Managing Genital Herpes in a Pregnant Patient

Student Name

Program Name or Degree Name (e.g., Bachelor of Science in Psychology), Walden University

COURSE XXX: Title of Course

Instructor Name

Month XX, 202X

Abstract

This comprehensive well-woman/obstetric paper discusses the case of a 26-year-old Caucasian pregnant female at 33 weeks gestation diagnosed with genital herpes (HSV type 2). The report analyzes the patient's background, medical history, physical exam, laboratory results, diagnosis, treatment, and management plan. Additionally, it reflects on the implications of the patient's pregnancy status and potential domestic violence concerns. Evidence-based guidelines and scholarly sources are utilized to support the treatment plan and reflections.

Managing Genital Herpes in a Pregnant Patient

The comprehensive well-woman/obstetric paper revolves around a specific patient, a 26-year-old Caucasian female who is currently 33 weeks pregnant. The patient sought medical attention due to the presence of symptoms that raised suspicion of genital herpes (HSV type 2). This essay aims to provide a comprehensive analysis of the patient's health status, medical history, results of the physical examination, and laboratory tests. Additionally, it will explore potential differential diagnoses, creating an effective management plan, patient education strategies, and the proposed follow-up care. Throughout this process, the treatment plan will be strongly grounded in evidence-based guidelines from reputable sources.

Episodic/Focused SOAP

Patient Information: MG is a 26-year-old married Caucasian female.

Chief Complaint: MG presented to the clinic stating, I have come for my lab results. She sought clarification and insights regarding her recent laboratory workup, specifically the results related to her symptoms of genital discomfort, itching, and painful sores. This led to concerns about a potential diagnosis of genital herpes (HSV type 2).

History of Present Illness (HPI): 26-year-old Caucasian female at 33 weeks of pregnancy reports experiencing symptoms of genital herpes, specifically in the genital area. The painful sores and itching are localized to the vulva and surrounding areas, and she has not noticed any similar lesions or discomfort in other regions of her body. The patient recalls that the symptoms of genital herpes began approximately two weeks ago. She first noticed a tingling sensation in her genital area, which was soon followed by the appearance of small red bumps that quickly progressed into painful fluid-filled vesicles. The sudden onset of these symptoms raised concern, leading her to seek medical attention promptly. The character of the patient's genital herpes symptoms is described as painful sores and itching. The sores are described as small, raised, and filled with fluid, causing discomfort and tenderness. The itching sensation is often intense and contributes to her overall discomfort. The patient further explains that the lesions tend to break open, leading to painful ulcers that eventually crust over before healing.

The patient's symptoms of genital herpes started approximately two weeks ago. Since then, she has noticed a cyclic pattern of symptoms with periods of exacerbation and partial relief. The painful sores and itching have been consistently present, but the intensity of symptoms has varied throughout the day. She also notes that the symptoms worsen after prolonged sitting or wearing tight-fitting clothing. MG rates the severity of her genital herpes symptoms as a 6/10. The pain is significant enough to interfere with her daily activities, causing discomfort and distress. However, she copes with the pain using over-the-counter pain relievers and sit baths, providing some relief. MG is not taking any medications besides the recently prescribed Acyclovir 400 mg orally three times a day for 7 days to manage the active herpes outbreak. She has not started the medication yet but is eager to begin the treatment plan to alleviate her symptoms. She denies any known allergies to medicines, foods, or environmental triggers. She reports using Acyclovir for a non-related medical condition without experiencing any adverse reactions. MG's past medical history is relatively unremarkable. She recalls experiencing occasional seasonal allergies characterized by sneezing and mild nasal congestion during specific times of the year.

Additionally, during her teenage years, she had an episode of mononucleosis, which resolved without complications. Apart from these instances, there have been no significant illnesses, surgeries, or hospitalizations in her medical history. The patient reports adhering to regular prenatal care during her current pregnancy, and all prior check-ups have indicated a healthy pregnancy without any major concerns.

Soc & Substance Hx: Happily married, and they have a supportive and loving relationship. She resides in a safe and stable home environment. She is currently employed as a part-time teacher and enjoys her work. Has a close-knit group of friends and participates in regular social activities. MG denies any history of substance abuse or dependence. Does not smoke, use tobacco products, or consume alcohol.

