Genital Ulcer Disease Case
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Institutional Affiliation
Date
Genital Ulcer Disease Case
Drug Therapy to Prescribe
I would prescribe an oral antiviral therapy acyclovir, famciclovir or valacyclovir for 10 days in this case. The choice of the actual antiviral agent would be dependent on the patient’s preference since the prices of these agents with famciclovir and valacyclovir being more expensive but having favorable dosing schedules. The patient's symptoms mirror those of genital ulcer disease and more precisely those of genital herpes. Genital herpes is the most prevalent genital ulcer disease in the US with the diagnostic criteria for the primary infection in women being genital pain, vesicles, malaise, fever, regional adenopathy and cervical lesions (Arcangelo & Peterson, 2017). The patient's symptoms clearly fit this diagnostic criterion. The mentioned three agents are the first line choice of therapy for primary genital herpes. The choice for systemic therapy, as opposed to topical therapy, is because the use of topical therapy is discouraged as they are less efficacious.
Parameters to Monitor Success of Therapy
Parameters for monitoring the success of therapy in this patient would be majorly clinical by monitoring for relief of symptoms and resolution of the genital lesions and reversal to normal skin. Normal skin is defined as loss of crust, swelling and dry flaking off all the vesicular lesions.
Specific Education
Specific education for J.R. based on the diagnosis and prescribed therapy would include education on:
The natural history of genital herpes laying emphasis on the potential for recurrent episodes, asymptomatic viral shedding hence the risk of sexual transmission to the partner.
Importance of informing her partner that she has genital herpes and the need for the partner to come to the clinic to be checked and start treatment
Importance of abstaining from sexual activity when lesions or prodromal symptoms are present
On safe sexual practices like the use of male latex condoms which when used correctly and consistently can reduce the risk of transmission of genital herpes.
The management of recurrent episodes with episodic therapy as it shortens the duration of the symptoms(CDC, 2015)
The possibility that the infection could have been present but asymptomatic in their partners so that recent infidelity is not necessarily implicated. Her partner is reported to have had fever blister pointing towards HSV 1 which establishes latency in the sensory nerves and can be reactivated to cause recurrent fever blisters and transmission to the partner with oral sexual contact.
The essence of adherence to treatment to prevent the emergence of resistance (Cunningham et al., 2012).
The potential effect of genital herpes in pregnancy and the importance of avoiding genital sexual contact and cunnilingus I the last trimester of pregnancy to reduce the risk of neonatal herpes.
The side effect profile of the prescribed antiviral and the adverse effects to watch out for. This will help her to distinguish between the onset of a new disease symptom from a normal drug side effect and is likely to increase her compliance with treatment.
References
Arcangelo, V., & Peterson, A. (2017). Pharmacotherapeutics for advanced practice(3rd ed.). Philadelphia [etc.]: Wolters Kluwer Health
CDC. (2015). Genital HSV Infections - 2015 STD Treatment Guidelines. Retrieved from https://www.cdc.gov/std/tg2015/herpes.htm
Cunningham, A., Griffiths, P., Leone, P., Mindel, A., Patel, R., Stanberry, L., & Whitley, R. (2012). Current management and recommendations for access to antiviral therapy of herpes labialis. Journal Of Clinical Virology, 53(1), 6-11. doi: 10.1016/j.jcv.2011.08.003