicians). In the US, its incidence is
second only to chlamydia among
bacterial STDs.

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 Aka as ‘clap’; one of the most common STDs
second only to Chlamydia
 Caused by Neisseria gonorrhoeae; its
incubation period is 2-8 days
 Transmitted by sexual contact & during
passage through the birth canal
 Usually targets the cervix & male urethra


Signs & Symptoms:
Symptoms may appear within 2-10 days after exposure to an infected person.

Women:
  Men:
 No symptoms (30-  Pain or burning
40%) during urination
 Infection & irritation of
 Thick, yellow penile
the cervix
discharge
 Need to urinate often
 Inflammation or
 Itching & burning of
the vagina with
infection in a duct
thick yellow green of the testicles
discharge  Infection or
 Bleeding between inflammation of
periods the prostate
 
Pelvic inflammation disease(20-40% of women
ronic pelvic pain and sterility from tubal adhesions in which fibrous tissue in the fallopi
thritis
gonorrheal
ningitis infections
(inflammation of the can
brain)be
or cured 95-99%
endocarditis of the
(infection time
of the heart) (1%)
lamydia, another sexually transmitted disease (60%)
Gonorrhea: Pathophysiology & Complications

Exposure to neisseriagonorrhea

Attach to the columnar or transitional epithelium

Penetrate through or between the cells

Connective tissues

Cause inflammation
Spread of infection through lymphatic and blood circulation

GONORRHEA

If treated If untreated
Gonorrhea: Diagnostic Tests &
Treatment
 Diagnosis : In men
 urethral smear is done
 urethral cultures may also be done
 in women, cervical cultures may be
done
 Clients infected w/ gonorrhea are
often infected w/ other STDs &
should be tested for syphilis,
chlamydia & HIV
 Cefixime (Suprax), ceftriaxone
(Rocephin), ciprofloxacin (Cipro), or
ofloxacin (Floxin) may be used for
treatment
 Rocephin may be given as a one time
injection for those who may not be
compliant
Gonorrhea: Nursing Care
 Client needs to follow-up 4-7 days after
treatment to ensure infection has
been cured
 Encourage referral of sexual partners
 Abstain from sexual contact until client
& partners are cured
 Instruct client on safe sexual practices
 Instruct client to finish entire course of
antibiotics as prescribed by the
physycian
 Notify all sexual partners to be tested
for infection

Aids
AIDS stands for Acquired
Immune Deficiency
Syndrome:

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AIDS stands for Acquired
Immune Deficiency Syndrome:

 Acquired means you can get infected


with it;
 Immune Deficiency means a weakness in
the body's system that fights
diseases.
 Syndrome means a group of health
problems that make up a disease.
 a virus that attacks the immune system
, the body’s natural defense system

Causative agent : AIDS is
caused by a virus called HIV,
the Human Immunodeficiency
Virus.
Mode of Transmission:
 having sex with an infected person
 sharing a needle (shooting drugs) with
someone who's infected
 being born when their mother is
infected, or drinking the breast
milk of an infected woman
 Getting a transfusion of infected
blood used to be a way people got
AIDS, but now the blood supply is
screened very carefully and the
risk is extremely low.
 Any way if the blood from an HIV
infected person enters the body
(example kissing an HIV/AIDS
infected person who's gums bleed).

Clinical Manifestation :
Early infection
 Fever
 Headache
 Sore throat
 Swollen lymph glands
 Rash

Later infection
 Swollen lymph nodes — often one of
the first signs of HIV infection
 Diarrhea
 Weight loss
 Fever
 Cough and shortness of breath

Latest phase of infection
 Soaking night sweats
 Shaking chills or fever higher than
100 F (38 C) for several weeks
 Dry cough and shortness of breath
 Chronic diarrhea
 Persistent white spots or unusual
lesions on your tongue or in your
mouth
 Headaches
 Blurred and distorted vision
 Weight loss

Symptoms of HIV in
children
 Difficulty gaining weight
 Difficulty growing normally
 Problems walking
 Delayed mental development
 Severe forms of common childhood
illnesses such as ear infections
(otitis media), pneumonia and
tonsillitis

Diagnostic test:
ELISA
WESTERN BLOT

Blood is drawn from a vein (venipuncture), usually


from the inside of the elbow or the back of the hand.
A needle is inserted into the vein, and the blood is
collected in an air-tight vial or a syringe.
Preparation may vary depending on the specific test.
Steps for western blot

