Herpes Simplex Virus (Genital Herpes Infection)
A substantial risk to the fetus is noted in pregnant women who have a primary first-episode herpes infection. When a woman contracts the genital herpes infection, systemic involvement occurs. After which the virus then spreads to the bloodstream, termed viremia, and crosses the placenta to a fetus.
Clinical Manifestations of Herpes Simplex Virus
With herpesvirus type 2 the following clinical manifestations will be experienced by the woman:
- Genital irritation and itching
- Vaginal and urethral discharge
- Copious and foul-smelling vaginal discharges
- Enlarged tender lymph nodes
- Reddened papules at the start then becomes itchy pustular that break and form painful wet ulcers, which then dry and develop crusts.
The effect of the herpes simplex virus infection varies, depending on the time the infection occurred:
- If the infection takes place in the first trimester of pregnancy, severe congenital anomalies or spontaneous miscarriage may occur. There is a 20% to 50% rate of spontaneous abortion if the infection occurred during this time.
- If the infection occurs during the second or third trimester of pregnancy, there is a high incidence of premature birth, intrauterine growth restriction and continuing infection of the newborn at birth. Infection after the 20th week age of gestation leads to the incidence of premature birth but not to teratogenic defects. The neonate can acquire the infection. Survivors have permanent visual damage and impaired psychomotor and intellectual development.
- If the woman has genital lesions present at birth the fetus may contract the infection from direct exposure at birth.
Nursing Management for Herpes Simplex Virus
- Women who have history of genital herpes and existing genital lesions is often advised to undergo cesarean section if fetal involvement is not present to reduce the risk of direct neonate exposure to infection at birth.
- Intravenous or oral Acyclovir (zovirax) can be administered to women during pregnancy.
- Treatment is towards relieving the woman’s vulvar pain.
- Creams containing sulfonamide may be used to treat bacterial infections.
- During the peak of infection, the client may be advised to stay in bed as it may be most comfortable for him or her.
- In cases where an infection is suspected to the pregnant woman, an amniocentesis can be performed to determine fetal involvement. If fetal involvement is present, a cesarean section delivery should never be performed.