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Drugs that combat herpes and CMV inhibit viral DNA replication by competing with viral substrates to form shorter, noneffective DNA chains. This action prevents replication of the virus, but it has little effect on the host cells of human because their DNA uses different substrate. These antiviral agents indicated for treatment of the DNA viruses herpes simplex, herpes zoster and CMV.

Contraindications and Cautions

Drugs indicated for the treatment of herpes and CMV should not used during pregnancy or lactation or I patients with known allergies to antiviral agents, renal disease which could interfere with excretion of the drug or severe CNS disorders.

Adverse Effects

The adverse effects most commonly associated with these antivirals include nausea and vomiting, headache and depression and rash and hair loss. Rash and inflammation and burning often occur at sites of IV injection and topical application.

Clinically Important Drug-Drug Interactions

The risk of nephrotoxicity increases when agents indicated for the treatment of herpes and CMV are used in combination with other nephrotoxic drugs. The risk of drowsiness also rises when these antiviral agents are taken with zidovudine and anti retroviral agent.

Nursing Diagnoses

The patient receiving a DNA-active antiviral agent may have the following nursing diagnoses related to drug therapy:
· Acute pain related to GI, CNS, local effects of drug
· Disturbed Sensory Perception related to CNS
· Deficient knowledge regarding drug therapy

Implementation

· Ensure good hydration to decrease the toxic effects on the kidneys.
· Administer the drug as soon as possible after the diagnosis has been made to improve effectiveness of the antiviral activity.
· Ensure that the patient takes the complete course of the drug regimen to improve effectiveness and decrease the risk of the emergence of resistant viruses.
· Wear protective gloves when applying the drug topically to decrease risk of exposure to the drug and inadvertent absorption.
· Provide safety precautions if CNS effects occur (e.g., use side rails, appropriate lighting, orientation, assistance) to protect the patient from injury.
· Warn the patient that GI upset, nausea, and vomiting can occur, to prevent undue anxiety and increase awareness of the importance of nutrition.
· Monitor renal function tests periodically during treatment to detect and respond to renal toxicity as soon as possible.
· Provide the patient with instructions about the drug therapy and to promote compliance.

The patient should:

· Avoid sexual intercourse if genital herpes is being treated, because these drugs do not cure the disease.
· Wear protective gloves when applying topical agents.
· Avoid the driving and hazardous tasks dizziness and drowsiness occurs.

Evaluation

· Monitor patient response to the drug
· Monitor for adverse effects
· Evaluate effectiveness of the teaching plan
· Monitor for the effectiveness of comfort and safety measures and compliance with regimen

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Herpes viruses account for a broad range of conditions, including cold sores, encephalitis, shingles and genital infections. Cytomegalovirus (CMV) although slightly different from the herpes virus can affect the eye, respiratory tract and liver and reacts to many of the same drugs.

1. Acyclovir (Zovirax) – is specific for herpes virus infections. Is excreted unchanged in the urine and therefore must be used cautiously in the presence of renal impairment. It crosses into breast milk and exposes the neonate to high levels of the drug.
2. Cidofovir (Vistide) – is used to treat CMV retinitis in patients with AIDS only. It is associated with severe renal toxicity and granulocytopenia. It is excreted unchanged in the urine and must be given with probenecid to increase renal clearance of the drug. Use in children with AIDS should be very cautious because of potential.
3. Famiciclovir (Famvir) – is most effective in treating herpes infections. It is well absorbed in the GI tract, reaching peak levels in 2 to 3 hours. It is metabolized in the liver and excreted in the urine and feces.
4. Foscarnet (Foscavir) – is available in intravenous (IV) form only. It can be highly toxic to the kidneys and is reserved for treatment of CMV retinitis in immunocompromised patients and for mucocutanneous acyclovir-resistant herpes simplex infections.
5. Ganciclovir (Cytovene) – which is available in IV and oral forms and is used for long term treatment and prevention of CMV infections. Primarily excreted unchanged in the feces with some urinary excretion. It is carcinogenic and should be used only with extreme caution in children.
6. Valacyclovir (Valtrex) – is an oral agent used for the treatment of herpes zoster and recurrent genital herpes. Rapidly absorbed from the GI tract and metabolized in the liver to acyclovir. Excretion occurs through the urine so caution should be used in patients with renal impairment.
7. Valganiclovir (Valcyte) – which is the oral prodrug of ganciclovir, is used for the treatment of CMV retinitis in AIDS patients. Primarily excreted unchanged in the feces with some urinary excretion.

