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Genital Herpes Nursing Guide

The content for this course was created by Tameka N. Warren, MSN, RN, CLC.

Genital Herpes Overview

This course is intended as a Quick Reference for genital herpes and will cover an overview as well as nursing considerations utilizing the nursing process. 

Genital Herpes Etiology and Epidemiology 

Genital herpes is a common and chronic sexually transmitted disease (STD). Genital herpes is caused by the herpes simplex virus type 1 (HSV-1) or the herpes simplex virus type 2 (HSV-2) (Centers for Disease Control and Prevention [CDC], 2021a). Genital herpes episodes/outbreaks occur at a primary point and then subsequently re-occur. The primary infection of HSV is often transmitted through mucosal membranes orally, vaginally, and anally. Small cracks in the skin or in the conjunctiva of the eyes are susceptible as well (Ayoade, 2021b). 

 After the primary outbreak, HSV becomes dormant/latent in the nerve cell ganglia. HSV remains dormant until it is reactivated by various stimuli, which causes new episodes/outbreaks and shedding of HSV. 

To understand the incidence of genital herpes infections, we must first designate the incidence in each type. HSV-2 is generally referred to as genital herpes and HSV-1 is generally referred to as oral herpes. 

 Genital herpes affects 11.9% of individuals aged 14 to 49 years of age in the U.S. (CDC, 2021a). Worldwide, genital herpes (or HSV-2) affects 13.2% of the world’s population aged 15 to 49 years of age (World Health organization [WHO], 2020). 

 These percentages increase significantly when considering that HSV-1 can be attributed to an increasing amount of genital herpes infections as well as HSV-2, thus increasing the incidence of genital herpes disease being reported (WHO, 2020). Due to this, we will refer to genital herpes as HSV throughout the remainder of this course with no designation between type 1 or 2. 

These staggering numbers can be due to fact that more than 80% of those infected are asymptomatic (Ayoade, 2020a). Meaning, they can be unaware of a recurrent episode/outbreak and completely unaware of being infected at all. Regardless of symptoms, the infected individual can shed HSV and, thus, transmit it to a partner(s). 

 Women are more likely to contract HSV than men. Age is also a factor; as age increases, HSV antibodies are more likely to be detected. Factors that increase the risk of HSV infection also include (CDC, 2021a): 

  • Low socioeconomic status 
  • Racial and cultural minorities 

Genital Herpes Diagnosis

  • Active infection diagnosis methods include (American Academy of Dermatology Association, 2021): 
    • Physical Exam: Visually inspect to see if lesions such as blisters, ulcers, or sores are present. 
    • Viral Culture: Swab an open lesion or deface a healing lesion and swab a sample (tissue or scraping) to send to the laboratory for confirmation. 
  • Asymptomatic/latent infection diagnosis methods include (CDC, 2021a): 
    • HSV type-specific antibody blood test: Detects HSV antibodies 
    • HSV nucleic acid amplification tests (NAAT): Most sensitive and specific that identifies presence of HSV-1 or HSV-2; polymerase chain reaction (PCR) tests are the most common NAAT for HSV. 

Genital Herpes Management 

HSV can be managed with antiviral medications, suppressive therapy, pain management, and preventive measures. The method of management can be determined by the state of the infection. 

Primary symptomatic infections are considered to be the first episode/outbreak of genital lesions after initial infection occurs. The primary infection may also be severe; therefore, a longer duration of one of three antivirals is recommended (CDC, 2021b): 

  • Acyclovir 400 milligrams (mg) orally 3 times a day for 7–10 days 
  • Famciclovir 250 mg orally 3 times a day for 7–10 days 
  • Valacyclovir 1 g orally 2 times a day for 7–10 days 

Recurrent symptomatic occurrences include all subsequent episodes/outbreaks of genital lesions that are related to the primary infection. Recommended antiviral therapy for a recurrent episodic treatment may include one of the following therapies (CDC, 2021b): 

  • Acyclovir 800 mg orally 2 times a day for 5 days 
  • Acyclovir 800 mg orally 3 times a day for 2 days 
  • Famciclovir 1 g orally 2 times a day for 1 day 
  • Famciclovir 500 mg orally once, followed by 250 mg 2 times a day for 2 days 
  • Famciclovir 125 mg orally 2 times a day for 5 days 
  • Valacyclovir 500 mg orally 2 times a day for 3 days 
  • Valacyclovir 1 g orally once daily for 5 days 

Management of recurrent episodes/outbreaks of HSV may also include suppressive therapy. Suppressive therapy involves the use of an antiviral daily for extended periods to help reduce and/or prevent recurrent symptomatic episodes. Suppressive therapy also helps to decrease the rate of transmission by reducing episodes of HSV-shedding during asymptomatic episodes. 

Recommended suppression therapies include (CDC, 2021b): 

  • Acyclovir 400 mg orally 2 times a day 
  • Valacyclovir 500 mg orally once a day 
  • Valacyclovir 1 g orally once a day 
  • Famciclovir 250 mg orally 2 times a day 

  For severe HSV infections with complications leading to a hospitalization, intravenous acyclovir therapy of 5–10 mg/kg body weight IV every 8 hours is recommended (CDC, 2021b). 

