CHAPTER 5 SEXUALLLY TRANSMITTED INFECTIONS

A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective? "I will wear loose cotton underwear." "I can pour hydrogen peroxide and water over my lesions." "I will apply a water-based lubricant to my lesions." "I should rub rather than scratch in response to itching."

"I will wear loose cotton underwear." Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions should not be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of hydrogen peroxide and water on lesions is not recommended.

A 20-year-old female comes to the sexual health clinic for follow up related to a positive test for the human papillomavirus (HPV). The client asks the nurse, "Is there anything I can do to get rid of this?" What is the nurse's best response? "This can be cured with medications such as the recombinant human papillomavirus quadrivalent vaccine." "There is currently no medical treatment to cure HPV." "The lumps on your cervix can be cured by cryosurgery." "The health care provider will prescribe antibiotics to cure this infection."

"There is currently no medical treatment to cure HPV." It is a lifelong recurrent viral disease treated but not cured with medical treatment. Immunization regimes such as the recombinant human papillomavirus quadrivalent vaccine are for HPV prevention not cure. Cryosurgery will eliminate HPV warts but not cure it. Antibiotics will not be effective for a virus.

The nurse is providing education on the prevention of sexually transmitted infections (STIs) to clients. The nurse understands which client is at the highest risk of contracting an STI? A 20-year-old client who reports having protected sexual intercourse with three others, male and female, over the past five years. A 25-year-old client who refused to receive the human papillomavirus vaccine and whose parents both have HIV. A 17-year-old client who is in a monogamous relationship with a 25-year-old partner and engages in unprotected sex. A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution.

A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution. The nurse will look for the client with the most risk factors for contracting an STI. The 30-year-old client is at the highest risk due to the use of alcohol and drugs and a history of forced sexual activity (3 risk factors). Other risk factors include age of 24 years or less, multiple partners, unprotected intercourse, and a history of STIs. Although the 17-year-old client is young and having unprotected intercourse, the client is in a monogamous relationship, indicating only 2 risk factors. The 20-year-old client is young and has protected intercourse with multiple partners (2 risk factors). The 25-year-old has no risk factors.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which most common bacterial STI in the United States would the nurse expect to include? chlamydia genital herpes gonorrhea syphilis

chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. Genital herpes is a viral STI. One in five people older than age 12, however, is infected with the virus that causes genital herpes.

A woman comes to the clinic reporting intense pruritus and a thick curd-like vaginal discharge. On examination, white plaques are observed on the vaginal wall. The nurse suspects which condition? bacterial vaginosis trichomoniasis vulvovaginal candidiasis chlamydia

vulvovaginal candidiasis

The nurse is educating a female client diagnosed with human papillomavirus (HPV). Which information will the nurse include in the client's education plan? "Your best option is to surgically remove genital warts to prevent you from spreading the disease." "During colder weather, you will note more outbreaks than during warmer weather." "You will be prescribed an antiviral medication to take that will clear your infection." "You should be sure to receive consistent testing for cervical cancer."

"You should be sure to receive consistent testing for cervical cancer."

What is the gold standard for herpes simplex virus (HSV) diagnosis? punch biopsy shave biopsy culture excisional biopsy

Culture The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but they would not be used for HSV.

When developing a program for STI prevention, which action would need to be done first? getting individuals to change their behaviors increasing the availability of resources educating on how to promote sexual health interfering with the mode of transmission

educating on how to promote sexual health

A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection? gonorrhea Candida albicans human immunodeficiency virus syphilis

gonorrhea

The nurse in the sexual health clinic is obtaining a health history of a client who suffers form heroin use disorder. The client reports chronic flulike symptoms accompanied by pruritis, fatigue, anorexia, and constant upper right quadrant pain. Which sexually transmitted infection would the nurse suspect? herpes simplex syphilis hepatitis A trichomoniasis

hepatitis A Hepatitis A produces flulike symptoms with malaise, skin rashes, fatigue, anorexia, nausea, pruritus, fever, and upper right quadrant pain. Symptoms of hepatitis B are similar to those of hepatitis A, but with less fever and skin rash involvement. Syphilis, herpes simplex, and trichomoniasis do not present with these types of symptoms.

Which factor in a client's history indicates she is at risk for candidiasis? menopause use of corticosteroids use of spermicidal jelly nulliparity

use of corticosteroids

A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are vaccines available to prevent STIs. How should the nurse respond? "There is a vaccine to prevent herpes simplex virus." "Researchers have developed a vaccine to prevent human immunodeficiency virus." "At present there are no vaccines available to prevent STIs." "A vaccine has been approved to prevent the human papillomavirus."

"A vaccine has been approved to prevent the human papillomavirus." Vaccine-preventable STIs can be effectively prevented through preexposure vaccination. Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. The only vaccines currently available are for prevention of hepatitis A virus, hepatitis B virus, and HPV infection. Vaccination efforts focus largely on integrating the use of these available vaccines into STI prevention and treatment activities.