Fam Hx: Family history indicates no significant chronic or hereditary illnesses, including parents, siblings, and grandparents. The cause of death of any deceased first-degree relatives is not applicable as all immediate family members are alive. There are no indications of any hereditary conditions that could impact MG's current health status.

Surgical Hx: Not undergone any previous surgical procedures.

<>Mental Hx: No history of diagnosed mental health disorders like anxiety, depression, or other psychiatric conditions. The patient denies any concerns related to anxiety or depression and does not report a history of self-harm practices or suicidal or homicidal ideation.

Violence Hx: No concerns about safety, personal violence, domestic violence, or issues related to her or her family's security in her history. The patient is in a stable and supportive relationship with her husband, and there are no indications of any history of violence or abuse.

Reproductive Hx: Reports regular menstrual cycles, is currently at 33 weeks gestation with her first pregnancy, and has not experienced any significant pregnancy complications.

ROS:

General: No significant weight loss, fever, chills, weakness, or fatigue.

HEENT: No visual disturbances, eye pain, or vision changes. She denies hearing loss, ringing in the ears, or ear pain. There are no complaints of sore throat or difficulty swallowing.

Skin: Experiences itching, burning, and painful sores in the genital area,...

…(CBC) and liver function tests (LFTs) should be ordered to evaluate her overall health status and rule out potential complications. Additionally, a detailed obstetric ultrasound should be performed to monitor fetal well-being and determine the appropriateness of a vaginal delivery.

To ensure comprehensive care, referrals to other healthcare providers are essential. MG should be referred to a maternal-fetal medicine specialist to receive specialized obstetric care during the remainder of her pregnancy. A consultation with an infectious disease specialist is also recommended to optimize the management of her genital herpes and provide expertise on antiviral therapy during pregnancy.

Therapeutic interventions should focus on controlling the current herpes outbreak and preventing recurrences. The prescribed Acyclovir 400 mg orally thrice a day for 7 days should be monitored for efficacy and potential side effects (ner et al., 2022). Educating the patient on the importance of following the prescribed medication regimen to optimize outcomes for both herself and her baby is crucial.

Educating the patient is paramount in effectively managing genital herpes during pregnancy. MG should receive comprehensive counseling on transmission prevention strategies, including avoiding sexual contact during active outbreaks, using barrier methods consistently, and informing her partner about the diagnosis. Additionally, she should be educated about the risk of neonatal herpes transmission and the importance of seeking immediate medical attention if she experiences prodromal symptoms close to the expected delivery date.

The patient's disposition should involve regular follow-up visits with her obstetrician to monitor the progress of her pregnancy and the herpes outbreak. These follow-up visits will ensure timely adjustments to the treatment plan if necessary and provide continuous support to the patient.

Reflection

Upon reflection, I agree with my preceptor's treatment plan for MG. The prescribed Acyclovir aligns with evidence-based guidelines for managing genital herpes during pregnancy. The decision to involve other healthcare specialists, such as a maternal-fetal medicine specialist and an infectious disease specialist, was crucial in providing comprehensive care to the patient. Collaboration among healthcare providers ensures MG receives the specialized care she needs throughout her pregnancy.

From this case, I have learned the importance of addressing infectious diseases in pregnant patients with a multidisciplinary approach. Pregnancy adds complexity to managing infections, and careful consideration of maternal and fetal well-being is essential. Additionally, this case highlighted the significance of patient education in preventing transmission and promoting safe practices during pregnancy.

In health promotion and disease prevention, factors such as age, ethnic group, and socioeconomic and cultural background are pivotal in shaping a patient's understanding and compliance with treatment plans. Tailoring educational strategies to address each patient's specific needs and beliefs is crucial for successful disease management.

In future cases, I would emphasize early testing for sexually transmitted infections during pregnancy to detect and manage conditions like genital herpes promptly. I would also strongly emphasize counseling patients about the potential implications of infections on their health and the health of their unborn child, fostering open communication and informed decision-making.

Overall, this experience has deepened my understanding of providing…