Tissue preparation
Samples may be taken from whole tissue or from cell
culture. In most cases, solid tissues are first broken
down mechanically using a blender (for larger sample
volumes), using a homogenizer (smaller volumes), or by
sonication. Cells may also be broken open by one of the
above mechanical methods.
Gel electrophoresis
The proteins of the sample are separated using
gel electrophoresis. Separation of proteins may be by
isoelectric point (pI), molecular weight, electric charge, or a
combination of these factors. The nature of the separation
depends on the treatment of the sample and the nature of
the gel.
Transfer
In order to make the proteins accessible to antibody
detection, they are moved from within the gel onto a
membrane made of nitrocellulose or polyvinylidene difluoride
(PVDF). The membrane is placed on top of the gel, and a
stack of filter papers placed on top of that.
Detection
During the detection process the membrane is "probed" for the
protein of interest with a modified antibody which is linked to a
reporter enzyme, which when exposed to an appropriate
substrate drives a colourimetric reaction and produces a colour
Treatment of AIDS
 RT Inhibitors
 Protease Inhibitors
 Fusion Inhibitors
 HAART

Opportunistic infections

 A number of available drugs


help treat opportunistic
infections. These drugs
include 
 Foscarnet and ganciclovir to
treat CMV (cytomegalovirus)
eye infections
 Fluconazole to treat yeast
and other fungal infections
 TMP/SMX
(trimethoprim/sulfamethoxazo
le) or pentamidine to treat
PCP (Pneumocystis carinii
pneumonia)

Chlamydia
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Chlamydia
DESCRIPTION ANATOMY

CAUSES COMPLICATIONS

SYMPTOMS TREATMENT

PREVENTION TESTS

SCREENING
CHLAMYDIA

gh symptoms of chlamydia are usually mild or absen

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CHLAMYDIA

you have it. If it's left untreated, however, C

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CAUSES

CHLAMYDIA TRACHOMAT

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CAUSES

gh:

n
rea.
ydia to her child during delivery, causing pneum

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ANATOMY

FEMALE REPRODUCTIVE MALE REPRODUCTIVE


ORGAN ORGAN

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SYMPTOMS

detect because early-stage infections often

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SYMPTOMS

occur, they usually start one to 3 weeks after y

ing, making them easy to overlook

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SYMPTOMS

ØPainful urination
ØLower abdominal pain
Øvaginal discharge
ØPenis discharge
ØPainful sexual
intercourse in women
ØTesticular pain in men

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ANATOMY

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ANATOMY

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SYMPTOMS

r vagina or penis, have pain during urinati

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SYMPTOMS

ems. Also, see your doctor if your sexual pa

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COMPL
ICATIO
NS

Human immunodeficiency virus (HIV)

ia are at greater risk of acquiring HIV than are

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COMPL
ICATIO
NS

Other STD

s, such as gonorrhea, syphilis and hepatitis. Your do

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COMPL
ICATIO
NS

Chronic pelvic pain


ated chlamydia may lead to chronic pelvic pain

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COMPL
ICATIO
NS

Infertility

pian tubes caused by chlamydia infect

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COMPL
ICATIO
NS

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COMPL
ICATIO
NS

coiled tube located beside each testicle. E

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COMPL
ICATIO
NS

and. Prostatitis may result in pain during or afte

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COMPL
ICATIO
NS

s can cause an eye infection, such as pink eye

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COMPL
ICATIO
NS

Rectal inflammation

nism can cause rectal inflammation. T

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COMPL
ICATIO
NS

Infections in newborns

canal to your child during delivery, causing pn

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TESTS

This can be done at the same time your doctor does

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TESTS

PAP SMEAR TEST


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TESTS

URINE TEST

analyzed in the laboratory may indicate

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TESTS

URINE TEST

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MEDICATIONS

ANTIBIOTICS

Azithromycin (Zithromax)
Doxycycline
Erythromycin

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MEDICATIONS

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MEDICATIONS

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MEDICATIONS

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TREATMENT

e to two weeks. During that tim

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TREATMENT

ot have signs or symptoms. Otherwise, the inf

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SCREENING

screening test is recommended. Even if you've bee

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SCREENING

Pregnant women.

hould be tested for chlamydia during your first

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SCREENING

omen and men at high risk.

