Sexually Transmitted Infections: Herpes Simplex Virus (HSV-1)
J.R. is a 36-year-old white, middle-class woman who has been sexually active with one partner for the past 2 years. She and her partner have no history of STIs, but her partner has a history of fever blisters. She reports genital pain, genital vesicles and ulcers, and fever and malaise for the last 3 days. Examination reveals adenopathy and vaginal and cervical lesions.
1.What drug therapy would you prescribe? Why?
2.What are the parameters for monitoring the success of the therapy?
3.Discuss specific education for J.R. based on the diagnosis and prescribed therapy.
Submission Instructions:
-the initial post should be formatted and cited in the current APA style with support from at least 2 academic sources.
-Class book: Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach (4th Ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Sexually Transmitted Infections
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1 What drug therapy would you prescribe? Why?
To know the drug regiment to be given, the diagnosis must be first confirmed. Initially, the patient’s partner admits to having fever blisters before presenting the patient’s symptoms. The patient also admitted to being monogamous and sexually active. Fever blisters are commonly known as oral cold sores caused by the herpes simplex virus 1 (HSV-1), which can also cause genital herpes, especially when oral sex is practiced. The disease is typically asymptomatic. However, it can present with a cluster of vesicles in one part of the external genitalia, perineum, upper thighs, perineum, or perianal areas, which can progress to ulceration. The associated manifestations include fever, malaise, or localized lymphadenopathy (Groves, 2016).
According to the Centers for Disease Control and Prevention (2021), the treatment of choice for the first symptomatic episode of this disease is oral Acyclovir 400 milligrams (mg), taken thrice daily for seven to ten days. Alternative treatments include oral famciclovir 250 mg thrice daily or oral valacyclovir 1 gram (g) twice daily. Both can be taken for seven to ten days. However, the duration of treatment can extend beyond ten days if the symptoms have not resolved.
These drugs belong to the class of antiviral drugs, which are acyclic nucleoside analogs. This targets the principal enzyme of the HSV-1, the thymidine kinase, responsible for converting antiviral compounds to transform to monophosphates, then diphosphates, and finally, triphosphates, through the help of cellular enzymes. The triphosphates help fix and prevent the formation of the viral deoxyribonucleic acid (DNA) polymerases, which are critical in replicating HSV-1. Furthermore, the triphosphates can alter the viral DNA chain by incorporating incorrect substrate. Specifically, acyclovir or valacyclovir removes the hydroxy group in the 3’ position, vital in the linking process (Sauerbrei, 2016).
Aside from these, the patient shall be prescribed oral paracetamol to relieve fever and an oral nonsteroidal anti-inflammatory drug (NSAID) to relieve pain (Osafo et al., 2017; Makino & Egi, 2016).
2 What are the parameters for monitoring the success of the therapy?
After the course of treatment, the patient shall be advised to undergo an HSV nucleic acid amplification test (NAAT) to detect the presence of the virus. The viral shedding of HSV-1 is intermittent, and a negative test does not necessarily mean they lack the presence of the virus. Therefore, the test can be done again or when the symptoms present again (Centers for Disease Control and Prevention, 2021). Repeat testing can be done one month after the negative test. However, in most cases, this is unnecessary (American Sexual Health Association, 2016).
Alternatively, the patient may undergo HSV serologic assays to detect antibodies or culture of the samples taken from the open ulcers. However, these have lower specificity and sensitivity than HSV NAAT (Centers for Disease Control and Prevention, 2021).
3 Discuss specific education for J.R. based on the diagnosis and prescribed therapy.
The patient education shall focus on identifying risk factors, mechanism of transmission of the virus, and medication comp...