There are few diagnoses that carry as much stigma with as few long-term health consequences as herpes simplex virus.  Considered an 'incurable' STD and characterized by painful genital lesions, most people experience shame and distress following a herpes diagnosis.  Nurses who are well informed about the prevalence of herpes, or HSV, the risks of transmission, and current testing recommendations can significantly reduce patient concern and promote best practice in herpes management.

There are two strains of the HSV virus.  HSV-1, historically considered oral herpes, is the virus responsible for 'cold sores'.  It affects about 60 percent of Americans.  HSV-2 is less prevalent; roughly 17 percent of Americans have it.  'Geographic' distinctions between the two strains have blurred as a result of oral sex.  It is possible to have genital outbreaks of HSV-1 and oral outbreaks of HSV-2.

Condom use, while universally recommended to prevent against the transmission of multiple infections, does not ensure complete protection against HSV.  Usually HSV is transmitted by direct contact with the virus via mucosal membranes or broken skin.  Rarely, however, it can also be transmitted in the absence of genital lesions (by a process known as asymptomatic viral shedding).  Initial, primary outbreaks are the most severe.  Subsequent outbreaks are almost always milder and less painful.  Some people infected by HSV never experience an outbreak. 

Available laboratory testing for HSV includes viral culture, DNA, and blood testing.  Culture testing must be done at the time of an active outbreak.  DNA-PCR testing is more sensitive that culture testing and can detect viral shedding alone.  DNA testing is therefore preferable, although it has not yet been approved by the FDA for testing genital specimens.  Blood testing for HSV-1 and HSV-2 antibodies is both sensitive and specific, but it cannot determine the timing of initial infection, nor can it pinpoint the exact location of viral shedding. 

For individuals who suffer from six or more herpes outbreaks per year, the CDC recommends long-term suppressive therapy with daily doses of Acyclovir or Valacyclovir.  People with prodromal symptoms can initiate therapy to prevent or reduce the severity of recurrent outbreaks.  Treatment regimens do not differ by HSV type. 

The only real 'danger' of HSV is the possibility of vertical transmission of the virus from mother to child during delivery.  Neonatal HSV can be life-threatening for newborns, incurring a mortality rate of 30 to 50 percent.  For this reason, women who are known to be HSV-positive are given suppressive therapy starting at 36 week gestation.  If lesions are present on the vulva, vaginal walls, or cervix at the start of labor, Cesarean section is recommended.  When couples are given anticipatory education and guidance prior to pregnancy, HSV diagnoses need not cause extreme psychological stress.

In serodiscordant couples, the knowledge that one partner is HSV positive while the other is negative can be another source of considerable emotional upset.  While the likelihood of contracting herpes during a single sexual encounter is minute, the longer the couple remains together the greater the chance that the HSV-negative partner will also become infected.  Suppressive antiviral therapy and condom use are encouraged in such cases, as is ongoing education.

Reference:

Kriebs, J. (2011, May/June). Understanding Herpes Simplex Virus: Transmision,

Diagnosis, and Considerations in Pregnancy Magangement. Journal of Midwifery; Women's Health, 53(3), 202-208.