University Health Clinic Case Study: Genital Herpes and Patient Care

This case study presents a 24-year-old male student, Justin, who presents with symptoms of genital herpes after engaging in unprotected sex. The assignment delves into the pathophysiology of genital herpes, caused by the Herpes simplex virus (HSV), and its transmission through sexual contact. It explores diagnostic methods like PCR blood tests and cell cultures, along with nursing assessments for impaired skin integrity and pain. Management strategies, including antiviral treatments like valaciclovir and aciclovir, are discussed, along with the ethical and legal issues that arise, such as informed consent and confidentiality. The role of the sexual health team, including counseling and patient education on safe sex practices and STI prevention, is also examined. The assignment emphasizes the importance of educating Justin about safe sex, limiting partners, and communicating about sexual health to prevent further STIs, highlighting the public health significance of addressing and managing this common STI.

Running Head: STI
STI
Name of the Student
Name of the University
Author Note

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Introduction
The paper deals with the case study of Justin. On placement in a student’s health clinic at
a local university, a 24 year old male student, named Justin is presented. He notices some
worrying symptoms including blisters on his penis. The patient has not experienced these
symptoms in the past. Upon investigation, the client revealed that the he had sex – including oral
sex three times in last 24 hours. The patient reported that he had not used condoms as his partner
informed him that the STD screen was clean for everything. In response to the case study, the
assignment discusses the sexually transmitted infection (STI) that Justin is highly likely to suffer.
In the context of the STI chosen the assignment will address the pathophysiology of this STI, the
assessment and management of this STI, ethico-legal issues that may arise with the diagnosis of
an STI. Further, the assignment will discuss the role of the sexual health team members involved
in the management of Justin. Lastly, the education needs for Justin to prevent further STIs are
outlined.
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Justin has been practicing unsafe sex and is experimenting with his sexuality. Because of
his unsafe sex practices, he is at risk of developing Genital herpes. It is one of the most common
STIs.
Pathophysiology of this STI
Genital herpes is caused by the Herpes simplex virus (HSV) and in most cases HSV type
2 is responsible for the disease. HSV-1 is often the cause of fever blisters or cold sores (Garland
& Steben, 2014). However, the patient denies the history of cold sores on his mouth or sore

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around his genitals before. His case history highlights that he rarely practices the safe sex, thus
the blisters on penis in such situations is mainly caused by the genital herpes. Genital herpes is
easily transmitted through sexual contact and may happen even if the concerned person is
containing virus without exhibiting the related signs or symptoms (Schiffer & Corey,2014). As
the virus enters the skin it travels along the nerve path, where it can become dormant and persist
there indefinitely. Both HSV 1 and HSV 2 infections occur by contacting the infectitious
secretions on oral, anal and genital mucosal surfaces. Contacting other anatomical site such as
eyes, non-mucosal surfaces, such as lesions on the buttocks and trunk can also cause genital
herpes. In this type of viral infection, the symptoms may appear months after the initial exposure.
The mucous membrane lines the opening of the body, which is the door to the viruses. The
primary infection is characterised with the small blisters on genital areas that may burst to leave
open sores. Genital herpes mainly affect genitals, mouth, and anal region (Johnston & Corey,
2016).
Assessment and management of this STI
Diagnosis of genital herpes includes several tests. PCR blood tests are used to look for
pieces of viral DNA. This is most common test and is accurate. The health care providers may
collect sample from sores for cell culture and can be observed under microscope for HSV (Liu et
al., 2015). Both the tests have a chance of giving false results, if the patient has started to recover
recently. Antibodies against HSV do not show up until several weeks and it is difficult to
identify the time of exposure or noticeable exposure. With the help of the direct fluorescent
antibody testing, it is easy to detect the glowing antibodies that stick to the viral antigens in the
sample. This testing is useful to differentiate between the HSV 1 and HSV 2. Overall, the clinical
diagnosis has low sensitivity and specificity (LeGoff et al. 2014).

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Nurses can asses for impaired skin integrity that is related to skin inflammation, vesicles
and crusting. Further assessments include hyperthermia indicating increased hypothalamic set
point, fatigue due to decrease in energy source and risk of imbalanced nutrition pertaining to
appetite down and lastly acute pain that may be caused by the infection in pain neurons. Based
on the assessment HSV is diagnosed (Posavad e al., 2017).
According to Fife et al. (2015), daily suppressive treatment with valaciclovir can reduce
HSV-2 transmission. This drug was investigated among HSV-2 discordant heterosexual couples.
The infection was reduced by 75%, for clinical disease and reduces the acquisition (measured by
serology) by 48%. Development of vaccine effective against this disease is not been found.
Antiviral treatment is helpful and commonly prescribed medication include- Zovirax, Famvir,
Valtrex, which are known to prevent outbreak. Antiviral medicine should be taken daily and it
makes the living easier. These medicines can be taken as pill. According to the guidelines of
WHO for adolescents with a first clinical episode of genital HSV infection, a standard dose of
aciclovir over valaciclovir or famciclovir is recommended (Sands-Lincoln & Goldmann, 2016).
The dosages are as follows-
 aciclovir 400 mg orally thrice daily for 10 days
 aciclovir 200 mg orally five times daily for 10 days
 valaciclovir 500 mg orally twice daily for 10 days
 famciclovir 250 mg orally thrice daily for 10 days
Intermittent therapy can consist of antiviral therapy for five or ten days. Suppressive
treatment for recurrent infections includes taking the antiviral drugs everyday and is given for six
outbreaks a year (Bibbins-Domingo et al., 2016). Therefore, the dosage may be like-

