Assessment

HISTORY. If the patient has an oral lesion, ask about a sore throat, increased salivation, anorexia, and mouth pain. During a primary episode, the patient may experience flulike symptoms, such as fever, malaise, and enlarged lymph nodes. If the lesion is not a primary one, the patient usually does not have any systemic complaints but may complain of a tingling, itching, or painful sensation at the site of the lesion. If the patient has a genital lesion, obtain a detailed summary of his or her sexual activity, including number of partners, use of barrier protection and birth control measures, participation in oral or anal intercourse, and previous (if any) history of sexually transmitted diseases (STDs). Inquire about any burning with urination, dysuria, dys-pareunia, pruritus, fever, chills, headache, and general malaise. On some occasions, the patient may be asymptomatic or have such mild symptoms that the outbreak goes unnoticed.

PHYSICAL EXAMINATION. Inspect the lips and the oral and pharyngeal mucosa for lesions and inflammation. The lesion may appear as a red, swollen vesicle, or if it has ruptured, it is ulcer-like with yellow crusting. Palpation of the lymph nodes in the neck may reveal cervical adenopathy. Take the patient's temperature. Inspect the genitalia for fluid-filled vesicles, or if the vesicles have ruptured, note an edematous, erythematous oozing ulcer with a yellow center. Examine the cervix by using a speculum, and inspect the walls of the vagina. Inspect the patient's perianal skin and the labia and vulva or penis and foreskin carefully to identify all lesions; note any abnormal discharge.

PSYCHOSOCIAL. Ask the patient about sexual practices, partners, and birth control methods. Assess the patient's knowledge of STDs and their implications. Assess the patient's ability to cope with having an STD. The diagnosis of an STD can be very upsetting to a woman or man who believes she or he was involved in a monogamous relationship. Tell patients that an outbreak of genital HSV may have had its origins even 20 to 30 years before the outbreak.

Diagnostic Highlights

Abnormality with Test Normal Result Condition

Explanation

Viral culture Negative Positive for HSV; differentiates between HSV-1 and HSV-2

Demonstrates presence of viruses in an active lesion; cultures are most accurate in the first several days of ulceration

Other Tests: Serologic tests may also be done in the presence of symptoms and a negative culture.

420 Herpes Simplex Virus

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