multiple sex partners


on't always use a condom
ossible exposure to any STD through an infec

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PREVENTION

Use condoms

ach sexual contact. Condoms used properly d

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PREVENTION

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PREVENTION

Limit your number of sex partners

s you at a high risk of contracting chlamydia an

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PREVENTION

Avoid douching

ecreases the number of good bacteria present in the

ith water or other mixtures of fluids. )

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PREVENTION
AVOID DOUCHING

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PREVENTION

gular screenings for sexually transmitt

sexually active, particularly if you have mu

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Source
http://edition.cnn.com/HEALTH/library/ch
lamydia/DS00173.html

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PATHOPHYSIOLOGY
EXPOSURE TO (chlamydia trachomatis)
> Sexual intercourse
ØIntimate contact between genitals and the rectal area

to the host cell and is ingested through the process of pha

Metamorphosis to become a reticulate or initial body


(Stage of the life cycle)

The initial body duplicates by binary fission.


iberating infectious organisms that are capable of re

chlamydial infection

Onset of symptoms
IF left untreated If treated
AMYDIA COMPLICATIONS ANTIBIOTICS

Irreversible damage GOOD PROGNOSIS

POOR PROGNOSIS
GENITAL HERPES
( Herpes Simplex Virus II )
Genital herpes
• is a recurrence, life-long viral infection
that causes hepatic lesions (blisters) on the
cervix, vagina, and external genitalia

• The name herpes comes from the Latin


herpes which, in turn, comes from the Greek
word herpein which means to creep.

• It is one of the most common and incurable
sexually transmitted disease that is spread
by sexual activity including oral sex
TWO TYPES OF HERPES VIRUS

1.) Herpes Simplex Virus type 1 (HSV 1) - HSV type


1 infection is mainly nongenital, occurring above the
waist (often on the lips or nose

2.) Herpes Simplex Virus type 2 (HSV 2).). HSV type


2 infection occurs primarily below the waist as a
sexually transmitted genital infection.

NOTE: It is possible for HSV type 1 to cause genital


infection and for HSV type 2 to cause oral lesions
MODE OF TRANSMISSION

Sexually transmitted or
It can be transmitted asexually
from wet surface
by self transmission
touching a cold sore
touching the genital area

There is no cure for herpes.
Once infected, the virus remains
in the body for life. However,
after several years, some people
will become perpetually
asymptomatic and will no longer
experience outbreaks, though
they may still be contagious to
others.
GLOBALLY:

HSV-2 infection has never been


systematically estimated. As of
October 1, 2008 more than half a
billion people are infected with the
herpes simplex virus type 2, the virus
that causes most cases of
genital herpes, and nearly 24 million
new cases happen per ye 536 million
people aged 15-49 are infected with
herpes simplex type 2 virus.
NATIONALLY
Philippines had approximately 21 Million cases of genital herpes as of year
2008 according to National Foundation for Infectious Diseases.

LOCALLY

From the Sentinel STI Etiologic Surveillance System (SSESS) their studies
showed that the prevalence of syphilis, genital warts and genital herpes were
still not that high in the country and particularly there is 0.03% of genital herpes
cases in Davao City.
ETIOLOGY
PRECIPITATING FACTORS:
•Herpes Simplex Virus type 2

•Multiple Sex Partners

•Unsafe sex

•Immunocompromised

PREDISPOSING FACTORS

•Poor Hygiene
•Starting Sexual activity before 18
•Gender: Women
SYMPTOMS :
Dysuria Anorexia

Fever Halitosis

Dyspareunia Oral cold sores

Pain , burning and Lymphadenopathy


tingling
sensation in the
affected area
PATHOPHYSIOLOGY
Predisposing Factors Precipitating Factors
üPoor hygiene ü Herpes Simplex Virus II
üStarting sexual activity Before 18 ü Having multiple sex partners
ü Unsafe sex
üGender: women ü Immunocompromised

Enters mucosal surface

Initiate replication in cells of the epidermis and dermis

Viral envelope glycoprotein C (gC) binds to a cell particle

Heparin sulphate binds to variety of protein ligament (gD), (gH), (gL), (gB)

Formed a complex and creates a hemifusion state then creates an entry pore

Virus fuses directly with the plasma membrane and release


protein in the cytoplasm which includes some toxin.

