A client assigned male at birth calls their primary care physician’s office and speaks to the nurse on-call. The client tells the nurse that they have a history of herpes simplex virus 2 (HSV-2), but do not currently have any active lesions. The client asks the nurse if it is acceptable to engage in sexual activity with their monogamous partner. Which is the best response by the nurse?

“You can engage in sexual activity, but you should wear a condom.”

“You should avoid having sex if your partner is not vaccinated for HSV.”

“You should abstain from all sexual activity if you have a history of HSV.”

“You can engage in sexual activity, but you should wear a condom.”

“You are okay to engage in sexual activity as long as you don’t have a fever or flu-like symptoms.”

Herpes simplex virus (HSV): Nursing

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Content Reviewers

Lisa Miklush PhD, RN, CNS,Maria Emfietzoglou, MD

Contributors

Filip Vasiljević, MD,Katherine May, BSN, RN,Rachel Yancey,Tina Collins

Herpes simplex is a highly contagious infection caused by herpes simplex viruses. There are two types of herpes simplex virus. Herpes simplex virus 1, HSV-1, tends to cause infections above the waist, typically affects the lips, and that’s called herpes labialis; while HSV-2 tends to cause infections below the waist, involving the genitals, and that’s herpes genitalis.

During the primary infection, both types also infect nearby sensory neurons and travel up their axon to sensory ganglia where they can lay dormant for life causing recurrent infections from time to time.

Okay first, let’s quickly review the physiology of the nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system includes all the nerves that connect the central nervous system to the skin, muscles, and other organs.

Cranial nerves are peripheral nerves that originate from the brain, and they’re mostly in charge of motor and sensory innervation of the head and neck.

A specific cranial nerve, cranial nerve V, is the trigeminal nerve and it’s responsible for the sensation in the face. Its sensory neurons create a nerve cell cluster called the trigeminal ganglion, located in the bones on the side of the face between the eyes and ears.

On the flip side, the peripheral nerves that originate from the spinal cord are called the spinal nerves.

Each nerve is formed by a dorsal root that contains sensory information, like touch, temperature, pain, and pressure from the skin and other tissues, and a ventral root that contains neurons that carry motor innervation from the spinal cord to the muscles.

HERPES SIMPLEX VIRUS
	KEY POINTS	NOTES
DEFINITION	Highly contagious infection caused by the herpes simplex virus (HSV) HSV-1 HSV-2 Can be dormant for life or cause recurring infections
PHYSIOLOGY	Central nervous system Brain Spinal cord Peripheral nervous system Cranial nerves Spinal nerves Nerves Dorsal root Ventral root
CAUSES AND RISK FACTORS	Risk factors Sex with multiple partners HSV-1 Kissing Sharing drinks Playing contact sports Sharing cosmetics HSV-2 Assigned female at birth Unprotected sexual contact
PATHOPHYSIOLOGY	Highly contagious Spread through direct contact Autoinoculation Mother to baby Once virus reaches new host Primary infection Recurrent infection
SIGNS AND SYMPTOMS	Primary infection Asymptomatic Symptomatic Burning, itching Small, tender, fluid-filled blisters Can progress to ulcers and crusts Last for 2-6 weeks Flu-like symptoms Recurrent infection Asymptomatic Prodromal period Lesions Less severe than primary infection HSV-1 Lips Herpes labialis / cold sores Gingivostomatitis HSV-2 Genital herpes Spread to anal and perianal regions Other areas of the body Herpetic whitlow Herpes gladiatorum HSV keratoconjunctivitis Complications Encephalitis Viral meningitis Blindness Miscarriage Intrauterine growth restriction Preterm labor
DIAGNOSIS	History Physical assessment Viral cultures PCR Tzanck test or smear Direct fluorescent antibody tests Western blot
TREATMENT	Moist compresses, ice packs Topical anesthetics Antipyretics Oral analgesics Antiviral medications
MANAGEMENT OF CARE	Goals of care Prevent spread of infection Promote comfort Provide emotional support Contact precautions Assess pain and lesions Administer prescribed medications Moise compresses, ice packs, sitz baths Listen to concerns Provide resources
PATIENT AND FAMILY TEACHING	Explain condition, plan of care, and how to safely administer medications Medication does not prevent the spread to others Keep all follow-up appointments Transmission prevention Rest, fluids, diet Cleanse lesions How to manage pain and discomfort When virus is most likely to become active Report to HCP Symptoms do not improve New lesions Pregnancy Symptoms of viral meningitis

Herpes simplex virus (HSV): Nursing

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