DEFINITION:

• A VIRAL DISEASE CHARACTERIZED BY THE APPEARANCE BY THE

APPEARANCE OF SORES AND BLISTERS ANYWHERE ON THE SKIN.
• SORES USUALLY OCCUR EITHER AROUND THE MOUTH AND NOSE OR ON THE
GENITAL AND BUTTOCKS (THUS, THE NICKNAME “VIRUS OF LOVE”).
• RELATED TO THE VIRUSES THAT CAUSE INFECTIOUS MONONUCLEOSIS
(EPSTEIN-BARR VIRUS), CHICKENPOX, AND SHINGLES.
DEFINITION:
•OCCURS IN 2 FORMS:
1. PRIMARY INFECTION – OCCURS DURING INFANCY AND CHILDHOOD,
BEFORE NEUTRALIZING ANTIBODIES ARE PRESENT IN THE SERUM
2. INDIVIDUAL BECOMES A CARRIER – OCCURS AFTER RECOVERYFROM
THE PRIMARY INFECTION
ETIOLOGIC AGENT: HERPES SIMPLEX VIRUS
OR HERPESVIRUS HOMINIS
TYPE 1 VIRUS
•CAUSES COLD SORES THAT USUALLY INFECT DURING INFANCY AND
CHILDHOOD
•SORE – TINY, CLEAR, FLUID-FILLED BLISTERS
•SORE COMMONLY AFFECTS LIPS, MOUTH, NOSE, CHEEKS (OCCUR
SHORTLY AFTER EXPOSURE). MAY ALSO DEVELOP WOUNDS ON THE
SKIN.
TYPE 1 VIRUS
•SYMPTOMS ARE BARELY NOTICEABLE
•TRANSMITTED THROUGH KISSING AND SHARING UTENSILS AND
TOWELS
•SORES OF THE PRIMARY INFECTION APPEAR 2 – 20 DAYS AFTER
CONTACT WITH AN INFECTED PERSON AND USUALLY LAST 2 – 10 DAYS
TYPE 2 VIRUS
•CAUSES GENITAL SORES, AFFECTING THE BUTTOCKS, PENIS,
VAGINA, OR CERVIX AND LASTS 2 – 20 DAYS.
•CAN BE CONTRACTED MOSTLY FROM SEXUAL CONTACT WITH AN
INFECTED PERSON
•AFFECTS 20% OF SEXUALLY ACTIVE INDIVIDUALS
TYPE 2 VIRUS
•CAN ALSO BE SPREAD BY TOUCHING AN UNAFFECTED PART OF
THE BODY AFTER TOUCHING THE HERPES LESION
•MANIFESTATIONS: MINOR RASH/ITCHING AND PAINFUL SORES,
FEVER, MUSCULAR PAIN AND BURNING SENSATION DURING
URINATION
SOURCE OF INFECTION:
•MAN IS THE NATURAL RESERVOIR OF HERPES SIMPLEX VIRUS
(HSV)
•MONKEYS ARE THE RESERVOIR OF INFECTION FOR HERPES SIMIAE
MODE OF TRANSMISSION:
•CLOSE CONTACT – KISSING (HSV TYPE 1) OR COITUS (HSV TYPE
2)
PATHOLOGY
•BEFORE THE BLISTER APPEARS, THE SKIN MAY ITCH OR BECOME VERY
SENSITIVE
•LESIONS ARE LIMITED TO THE EPIDERMIS OR SUPERFICIAL
MEMBRANE
•THE BLISTER BREAKS AS A RESULT OF INJURY, ALLOWING THE FLUID OF
THE BLISTER TO OOZE AND CRUST
PATHOLOGY
•THE CRUST FALLS OFF, LEAVING SLIGHTLY RED, HEALING SKIN;
HOWEVER THE VIRUS REMAINS IN A RESTING STATE
•THE INFECTION MAY RECUR IN EITHER THE SAME LOCATION OR IN
A NEARBY SITE. THE INFECTION MAY RECUR EVERY FEW WEEKS
OR LESS FREQUENTLY
PATHOLOGY
•SUBSEQUENT INFECTIONS TEND TO BE MORE MILDER THAN THE
PRIMARY INFECTION. THIS CAN BE SET OFF BY A VARIETY OF
FACTORS, INCLUDING: FEVER, SUN EXPOSURE, AND MENSTRUAL
PERIOD.
•FOR MANY, THE RECURRENCE IS UNPREDICTABLE & HAS NO
RECOGNIZABLE CAUSE
INCUBATION PERIOD

VARIABLE BUT MAY BE BETWEEN 2 – 12 DAYS

COURSE OF THE DISEASE
i. MILD TO MODERATE
1. ORAL HERPES – GINGIVOSTOMATITIS IN YOUNG CHILDREN IS THE
MOST COMMON MANIFESTATION
• VESICULAR & ULCERATIVE LESION IN THE BUCCAL MUCOSA AND
MAY INVOLVE THE TONGUE
• INFLAMMATION OF THE GUMS, CERVICAL ADENOPATHY, AND FEVER
• EXCESSIVE SALIVATION DUE TO PAIN ON SWALLOWING (INFANTS &
YOUNG CHILDREN)
COURSE OF THE DISEASE