Complications can vary and may include (Ayoade, 2021b): 

  • Aseptic meningitis 
  • HSV encephalitis 
  • Extragenital lesions (e.g., buttocks, groin, or thigh) 
  • Ocular HSV infection 
  • Dermatologic infections 
    • Eczema herpeticum 
    • Herpes gladiatorum (observed in wrestlers) 
    • Herpetic whitlow (affects cuticles of the fingers) 
  • Bacterial and fungal superinfections 
    • Candidal vaginitis in women 
    • Balanitis in uncircumcised men 
  • Urinary retention due to: 
    • Ganglionitis 
    • Radiculitis 
    • Myelitis 
  • Disseminated infection, which most often affects the skin, but may include: 
    • Visceral organ infections 
    • Esophageal infections 
    • Adrenal necrosis 
    • HSV cystitis 
    • HSV arthritis 
    • Interstitial HSV pneumonitis 
  • Increased risk of HIV transmission 
  • Pregnancy and neonatal complications 
    • Dermatologic 
      • Lesions 
      • Hypopigmentation 
      • Hyperpigmentation 
      • Aplastic cutis (absence of skin, usually on the scalp) 
    • Neurologic 
      • Microcephaly 
      • Hydranencephaly 
      • Calcifications 
    • Ocular-each can lead to visual disturbances or blindness 
      • Microphthalmia 
      • Optic atrophy 
      • Chorioretinitis

Genital Herpes Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for genital herpes are listed below. 

Genital Herpes Assessment

 A thorough history should be taken that includes: 

  • Past and present health condition 
  • Current symptomology 
  • Sexual history and practices 

Upon physical assessment for genital herpes, the individual may present with lesions on the labia, vagina, cervix, penis, scrotum, thighs, buttocks, and anus. These lesions can present as fluid filled blisters, open sores, and/or scabs. The individual can report the lesions are itchy, painful, and may have been having symptoms for up 2 to 4 weeks. 

Some common viral response symptoms may be present including: 

  • Fever 
  • Swollen lymph nodes 
  • Headache 
  • Myalgia 
  • Malaise 

During assessment, it is also important to assess the individual’s emotional and mental state. Depression, anxiety, and even self-harm behaviors may occur due to HSV infection. 

Nursing Diagnosis/Risk For 

During the primary and recurrent episodes/outbreaks, the individual is at risk of the following nursing diagnoses related to genital herpes: 

  • Risk for acute pain 
  • Risk for impaired skin 
  • Risk of infection and spread of infection 
  • Risk of deficient knowledge of disease and disease processes 
  • Risk for infection transmission 
  • Risk for disruption of the symbiotic maternal-fetal dyad as a result of possible pregnancy-birth-related conditions 

There is a societal stigma surrounding genital herpes, which can lead to psychological distress and can have a negative impact on quality of life, interpersonal, and sexual relationships (WHO, 2021). Nursing diagnoses related to these factors must also be explored: 

  • Risk for ineffective coping 
  • Risk for anxiety 
  • Risk for depression 
  • Risk for low self-esteem 

Interventions 

Interventions should include measures to increase comfort during active infections including: 

  • Following prescribed antiviral treatment 
  • Pain control through over-the-counter analgesics 
  • Sitz baths to ease pain and itching 
  • Keeping lesions clean and dry 
  • Rest to combat malaise and myalgia
  • Increasing fluid intake 
  • Stress reduction methods 

Expected Outcomes 

  • The individual will report: 
  • Decrease in symptoms 
  • Decrease in recurrent episodes/breakouts 
  • Use of safe sex practices 
  • Open communication about diagnosis with sexual partners 
  • Effective coping and management of psychosocial effects 

Individual/Caregiver Education 

  • Disease process: Educate on various disease topics needed for adequate management 
    • Ensure the individual is aware of and can identify symptoms of outbreaks. 
    • Stress that there is not a cure, but the disease can be managed. 
    • Promote awareness of increased risk of HIV infection and other sexually transmitted infections due to the presence of lesions. 
  • Recurrent episodes/outbreak reduction: Ensure the individual is aware of methods to help reduce recurrent episodes such as suppressive therapies. 
  • Transmission prevention: Ensure the individual understands that condom use is important and that HSV can be spread with the use of a condom, as HSV can shed from areas outside the condom (CDC, 2021a). 
  • Communication: The individual must communicate their HSV status to their partners and methods for them all to stay protected. 
  • Self-care measures and support groups 

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Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2025

Course Contributor 

The content for this course was created by Tameka N. Warren, MSN, RN, CLC. 

Tameka N. Warren, MSN, RN, CLC, earned her Bachelor and Master of Science in Nursing degrees from Indiana University School of Nursing at IUPUI, and her Associate of Science in Nursing from Ivy Tech College. She has over 16 years of nursing experience in public health, regulation, home health, education, maternal child community health, and long-term care environments. Tameka served as a Public Health Nurse Surveyor (Home Health & Hospice) certified by the Centers for Medicare & Medicaid Services, or CMS, a maternal and infant mortality advocate, an ALPP Certified Lactation Counselor, and an Adjunct Clinical Professor. Tameka’s passion is to serve the most vulnerable populations affected by health disparities and to inspire a new generation of nurses to do the same successfully. 

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