FEVER Replication continues and provides entry to the cutaneous neurons Lymphadenopathy
Virus ascends through a peripheral nerve to the sacral dorsal ganglia

Continuous to permit infection of the sensory


or autonomic nerve endings ORAL COLD
Ulcerated Blisters at
skin the genital SORES
area Virus transport intra-
axonaly and enter the halitosis Severe
dysuria dyspareunia neuronal cell and mouth pain
migrates in the axon
Burning and
tingling sensation
Virus takes-up anorexia
permanent residence in
the nerve cell
Videos:
Ø DNA Replication
Dnarep.swf

Hsvrna.swf
HSV.rna

structure.swf
Structure

Latency.swf
Latency

Binding.swf
Binding

Release.swf
Release

Encap.swf Encap
LATENCY ESTABLISH
Exposure to strong sunlight
FEVER
Breakage of latency causes
virus to travel back down to the
STRESS nerve axon
Irritation of the genital area

Immune
suppression
Leads to renewal of virus
proliferation in the nerve
cell

REOCCURENCE OF INFECTION

GENITAL HERPES
If treated If not treated:
•Medications •Complications
ØAcyclovir (Zovirax)
-Multiple
ØFamiclovir
Sclerosis
ØAnalgesics
•Tests -Alzheimer’s
ØViral culture disease
ØTzanck test
-Cervical
Cancer
-Perianal
ulcer
Continuous exposure to
Prevent reoccurence of outbreak infection

Overwhelming infection

GOOD Medical Sepsis

PROGNOSIS
DEAT
H
V . MANAGEMENT

There is no cure for HVS-2 infection, but


treatment is aimed at relieving the
symptoms. The goals are to prevent the
spread of infection, to make the patient
comfortable, to decrease potential health
risks, and to be supportive and initiate a
counselling and education program.
DIAGNOSTIC
Sensitivity TESTS
Refers to the likelihood of the test correctly
diagnosing herpes.

Specificity

The probability of a test correctly determining that


a patient does not have herpes.
A . Viral
culture
This is where the virus is grown in
material known as a culture medium. A
viral culture looks for the presence of the
virus in the lesion.
• Provides a way to tell whether the
infection is caused by HSV-1 or HSV-2
B. Tzanck Test (Herpes skin test;
Chicken pox skin test)
The Tzanck test is a method of testing for the
herpes simplex virus (which causes cold sores,
fever blister, or genital sores), or varicella-
zoster virus (which causes chickenpox and "
shingles").

C. Blood Tests (serologic tests)


NURSING MANAGEMENT
Assessment
•Goals

•Nursing intervention

ØRelief of Pain

ØControl of Infection
ØPatient Education
ØPatient Education and Self-Care
for Genital Herpes
PHARMACOLOGICAL
MANAGEMENT
ACYCLOVIR (Zovirax )

Classification: ANTIVIRALS

Indication:
•Recurrent genital herpes infections.
•Treatment of limited non-life threatening herpes simplex
infections in immunocompromised patients
ACTION:
Interferes with viral DNA synthesis .It inhibits the
viral replication,decreases viral shedding and
reduced time for healing lesions.
ADVERSE REACTION/SIDE EFFECTS
seizure, dizziness, headache
diarrhea, nausea, vomiting
pain, phlebitis and local irritation
IBUPROFEN (Advil )
Classification: antipyretics ,antirheumatics,
nonopioid analgesic, nonsteroidal
anti-inflammatory agent

Indication:
•Mild to moderate pain od dysmenorrheal
•Slows progression of lung disease
Action:
Inhibits prostaglandin synthesis.
Decreased pain and inflammation.
Reduction of fever.
ADVERSE REACTION / SIDE EFFECTS :

headache, dizziness, drowsiness

• blurred vision and tinnitus


•GI bleeding, constipation, vomiting and
abdominal discomfort and nausea,
• skin rashes
ACETAMINOPHEN ( Acephen )
Classification: para-aminophenol derivative,nonopioid
analgesic, antipyretic

Indication:
Mild pain or fever

Action:
May produce analgesic effect by blocking pain
impulses, by inhibiting prostaglandin or pain receptor
sensitizers. May relieve fever by acting I hypothalamic heat-
regulating center. Relieves pain and reduces fever.
SURGICAL MANAGEMENT

There is no need for surgical treatment for


genital herpes. But if you are pregnant and
genital herpes is diagnosed or suspected at
the time of labor and delivery, a
cesarean section (surgical) delivery may be
recommended to protect the baby from
getting a herpes simplex infection, which can
cause serious health problems. A mother
can pass the herpes simplex virus (HSV) to
her baby if she has a sore or blister present
Thank You…