herpes simplex [Gk, herpein + L, simplex, uncomplicated] , an infection caused by a herpes simplex virus (HSV), which has an affinity for the skin and nervous system and usually produces small, transient, irritating, and sometimes painful fluid-filled blisters on the skin and mucous membranes. HSV1 (oral herpes, herpes labialis, cold sore) infections tend to occur in the facial area, particularly around the mouth and nose; HSV2 (herpes genitalis) infections are usually limited to the genital region. ▪ OBSERVATIONS: The initial symptoms of an HSV1 infection usually include burning, tingling, or itching sensations about the edges of the lips or nose within 1 or 2 weeks after contact with an infected person. Several hours later, small red papules develop in the irritated area. Later, small vesicles, or fever blisters, filled with fluid erupt. Several small vesicles may merge to form a larger blister. The vesicles generally are associated with itching, pain, or similar discomfort. Other effects often include a mild fever and enlargement of the lymph nodes in the neck. Laboratory analysis of the vesicular fluid usually shows the presence of herpesvirus particles and the absence of pyogenic bacteria. Within 1 week after the onset of symptoms, thin yellow crusts form on the vesicles as healing begins. In skin areas that are moist or protected and in severe cases, healing may be delayed. HSV2 infections in adolescence are associated with an increased incidence of cervical cancer in adulthood. ▪ INTERVENTIONS: Treatment of herpes simplex is symptomatic. The lesions may be washed gently with soap and water to reduce the risk of secondary infection. Topical penciclovir cream may speed healing. When secondary infections have begun, antibiotics are prescribed. Although there is no cure, treatment includes oral acyclovir or valacyclovir. ▪ PATIENT CARE CONSIDERATIONS: Because herpesviruses are extremely contagious, the nurse follows all appropriate procedures in contacts with patients to avoid acquiring and transmitting the infection. Washing the hands and wearing disposable gloves when in contact with oral secretions or genitalia help prevent transmission of the virus. Once acquired, the virus tends to remain latent in the tissues of the nervous system and may be reactivated by a variety of stimuli, including a febrile illness, physical or emotional stress, exposure to sunlight, or ingestion of certain foods or drugs. Topical sunscreen preparations offer some protection against exposure to the sun, and patients are advised to avoid repeated exposure to stimuli to which they are sensitive. The complications of herpetic infections may include encephalitis, herpes simplex keratitis, and gingivostomatitis. In cases involving systemic complications, IV acyclovir, blood transfusions, IV solutions, and other therapy may be required. In uncomplicated cases the herpes attack is usually self-limiting and runs its course in 3 weeks or less.
