Herpes simplex virus (HSV) is one of the most common sexually transmitted infections (STIs) encountered in clinical practice and on nursing exams. It is a lifelong viral infection that can remain dormant in the body and reactivate periodically, causing recurrent outbreaks of painful lesions.
You will learn the following in this review:
- The difference between HSV-1 and HSV-2
- How the virus is transmitted (including asymptomatic shedding)
- Classic signs and symptoms and prodromal indicators
- CDC screening guidelines and who is considered high risk
- Antiviral treatment and key medication teaching points
- Priority nursing education for preventing transmission in sexual partners and newborns
What is Herpes Simplex Virus (HSV)?
Herpes Simplex Virus Infection is caused by two main virus types:
HSV Type 1 (HSV-1)
- Typically causes oral herpes
- Found around the mouth and lips (cold sores)
- Can spread to the genitals through oral sex
HSV Type 2 (HSV-2)
- Sexual contact (vaginal, anal, oral)
- Can spread even when no visible lesions are present
Remember: Both HSV-1 and HSV-2 can infect oral and genital areas
How HSV is Transmitted
HSV-1 Transmission
- Saliva (kissing)
- Shared contaminated objects (cups, utensils)
- Direct contact with oral lesions
- Oral sex → can spread to genitals
HSV-2 Transmission
- Sexual contact (vaginal, anal, oral)
- Can spread even when no visible lesions are present
- Typically causes genital herpes
Important Concept: Asymptomatic Viral Shedding
- Virus can be spread without symptoms or visible sores
- This is a major reason HSV spreads easily
HSV and Pregnancy Risks
HSV can affect pregnancy and newborns:
- Rarely crosses placenta (in utero transmission is uncommon)
- Most risk occurs:
- During vaginal delivery
- Postpartum close contact
Neonatal Herpes
- Can be transmitted from mother or caregiver
- Affects:
- Nervous system
- Organs
- Can cause severe infection or complications in newborns
Signs and Symptoms of Herpes: “HSV” Mnemonic
H – Herpetic Lesions
- Painful, red, fluid-filled sores
- Clustered blisters (mouth or genitals)
- Lesions eventually crust over and heal
S – Sensation
- Tingling, burning, or itching before outbreak
- Early warning sign of recurrence
V – Viral Symptoms
- Fever
- Fatigue
- Headache
- Swollen lymph nodes
- Body aches
Remember: Some patients may be asymptomatic.
Screening and Diagnosis (CDC Guidelines)
HSV is not routinely screened unless:
- Patient has symptoms
- High-risk patients:
- Other STIs
- Multiple sexual partners
- Incarceration history
Pregnancy Screening:
- Not routinely screened unless:
- Symptoms present
- High-risk status
Treatment for HSV
No Cure Available
HSV is lifelong, but manageable.
Antiviral Medications
- Example: Acyclovir
- Ends in “-vir” → antiviral clue
How Antivirals Work
- Reduce severity and duration of outbreaks
- Decrease viral shedding
- Lower transmission risk
Timing Matters
- Most effective if taken within 1–2 days of symptom onset
- Especially when tingling/burning begins
Pregnancy Use
- Helps reduce risk of neonatal transmission
- Often given in late pregnancy (~36 weeks)
Patient Education
For Oral Herpes and Newborns
- Avoid kissing baby (especially face)
- Wash hands before/after touching baby
- Do not share items (cups, utensils, towels)
- Cover active lesions
- Avoid touching/picking lesions
For Genital Herpes
- Avoid sexual contact during outbreaks
- Use condoms consistently (reduces but does NOT eliminate risk)
- Inform sexual partners
- Avoid sharing items like razors or towels
General Prevention Tips
- Keep lesions clean and dry
- Do not pick or scratch lesions
- Practice frequent hand hygiene
- Notify partners for testing and treatment
Key Concepts
- HSV-1 = oral herpes, HSV-2 = genital herpes (but both can overlap)
- Transmission can occur even without symptoms
- No cure: only symptom control with antivirals
- Highest transmission risk occurs during active outbreaks
- Neonatal herpes is a serious complication
- Patient education is critical for prevention
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You may be interested in: Herpes NCLEX Questions
References:
American College of Obstetricians and Gynecologists. (2023). How to prevent STIs. https://www.acog.org/womens-health/faqs/how-to-prevent-stis
Centers for Disease Control and Prevention. (2021). Sexually transmitted infections treatment guidelines, 2021. U.S. Department of Health and Human Services. https://www.cdc.gov/std/treatment-guidelines/default.htm
World Health Organization. (n.d.). Sexually transmitted infections (STIs). Retrieved November 22, 2024, from https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)