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Herpes simplex is part of a group of other herpes viruses called Herpesviridae, that include human herpes virus 8 (the cause of Kaposi’s sarcoma), herpes zoster (the virus responsible for shingles and chicken pox) and cytomegalovirus (CMV).

There are two strains of the virus: type 1 (HSV1), usually associated with the mouth, lip, and face infections and is responsible for cold sores and fever blisters; and type 2 (HSV 2), usually associated with infections of the sex organs (it is the main cause of the condition known as genital herpes) and both of these strains of virus can cause extremely painful infections in humans.

Both type 1 and type 2 herpes viruses reside in a latent state in the nerves which supply sensation to the skin. The virus ‘buds off’ from the nerve ending and infects the surrounding skin cells, producing a painful cluster of pale blisters that are crammed with herpes simplex virus and are highly infectious.

Recurrences of Type 1 infection can occur on virtually any part of the body surface but are most frequent on the face, particularly on or around the lips. Infection of the mouth is very common and though the appearance may be a source of concern, it presents no serious risks to your general health.

Herpes simplex is actually the most common virus found in humans, causing infections of the skin and mucous membranes but is also an uncommon cause of more serious infections in other parts of the body. Virus infections from herpes may cause severe extensive disease in immune-suppressed individuals (HIV or cancer patients, for example).

Like all members of the herpes virus family, the herpes simplex virus stays with us for life. The virus affects only humans and there is no cure. It is estimated that over half a million new cases of the virus occur every year and in the United States alone, one out of five of the total adolescent and adult population are infected.

Newborns can catch herpes simplex from their mother during birth. If a newborn is infected with the virus, the following symptoms of infection may emerge during the first month after birth: irritability, breathing problems, fever, convulsions, jaundice (yellowish skin), sores on the skin, bruising or low platelet counts (platelets are the part of blood that makes it clot). In the most extreme cases, babies infected with herpes simplex may develop severe eye problems, a small brain size, mental retardation, seizures or even die.

The virus rarely spreads to the baby through the placenta of the mother but to decrease the risk of infecting newborns, a caesarean delivery (C-section) is recommended for pregnant women who have an active herpes simplex infection at the time of delivery.

One fascinating fact about herpes is that at least one third of children are infected by the virus by the end of childhood.

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There are herpes drugs, which help with the frequency of shedding (the warts). Unfortunately you can shed at any time, but the medication does help. Statistically speaking, after five years with a partner who has herpes you’re most likely going to be infected. That doesn’t mean you’re going to have lesions, but if you do blood tests of a person who has lesions, most people have it.

There are two types of herpes. The ones that we look out for are herpes simplex, type I and type II. Type I is from the waist up and type II is the genital herpes from the waist down. You can inoculate yourself by just touching your mouth and then touching the genitalia. You can get type I in the genitalia area and then get type II in the oral area. If someone has it on the mouth you can touch someone down there and contract it. Many times, people have one outbreak and then only a little bump, but then they’re shedding and they don’t realize it.

What can cause outbreaks and how do you contain them?

Full outbreaks are caused by stress, trauma or emotional upsets. Some people will outbreak every month and then other people will have just one outbreak. The longer you have herpes, the less frequent outbreaks are. Keeping the infected area dry is important; it will run its course. There are ointments and stuff some people swear by; other people say they don’t do a thing.

Besides pregnancy, what kind of emotional toll can sex take on a young person?

We see the implications of sex before marriage every day. What we tell the girls that come through our doors is that premarital sex is always negative; every single consequence is negative. It’s because they are dying to have somebody love them. A lot of times it’s because their father never married, or they are fatherless.

There is a huge emotional component to young women having sex. They desperately want a man to take care of them. Women give sex to get love, and men give love to get sex. Sex is supposed to be a fabulous bonding thing for marriage, and it is degraded outside of marriage, and then it becomes not the special thing God intended it to be.

Also, STDs are transferable every day of the year - herpes, HIV, HPV and hepatitis, which you will have for life. One woman had contracted herpes and she could barely walk on her wedding day. That’s just a degrading way to enter a marriage. These relationships tend not to be real stable in spite of the sex; they haven’t built it on a strong friendship so it’s shaky and when they split up there is a lot of emotional pain. So it’s just humiliating and sad.

What about the emotional impact on a guy?

