51 110 Definition Recurrent, inflammatory viral infection characterized by the appearance of either a single vesicle or multiple clusters of small vesicles on the skin or mucous membrane usually caused by herpes simplex virus type 2. Transmission is by direct contact during the vesicular phase. Although there is no cure for herpes, there are medications that can alleviate some of the discomfort that outbreaks cause. Herpes simplex type 2 is classified as a sexually trans- mitted infection (STI) that has reached epidemic proportions in the United States. Characteristics Genital vesicles and lesions, dyspareunia (pain with sexual intercourse), erythema, pain, fever, lethargy, lymphadenopathy, dysuria, headache, or anorexia. Sores may take 2–4 weeks to heal. Policy Evaluate infected employee in the occupational health unit and provide support, counsel, and education regarding the disease and its transmission. However, herpes in the eye is con- sidered a medical emergency and should be referred immediately. Refer infected employee to personal health care provider for treatment. Maintain employee confidentiality. Objectives Clinical Assessments and Interventions Referral for Medical Action Herpes Simplex Type 2 (HSV-2) (Genital) ● Primary episode. ● Diagnosed or suspected preg- nancy. ● Signs of primary or secondary infections. ● Conjunctivitis or keratitis—refer to ophthalmologist. ● Neurological findings. ● Immunosuppressed employee. Follow-up Actions ● Discuss etiology of disease and identify factors that can cause reactivation. ● Discuss mechanisms of transmis- sion and initial signs of possible flare-up. ● Educate about flare-ups and pro- phylactic therapy if many flare- ups occur per year. Determine extent of illness and employee knowledge level. Provide for symptom relief including mea- sures to reduce the number and severity of lesion outbreaks and cross-contami- nation. Prevent spread of infection to others. ● Assess the site of infection if appropriate and record a brief history of the illness. ● Obtain health history to determine whether employee is immunosuppressed individual is at higher risk of contracting herpes infec- tion, which can be more severe. ● Administer analgesics per standing order. ● Advise and discuss the following: – Keeping the area clean and dry. – Increasing fluid intake. – Using good personal hygiene. – Using frequent warm soaks. – Avoiding scratching or irritating the area and touching other body parts, most im- portantly the eyes, with hands or other material contaminated with secretions. ● Advise employee that symptoms can be con- trolled with a prescribed medication if started early (e.g., acyclovir, famciclovir, Valtrex). ● Instruct employee to avoid sexual inter- course during the period of symptoms or active lesions. Review benefits of using con- doms during sexual intercourse between outbreaks. ● Caution employee that virus has been shown to shed through intact skin. Guideline continues on next page