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 aciclovir 400 mg orally thrice daily for 5 days
 800 mg twice daily for 5 days,
 800 mg thrice daily for 2 days
Legal and/or ethical issues that may arise with a diagnosis of an STI
Diagnosing and management of HSV involves use of several medical equipments and
processes. The circumstances under which it is conducted may raise ethical or legal concerns.
The ethical issues that may arise in this case are the patient safety, informed consent, and
confidentiality. The care providers must strictly follow the four principles of ethics such as
beneficence, maleficence, social justice and respect for autonomy (Scott, 2014).
Administering the patients with medicines that are not examined may lead to adverse
outcomes and may be as fatal as death. Breaking the protocol of patient safety may cause ethical
issues particularly in Expedited Partner Therapy. This act may cause legal consequences on the
ground of professional negligence. It may lead to legal lawsuit against the hospital, claiming for
compensation for heath loss. If the patient fails to provide informed consent regarding the choice
of the treatment then the care provider fails to make clinical decision. Initiating treatment
without taking informed consent may have adverse complications. It is considered the breach of
patent’s autonomy, respect and dignity. Patients should be informed about availability of testing
of HSV, treatment and lack of sensitivity and specificity of antiviral drugs. In Australia, federal
government sets regulations on use of blood tests and genetic tests using human subjects
(Todres, 2017).
In case one the partners visits the clinic together and the infection of one of them is
revealed, the relationship may be compromised. If the partner hides the information, it may lead

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to ethical and legal issues. Lawsuits are obvious when the potential partner allegedly gives them
the herpes. Leaking the patient’s health information to third party may involve legal
consequences as it may involve defamation and social stigmatisation. In case one partner does
not want the information to be shared by the other partner, and if the request is denied it may
lead to compromising of confidentiality and the patient may resort to legal help. Partners can also
file lawsuits that their opposite consorts have given them herpes (Caulfield & Willis, 2016)).
Role of the sexual health team members involved in the management of Justin
Nursing management include keeping the affected area clean and dry to keep away other
infections. Sexual contact must be avoided until the sores are gone. Home care for management
for Justin includes bathing in warm water, keep the area clean and wear comfortable clothing
(Whitehead, 2017).
Counselling the infected patients is best way to manage the disease. Justin must be
counselled along with his potential partner to cope up with the infection. It will help prevent the
sexual and perinatal transmission. Counselling is based on the natural sources of disease and
asymptomatic shedding, first episode and recent infection, information pertaining to
antiretroviral therapy and its impacts, successive therapy with recurrent infections. The patient
should be educated about the side effects of the medicines. The rationale for counselling is to
break the cycle of recurrent infections. It can be possible only if the patient has knowledge of the
infection, and daily antiviral therapy (Davis et al., 2016).
Management of the genital herpes not only involves dealing with the physical symptoms
but also the psychological concerns. Patients often feel anxiety due to uncertainty related to
disease and its curability. Anxiety related to denial and refusal from potential partners is the main

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cause of concern. Therefore, the sexual health team members should address the psychological
concerns in this manner. Intervention for mental distress, anxiety and depression due to STI may
include patient centered care and therapies such as “Acceptance and commitment therapy” or
psychodynamic therapy. Justin can be engaged in relaxing or recreational activities such as
exercise, sports or anything that can calm his mind (Jayasuriya et al., 2015).
Education needs for Justin to prevent further STI's
The patient must be educated about safe sex and severe disorders associated with the
genital herpes. The rationale for the education is to prevent the recurrent infections. The
consequences are worst when the infection is spread to mouth, eye and central nervous system.
Justin must be aware of the fact that the risk of HIV infection is doubled in the people diagnosed
with genital herpes (HSV 2). The use of condoms can prevent the herpes virus infection. Justin
must be informed to use condoms when meeting new partners. The patient should be instructed
to avoid sex during the lesions or prodromal symptoms. Most people are unaware of the HSV
infection and those with history of STDs are highly likely to have genital herpes. It is because
genital herpes are hard to spot. Therefore, Justin must learn to communicate with his partner
about history of STDs and sexual history. Limiting the sexual partners is advisable for Justin, as
it will reduce the risk of exposure to HSV and other STIs. As the patient has multiple sex
partners, he should ensure that she is tested for genital herpes (Davis et al., 2016).
Justin should be aware of consequences of sexual contact with partner who has genital
sores. Oral sex is risky as the oral herpes may pass to the genitals through the process. Oral
herpes causes sores are known to cause cold sores of fever blisters. Since, Justin frequently
engages in orals sex he may be at high risk of future infection and he should be advised to

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receive oral sex from partners with cold sores. The patient may never have an outbreak but may
be highly contagious to the sexual partner. Therefore, Justin should be advised to educate the
same to his partners (Davis et al., 2016). According to McGregor et al. (2014) illicit drugs
impairs judgment and lower inhibitions. During intoxication, people are less careful to practice
safe sex, which may lead to adverse outcomes. Since, Justin is the regular, binge drinker he must
be educated about adverse consequences of sex while intoxication.
Conclusion
Genital herpes is the significant public health issue as it can cause substantial morbidity if
it is left untreated and undiagnosed. It is one of the most common STIs and is highly likely to
occur in the people with unsafe sex practices. All the patients with ulcers in the genital area are
suspected to have HSV. Overall, the clinical diagnosis has low sensitivity and specificity.
Nursing assessment includes physical examination for the related symptoms. Although there is
no exact cure for the illness, it can be effectively managed. The health care team must help the
patient to cope up with the illness by education, counselling, medication and home care. In
addition to the physical problems, the health care team must also deal with the psychological
issues of the patient. Education and counselling will prevent of recurrent infections as well as
risk of HIV.

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