Guys are just as vulnerable to family instability and they need a father as well, and a lot of this desire is to keep this girl, and then jealousy comes in. They want stability as well. Men do have a much more powerful sex drive than women. Women don’t feel pressure to have sex but men are always building up sperm. But they have the same emotional needs; they have that component as well. We get some guys who are very broken hearted as well. They’re not animals either, but some are and can be pretty callous as well. But most guys care about the girl, and if she’s pregnant, it’s a pregnant experience for both the male and the female. Strong parenting and loving married parents are the best a child could have. Encourage your readers to get married and make it last.

In your opinion, how big of a difference does it make to wait until you are married? Does having a certificate make that big of a difference?

Huge. We are in a culture that down-plays it and says, “It’s ridiculous to be concerned about it.” The impact is far more devastating and very glossed over. For people to put God first, speak his will and make a commitment is huge. Wait until you are older and ready to get married and are able to really start focusing on whom God is bringing into your life. It’s almost irresistible apart from God’s grace. We just crave that intimacy, but that’s why God created the institution of marriage. I think premarital sex interferes with peoples’ ability to do well and focus in college.

Do you think that there are still couples or individuals out there who are waiting for marriage, or is the number of sexually active youth increasing all the time?

We see a population that is definitely not waiting. On the Whitworth campus I’m sure there are people who lie about it, but there are definitely people who are waiting.

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Q: I read that in the United States over 6 million men and women get a Human Papilloma virus (HPV) infection every year. If it’s so common, should we really be worried?

Well, they found that cervical cancer is related to a virus, and they’ve finally been able to document cervical cancer: It’s mostly due to HPV. There are hundreds of types of the HPV virus. There are several different types of genital warts, and half of them are benign. Usually, most warts have their own lifespan and will eventually go away. The other half are the higher risks ones and are known to cause cervical cancer.

Gardasil does not protect against all of these viruses. The ones that they do protect you against are the high-risk viruses. For the benign types, they protect you against two of the viruses. What’s really interesting is that they are also finding out that you get some sort of cross protection. The way the virus lives is sort of like a branch on the tree - if you immunize against this one you might have cross protection against the second one on the branch. You’ll be protected against eight types of the virus instead of four.

Q: I’ve heard that HPV is untraceable in men. Is this true?

Pretty much, unless they have warts. I don’t think there are any blood tests to detect HPV in men. But they are trying to get our young men vaccinated, too. They are working on a Gardasil for men. They are figuring if they can immunize young men and young girls before they get sexually active they can cut down cervical cancer just by doing that.

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Sue Lynn, a nurse practitioner at the Whitworth Health & Counseling Center, discusses the physical aspects of sexual health.

Q: What would you consider to be some of the biggest issues facing both men and women today when it comes to sexual health?

For people that are sexually active, I would say infections, unplanned pregnancy, contraception and safe sex praxis. For women who are not sexually active, there are some who come in, such as women who are planning to get married, and a lot of times they are at the age where they should have a women’s health exam before they get married. I do like to do some teaching to women who haven’t been sexually active to prepare them.

Q: Do you think the fact Whitworth is a Christian university hinders people from being open about sexual health?

On occasion we’ll have someone who became carried away and maybe went a little bit farther than they thought they should have. This is for both men and women. There are all those guilt feelings because they weren’t taught, or the students around them have made them feel like this isn’t the right thing to do. It’s hard to accept the fact that we are human, and we have hormones. God gave us feelings, and it’s just what you choose to do with it. You have to decide if this is something you’ll be tempted to do again or wait until you get married. What you learn from it is what counts.

Q: Does the Health Center here make contraceptives available by prescription?

I talk to young women, especially if they have issues with their menstrual cycle. Sexuality is a part of being human, and that involves the function of the sexual organs - especially for women. I do a lot of teaching about their cycles and it’s important that women know how their hormones function, how that regulates your period and how that can make you miss a period. A lot of times I will prescribe contraception pills if there’s a request for it. Also, there are many benefits of being on the pill for women who have painful periods. The birth control pill will help if a woman has irregular periods. There are a lot of reasons for getting on birth control.

Q: What do you do here when a young woman comes to you with an unplanned pregnancy?

If by chance a young woman does get pregnant, I don’t advocate abortion at all, but we give them the information so we can help them make the right decision. The reason we are here is to support the person. The effects of abortion are highly emotional. I think young women go into abortion thinking it’s going to be an easy way out, not having to deal with pregnancy and figuring out to do with the infant and all of that. There are a lot of hidden emotions that women will have to deal with down the road. It’s not as easy as it seems. And for some women I imagine, it might be a little harder to get pregnant later on.

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