Herpes: The update you really need for better practice

Herpes: The update you really need for better practice

Nurse Practitioners of Oregon Salishan

October 5th,2017

Terri Warren, BA, BSN, MEd, MSN 503-701-2798

twestover@

The Herpesvirus family

? HSV 1 and 2 ? Varicella zoster

? chicken pox and shingles ? Epstein Barr

? Mono ? Human Herpes Virus 6 and 7

? rashes in children like roseola and sixth disease, maybe MS ? Cytomegalovirus

? common infection, trouble in immunosuppressed people ? HHV 8

? found mostly in AIDS patients, Kaposi sarcoma

Who has herpes simplex virus?

? 56% of the US population between 14-49 has HSV 1

? 16% of the same population has HSV 2

? Women are more likely to be infected than men due to the receptive nature of intercourse

? About 50% of African Americans in this age group have HSV 2, far more than Caucasians with the same number of sex partners

HSV 2 compared to other STIs

Symptoms of HSV

? Sores in the genital area that may start out as blisters, then break, form an ulcer, then a crust

? May be atypical, like cracks, fissures, red irritated areas, abrasions, "friction burns"

? If internal, may cause discharge - watery ? May occur anywhere in the boxer shorts area ? Most infections unrecognized, ~80% don't know,

don't have symptoms or don't recognize symptoms

Why do 80% of those infected with HSV 2 not know it?

? Most HSV infections are subtle, not dramatic ? Outbreaks occur in entire "boxer shorts" area ? People attribute symptoms to other things ? Providers are misdiagnosing HSV as shingles ? Existing HSV 1 infection ameliorates HSV 2 ? People aren't being tested

Why look for herpes by lab test?

? Patients expect it is included in STI screen ? HSV is most prevalent STI in the US ? Identification can reduce transmission ? Clear up misdiagnosis of other things ? May reduce neonatal risk

What does the CDC say?

"The clinical diagnosis of genital herpes can be difficult, because the painful multiple vesicular or ulcerative lesions typically associated with HSV are absent in many infected persons. .........Therefore, the clinical diagnosis of genital herpes should confirmed by laboratory testing. Both virologic and type-specific serologic tests for HSV should be available inclinical settings that provide care for patients with STDs or those at risk for STDs."

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