2. LABIAL HERPES – COMMONLY KNOWN AS COLD SORES OR

FEVER BLISTERS
- LESIONS THEN CRUST AND HEAL WITHIN 3 –
10 DAYS. SUBSEQUENT RECURRENCES ARE USUALLY CLOSE TO
THE ORIGINAL SITE.
COURSE OF THE DISEASE
3. OCULAR HERPES – HERPETIC KERATITIS POTENTIALLY LEADS
TO LOSS OF VISION
• PRIMARY KERATITIS – MAY BE ACCOMPANIED BY
CONJUNCTIVITIS AND PREAURICULAR LYMPHADENOPATHY
• RECURRENT KERATITIS IS USUALLY UNILATERAL, BUT 2 – 6%
OF CASES MAY BE BILATERAL
COURSE OF THE DISEASE
3. OCULAR HERPES – HERPETIC KERATITIS POTENTIALLY LEADS
TO LOSS OF VISION
• MORE SERIOUS DISEASE MAY OCCUR IF THE STROMA IS
INVOLVED OR IF IRIDOCYCLITIS OCCURS
COURSE OF THE DISEASE
4. CUTANEOUS HERPES
• ACCOMPANIED BY DEEP BURNING PAIN, FEVER, SKIN EDEMA,
ASCENDING LYMPHANGITIS AND REGIONAL
LYMPHADENOPATHY
•MAJORITY OF SAMPLES ISOLATED ABOVE WAISTLINE = TYPE 1
•MAJORITY OF SAMPLES ISOLATED BELOW WAISTLINE = TYPE 2
COURSE OF THE DISEASE
5. ERYTHEMA MULTIFORMS
• HSV LESIONS SOMETIMES APPEAR AS ZOSTERIFORM
DISTRIBUTION THAT MIMICS HERPES ZOSTER.

6. GENITAL HERPES – ONE OF THE MOST COMMON STDS

COURSE OF THE DISEASE
ii. SEVERE TO FATAL
1. NEWBORN – NEONATAL HERPETIC INFECTION IS USUALLY ACQUIRED
FROM MATERNAL INFECTION AT THE TIME OF DELIVERY.
2. ECZEMA VARICELLIFORM ERUPTION – MOSTLY COMMON IN ATOPIC
DERMATITIS
• OCCASIONALLY OCCURS IN PATIENTS WITH OTHER SKIN
DISORDERS SUCH AS SEBORRHEIC DERMATITIS AND DIAPER RASH.
• FATALITY RANGES 5 – 10%. DEATH IS USUALLY DUE TO VIREMIA TO
THE BRAIN AND VISCERAL ORGANS OR SUPERIMPOSED BACTERIAL
INFECTION
COURSE OF THE DISEASE
3. ENCEPHALITIS – CONSIDERED AS ONE OF THE MOST
COMMON NON-EPIDEMIC FORMS OF HERPES INFECTION IN
THE U.S. AND OTHER COUNTRIES.
- MAY BE OBSERVED IN INFECTED PATIENTS
OF ANY AGE, EVEN THOSE WHO ALREADY HAVE CIRCULATING
HSV IN THE BLOOD.
COMPLICATIONS
1. BACTERIAL INFECTION WHICH MAY ACCOMPANY HERPETIC
GINGIVOSTOMATITIS, DEHYDRATION, AND ACIDOSIS.
2. IN RECURRENT INFECTION IN CHILDREN, IMPETIGO MAY INFECT
VESICULAR LESIONS
DIAGNOSIS
1. ISOLATION OF A VIRAL AGENT FROM A VESICULAR LESION OR
BLOOD
2. NEUTRALIZING ANTIBODY TITER BETWEEN EARLY &
CONVALESCENT SETUP
3. ISOLATION OF SPECIFIC TYPES OF CELLS BY A FLUORESCENT
TECHNIC
PREVENTION AND CONTROL

THERE ARE NO EFFECTIVE PREVENTIVE OR CONTROL

MEASURES FOR HERPES SIMPLEX
PREVENTIVE MEASURES
•ACTIVE IMMUNIZATION WITH LIVE, ATTENUATED VARICELLA
VACCINE IS NECESSARY
•AVOID EXPOSURE TO INFECTED PERSONS
•PATIENT MUST BE ISOLATED TO AVOID TRANSMISSION
TREATMENT AND MANAGEMENT
1. ORAL ANTI-VIRAL DRUGS SUCH AS ACYCLOVIR, FAMCICLOVIR, OR
VALACYCLOVIR
2. PERSONAL HYGIENE
3. RESTORATION OF FLUID AND ELECTROLYTE BALANCE
4. ISOLATION OF CLIENTS, ESPECIALLY THOSE WITH ECZEMA
HERPETICUM OR NEONATAL HERPES
5. PRACTICE OF UNIVERSAL PRECAUTION AND THOROUGH
HANDWASHING
NURSING DIAGNOSIS
1. ACUTE PAIN
2. RISK FOR SECONDARY INFECTION
3. RISK FOR INEFFECTIVE SEXUAL PATTERN
NURSING CARE
1. PROVIDING COMFORT
2. SPECIAL CARE SHOULD BE DIRECTED TO PREVENT INFANTS AND
YOUNG CHILDREN WITH ECZEMA FROM EXPOSURE TO HERPESVIRUS
INFECTION
3. IN ACUTE HERPETIC GINGIVOSTOMATITIS , SECRETIONS FROM THE
MOUTH SHOULD BE COLLECTED IN TISSUES AND PROPERLY
DISPOSED.
NURSING CARE

4. PATIENTS SHOULD BE CAREFULLY OBSERVED FOR EVIDENCE OF

DEHYDRATION AND I & O RECORDS (SHOULD BE MAINTAINED
DURING ACUTE STAGE)