Discussion 1 Everton
STIs Therapy & Education
What drug therapy would you prescribe? Why?
With J.R.’s partner having a history of fever blisters and now her reporting that she has genital pain, genital vesicles and ulcers, fevers, malaise, adenopathy, vaginal lesions, and cervical lesions, J.R. has been exposed to herpes simplex virus 2. Herpes Simplex Virus 2 is a virus that is spread through sexual contact or bodily fluids causing genital herpes to come about (World Health Organization, 2022). Being that J.R. has been diagnosed with herpes simplex virus, the first- line drug therapy that would be prescribed is oral acyclovir 400 mg three times a day for seven to ten days (Arcangelo & Peterson, 2006). According to Arcangelo and Peterson (2006), antiviral medications should be used at the onset of a breakout in order for it to be effective. The purpose of prescribing an antiviral medication, such as acyclovir, valcyclovir, or famciclovir, is to reduce the severity of the symptoms and the amount of time the patient would have symptoms for. This also goes for the onset of recurrent episodes. According to the World Health Organization (2022), antiviral medications cannot cure the herpes simplex virus.
What are the parameters for monitoring the success of the therapy?
According to Arcangelo and Peterson (2006), if symptoms resolve, there is no need for follow- up evaluations of the herpes simplex virus infection. The use of antiviral medications are intended to assist with reducing symptoms rather than curing the virus; therefore, monitoring for symptoms to know when to begin the therapy would assist in reducing the length of symptoms. However, treatment with antivirals, such as acyclovir 400 mg twice a day, famciclovir 250 mg twice a day, or valacyclovir 1 g once a day, is warranted for patients who have six or more recurrences of genital herpes per year (Emmert, 2000).
Discuss specific education for J.R. based on the diagnosis and prescribed therapy.
Educating J.R. on the importance of informing sexual partners of exposure is the first thing she needs to do. Anyone she has become sexually active with after the exposure or future partners must know of her diagnosis of herpes simplex virus. It is also important to educate her on refraining from any sexual activity with any open or active lesions as this could be an increased risk of further exposure to others (Arcangelo & Peterson, 2006). According to Arcangelo and Peterson (2006), protection could be used and would be encourage should she feel the need to have sexual contact with anyone, but it is best to emphasize not having any sexual activity. However, the spread could still occur even without the onset of active lesions or symptoms. In addition, it is important to explain to J.R. that taking the antiviral medications are important for treating the symptoms and controlling the frequency of the virus but is not intended to cure the infection as it is not curable once exposed. According to Emmert (2000), emotional stress can trigger a recurrence of herpes simplex virus; therefore, it is imperative to teach J.R. to reduce stress as much as possible, as well as ensuring management of systemic symptoms to prevent further recurrence of the herpes simplex virus.
Arcangelo, V. P., & Peterson, A. M. (2006). Pharmacotherapeutics for advanced practice: A practical approach. Lippincott Williams & Wilkins.
Discussion 2 (Mylika)
1. What drug therapy would you prescribe? Why?
In general, it seems the patient can have both types of herpes, HSV-1, and HSC-2, because both are asymptomatic and can go undiagnosed for many years. If it becomes symptomatic, the blisters at the point of infection and ulcers can be painful in severe cases. The treatment for genital herpes is antiviral drugs such as valacyclovir (Valtrex), acyclovir (Zovirax), and famciclovir (Famvir), all administered orally (CDC, 2022). The patient’s severe symptoms point to infection, which makes acyclovir a suitable drug for her illness because of its oral bioavailability. The recommended dose of acyclovir therapy until the patient shows improvement is 5 to 10mg per kilogram every 8 hours for less than seven days. Antiviral treatment should be completed in its entirety.
Genital herpes has no cure, and the treatment suppresses the illness. The recommended oral regimen of acyclovir is 400 mg, to be taken three times a day for a week (CDC, 2022). The primary treatments for genital herpes treatment are suppressive and intermittent. In this case, the patient, J.R., intermittent option is the most appropriate as the physician can manage the patient’s situation by prescribing antiviral drugs when there is a flare-up. The patient can take pills for two to five days, taking the symptoms away and making the sores disappear.
2. What are the parameters for monitoring the success of the therapy?
Intermittent episodic therapy is the treatment strategy here that allows better monitoring. The doctors can always prescribe an antiviral drug if J.R. has another flare-up. Further, the patient can take the pills as soon as they notice sores or expect an outbreak. In most cases, the sores heal on their own and disappear. However, it is recommended to take drugs because it makes the symptoms less severe. Managing recurrent oral infections requires employing various strategies for immunocompetent patients with recurrent oral infections (CDC, 2022). The treatment choice depends on the severity of the symptoms and the patient’s preference. Many patients experience occasional clinical recurrences with minimal signs; treatment might be necessary in such cases. According to CDC (2022) guidelines, treatment options include relief with local antiseptics and anesthetics in case of minor discomfort. The management of non-oral infections in the skin, eye, or genital tract will depend on how specific manifestation occurs. Intravenous therapy will be employed for more severe diseases.
3. Discuss specific education for J.R. based on the diagnosis and prescribed therapy.
Adenopathy can be treated with acetaminophen or ibuprofen to relieve pain and discomfort. J.R. should also be educated on adenopathy causes and its compromise on the immune system (Freeman et.al., 2018). J.R should learn to manage her infection with medication and self-care measures. As an individual with genital herpes, she should talk to her sexual partner and use condoms. Genital herpes can be spread without blisters, which makes it necessary for the patient to take preventive measures to protect others and her from transmitting the illness (Klatte, 2020). Since herpes is not curable, the diagnosis is a distressing and an emotional experience. Thus, J.R should consult her health care provider on how to properly manage the symptoms. Counseling and support groups are beneficial for a person living with genital herpes. J.R should learn about her triggers for recurrence. Stress, fatigue, and sunlight or menstrual periods can trigger recurrent herpes outbreaks for some people.
(2022, March 23). Herpes – STI treatment guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment-guidelines/herpes.htm
Freeman, A. M., & Matto, P. (2018). Adenopathy.