Reflection On Urgent Care

Introduction

In my first clinical rotation I worked in an Urgent Care clinic that has actually turned into the primary care site for a large number of patients. I met a young women age 24, who had been seen in the Urgent Care five times in the past year for Genital Herpes. She did not understand that the suppressive medication ( Famciclovir ) was prescribed to be taken daily to prevent the outbreaks. My preceptor was a bit irritated with the girl- because she was non compliant. She was also frustrated that the girl did not follow up with a GYN provider as she was told too. The girl had good insurance and could go to any GYN in the area. My conclusion was that she was too embarrassed to go to a single provider, and to be accountable for her own health. It was less intimidating to come to Urgent Care.

I asked my preceptor to let me talk to the girl, as I felt I had the time and had made a connection with her.

She had an outbreak while taking the medication a few months ago, so she said it did not work, and quit taking it. I spent about an hour talking to her, and printed out some information from uptodate online. She agreed to take the current prescription for her current outbreak and then go back to the suppressive therapy.

My second clinical was at a geriatric practice where we saw several geriatric female patients who had Herpes, and were taking suppressive therapy. It kind of stuck with me that Herpes is a chronic, sexually transmitted disease that affects a person’s entire life. The focus of my paper will be on females with genital herpes, and the importance of education of these

patients.
Herpes Infection
Genital Herpes is a sexually transmitted disease, which is characterized by outbreaks of tiny vesicles in the perianal or vulva region. They may appear as fluid filled pimples on a tender reddened base. The lesion’s are often grouped together along a sensory nerve tract. The first outbreak is usually the most severe, and accompanied by systemic effects of the virus.
Clinical Presentation
Many patients may have a prodromal phase of fever, malaise and flu like symptoms. They may present with the feeling that they have a painful rash, or blisters on their genital area. The lesions may be accompanied by enlarged regional lymph nodes, dysuria, and vaginal discharge. It is difficult for woman to visualize the painful lesions, and they may not be sure of what it is . The major problem with this virus is that a large number of people who are infected with herpes are not aware of it. The cumulative lifetime incidence of HSV-2 reaches 25 % in white women compared with 20 % in white men, and 80 % in African American women compared with 60 % in African American men” (Provenzale, Evans, Russell, Hoory, & Mark, 2011, p. 325), The fact is that most people who are infected with Herpes, are not aware of it. The virus is transmitted unknowing to a significant number of people, mainly our young African American youth.
Research Questions
It is painfully obvious to me that the general public needs to be educated on the risks, presentation and transmission of Herpes. My first question is why does the U.S. Preventative Task force maintain that blood testing for Herpes, does not improve outcomes or reduce transmission of the virus? My second question is what is the most effective method to educate our youth on Herpes? What can we do as a society to control, prevent , and eradicate this chronic STD.