Sexually transmitted infections
Subjective data: Ms J.M. is a 23 year old African American female who came today at the clinic for a follow of the positive serology testing for herpes simplex 1 and herpes simplex 2. This infection was realized three months ago.
J.M is in the clinic after she has been denying for close to three months that she was not diagnosed with herpes. She came back to the clinic when she realized that her lingual lymph nodes were swollen and had become tender for the last one week. Dysuria was seen with 3 irritations of vesicular lesions in her vagina and they had not broken so far. She has been experiencing fever occasionally, chilly body, headache and generalized malaise.
She confirmed to me that she had sexual intercourse 2 days ago with her boyfriend with whom they have known each other for close to 6 months now. When having sex she has not been using condom and she cannot determine whether her boyfriend has been engaging sexual practices that are safe. She has been using birth control pills to limit chances of conception.All the systems emerged to be within normal limits except the palpable and tender right and lower inguinal lymph node was noticed. (Celum, Ward & Lingappa, 2010),
Initial differential diagnoses:
Gonorrhea
Syphilis
Chlamydia
Herpes zoster
Vaginitis
Lymhogranuloma venereum
A complete physicals was done on the patient right from the head to the toe, this included a pelvic examination. This was aimed to determine pap smear and for any possible sexually transmitted disease like gonorrhea, Chlamydia, syphilis, trichomoniasis, condylomata acuminate and bacteria vaginosis. The patient also signed a consent in order that HIV testing could be conducted. A tissue culture was obtained from the vagina lesions. Then a repeat for serologic tests for both herpes simplex type 1 and 2 antibodies was carried out. There was realization of cervical motions tenderness and cervical ectopy on the pelvic exam. The patient was somehow upset for the positive tests for the herpes simplex 1 and 2. Due to this she stated that she would have preferred a test for HPV. The patient had some deficit in knowledge and the patient was urged to speak out what she felt. From the tests conducted it emerged that the results of the positive tissue culture and serology for herpes simplex type 1 and 2 were all positive.
The nursing diagnosis was given to be that the risk of infections related to the failure to implement a safe sexual practices and the lack of knowledge concerning the process of the disease. There is anxiety which relates to the impact the disease has on the current relationship. (Corey, & Ward, 2009)
The medical diagnosis in herpes simplex virus type 1 and herpes simplex virus type 2
HSV- 2 infections increases the risk for human immunodeficiency Virus (HIV). It is a lifelong infection.The plan patient was based on the based on the patient’s demonstration of the understanding of the disease. He was to know that it is made of two strands, herpes simplex virus type 1 which causes infection above the waist mostly in the gingitive, the dermis, the respiratory tract and the central nervous system. Herpes simplex virus type 2 affects the area below the waist.
This includes the genital tract and the perineum. A prescription for the actual diagnosis was Acylovir 20mg which was to be administered orally. It was to be taken 5 times a day for 10 days.The patient was encouraged to undergo a diagnostic test and some education concerning the infection. The patient’s partner should consider using protection before engaging in any sexual activity.
The patients should get to know how the disease manifests itself and should know that the initial lesions are seen in a period of 21 days. The episodes of lesions outbreak are also recurrent. The patients should be let to know that there is no specific cure for genital herpes. Use of some of the pharmacological therapies are aimed at managing the palliates. The partner should know that the disease is infectious and it can be transmitted to their partners as well as the newborns. This can happen even in the absence of lesions. Due to this it is advisable to use condoms before engaging in sexual intercourse. When lesions are present the patient is advised to abstain from sexual intercourse. Recurrences of lesions and viral shedding are common in the course of the disease. Patients should be alerted that annual pelvic screen would be essential to them. In case there is a recurrence in the genital lesions or symptoms such as purulent discharge and Dysuria patients are advised to report to the clinics in order that a follow-up evaluation is conducted. (Wasserheit & Golden, 2009)
Evaluation and revisions
The patients spelt out what she felt and the understanding and the doubts about who could possibly have infected her. Finally she however admitted the reality that she was already infected and vowed to comply with the treatment plan.On following up the patient indicated that she was still coping with the new illness. She also stated that she is still taking the current pharmacological therapy and that are lesions are crusting out.I think it will be good to ask the patient about her prior sexual partner. This will determine any unsafe sexual practices in the past and tell her that incubation period is 2 to 21 days. (Graham, Kaul & Janssen, 2009)
Reference:
Celum C., Ward, A. & Lingappa (2010), Acyclovir and Transmission of HIV-1 from persons infected with HIV-1 and HSV-2 The New England journal of medicine. Vol 362: pp 427-439
Corey, L & Ward, A. (2009) Maternal and neonatal herpes simplex virus infections. The New England journal of medicine. Vol. 361, 1376-1385
Graham, B.B., Kaul D.R. & Janssen, W.J. (2009). Kiss of death. The New England journal of medicine. Vol 360. pp2564-2568
Wasserheit, J.N. & Golden, M.R. (2009) Prevention of viral sexually transmitted infections: The New England journal of medicine, Vol 360: pp 1349-1
