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Instructions: Response must be at least 300 words written in current APA format with at least two academic references cite. References must be within the last five years. Response must refute/correct, or add additional nuance.

Unfortunately for J.R. “fever blisters” are not as innocent as many would believe.  The two types of viruses that are responsible for vesicle like lesions on the skin are HSV-1 and HSV-2.  Typically, HSV-1 herpes is associated with infections of the face and skin above the waist while HSV-2 is associated with the genitals and skin area below the waist (Arcangelo et al., 2017).  According to Jaishankar & Shukla (2016), the prevalence of HSV-1 occur on the genital region is becoming more common place.  One reason stated is that a younger generation of people are engaging more in oral sex (Jaishankar & Shukla, 2016).

Many misconceptions lay behind the pathology of these two herpes viruses.  The general notion is that HSV-2 can only be transmitted through sexual contact while HSV-1 can only occur on the lips and is transmitted through kissing (Jaishankar & Shukla, 2016).  This misconception allows infected people to engage in risky activity that can spread the viruses to other areas like the lips or genitals without them realizing (Jaishankar & Shukla, 2016).  Though HSV-2 is harder to transmit to the lips, it is possible.  HSV-1 is now thought to be the cause of most genital herpes outbreaks reported (Jaishankar & Shukla, 2016).

Drug therapy to treat this disease is dependent on patient income statues and preference.  The first line treatment for a genital herpes outbreak would begin with acyclovir 400 mg, orally three times a day or acyclovir 200 mg, orally five times a day for seven to ten days (Arcangelo et al., 2017).  Acyclovir would be chosen if the patient preferred a lower costing medication as it is the cheapest drug for this treatment (Arcangelo et al., 2017). 

Valacyclovir 1.0 g, orally two times a day or famciclovir 250 mg, orally three times a day for seven to ten days would be the preferred treatments if they are within the patient’s budget (Arcangelo et al., 2017).  In order to continuelly treat this disease recurrent, second line therapy should be used in the prodromal phase or within one day of visible appearance of blisters (Arcangelo et al., 2017).  To accommodate for scheduling and patient compliance acyclovir 800 mg, orally two times a day for 5 days, famciclovir 1,000 mg, orally twice a day for one day or valacyclovir 1.0 g, orally once a day for 3 days can be taken to possibly shorten the duration and severity of the outbreak (Arcangelo et al., 2017). 

Parameters for monitoring success of therapy aim to control the symptoms of herpes episodes as well as reduce the frequency and severity of future outbreaks (Arcangelo et al., 2017).  If J.R. experiences more than six outbreaks in a year, she can be started on third-line, suppressive therapy of oral antivirals (Arcangelo et al., 2017).  As this disease cannot be eradicated the main focus of treatment is the reduction in symptoms.

Education should focus on treatment of this disease reducing symptoms and not curing the illness.  J.R. should be instructed to inform her sexual partner of her infection and abstain from sexual activities until the outbreak has been resolved (Sauerbrei, 2016).  She should be instructed about the different treatment programs and how each one controls symptoms differently.  J.R. should be counseled on the stigma of this disease and presented the statistics that many Americans have this disease and live meaningful lives that includes a safe, but active sex life (Sauerbrei, 2016).

J.R. should inform their partner that if their fever blister moves to another location on their body or if they begin to experience the same symptoms as her on his genitals to seek medical attention.  Lastly, J.R. should be informed that if she plans on or becomes pregnant to discuss continued medication with her provider in order to prevent any contraindications (Arcangelo et al., 2017). 

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