A client has presented reporting symptoms that suggest a gonorrheal infection. After laboratory testing confirms this diagnosis, the nurse anticipates that the client will also be treated for which infection? HPV syphilis candidiasis chlamydia

chlamydia

Which stage of syphilis occurs when the infected person has no signs or symptoms of syphilis? primary secondary tertiary latency

latency Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.

After teaching a group of college-aged students about condom use, the nurse determines that additional teaching is needed when the students make which statement? "Latex condoms are the best protection from STIs." "Condoms should be stored in a cool, dry place." "Condoms should be applied before any genital contact." "It's okay to use petroleum jelly with a latex condom."

"It's okay to use petroleum jelly with a latex condom."

During a health education session, a teenage client asks the nurse when she should have her first "Pap test." How should the nurse reply? "When you turn 21 years old." "When you first start having sex." "It all depends on your family history of cancer." "As soon as possible and every year thereafter."

"When you turn 21 years old."

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age? 25 40 28 32

25 The CDC (2015) recommends yearly chlamydia testing of all sexually active women aged 25 or younger, older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners), and all pregnant women).

Which instruction should be given to a woman newly diagnosed with genital herpes? Use a water-soluble lubricant for relief of pruritus. Obtain a Papanicolaou test every 3 years. Have your partner use a condom when lesions are present. Limit stress and emotional upset as much as possible.

Limit stress and emotional upset as much as possible. Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it is not known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Papanicolaou test is recommended every year.

A nurse is presenting a program for a local women's group about STIs. When describing the information, the nurse would identify which infection as the most common cause of vaginal discharge? candidiasis gonorrhea chlamydia syphilis

candidiasis

A group of students is reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which cause of condylomata? human papillomavirus Treponema pallidum Haemophilus ducreyi bacillus herpes virus

human papillomavirus

A male client appears in the walk-in clinic and requests treatment for trichomoniasis as his girlfriend was recently diagnosed with it. What medication would the health care provider most likely prescribe? penicillin G metronidazole clotrimazole acyclovir

metronidazole

Copious amounts of frothy, greenish vaginal discharge would be a symptom of which infection? gonorrhea trichomoniasis Gardnerella vaginalis vaginitis candidiasis

trichomoniasis

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection? treponemal testing IgG/IgM antibody testing viral culture of vesicular fluid Papanicolaou smear

viral culture of vesicular fluid

A nurse is engaged in primary prevention activities for human papillomavirus (HPV). The nurse would be most likely involved with which activity? administering HPV vaccine educating about HPV testing in women over age 30 teaching about the importance of regular Papanicolaou test encouraging treatment for genital warts

administering HPV vaccine

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? chlamydia syphilis gonorrhea genital herpes

genital herpes Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A community health nurse is conducting a class on sexually transmitted infections (STIs). She states that "STIs are discriminatory." What would the nurse most likely use to support this statement? "All individuals are susceptible if exposed to the infectious organism." "Certain infections can be transmitted to the newborn." "After only a single exposure, women are twice as likely as men to acquire STIs." "Women are diagnosed with two thirds of the new cases of STIs annually." "Women are equally diagnosed over men as they will seek treatment first."

"Women are diagnosed with two thirds of the new cases of STIs annually." "After only a single exposure, women are twice as likely as men to acquire STIs." "Certain infections can be transmitted to the newborn." STIs are biologically sexist, presenting greater risk and causing more complications among women than among men. Women are diagnosed with two thirds of the new cases of STIs annually in the United States. After only a single exposure, women are twice as likely as men to acquire infections from pathogens. Certain infections can be transmitted in utero to the fetus or during childbirth to the newborn.

A client is receiving ceftriaxone as treatment for gonorrhea. What would be most important for the nurse to emphasize to the client? Report signs of an oral yeast infection. Avoid alcohol consumption. Take the drug on an empty stomach. Use a sunscreen when outside.

Avoid alcohol consumption. If alcohol is ingested when taking ceftriaxone, the client can experience a disulfiram-like reaction. Therefore the nurse would need to emphasize avoiding alcohol consumption. Taking the drug on an empty stomach may be appropriate but not the most important consideration. Using a sunscreen would be appropriate if the client was receiving doxycycline or tetracycline. Reporting the appearance of an oral yeast infection would be appropriate for a client receiving tetracycline.

A client is being discharged from the gynecological unit after treatment for acute pelvic inflammatory disease (PID). What priority instruction regarding disease management should the nurse include? Refer the client to the women's sexual health clinic. Discuss the necessity of completing the antibiotic therapy. Provide the client with brochures on sexually transmitted infection prevention. Arrange for follow-up visits to her health care provider.

Discuss the necessity of completing the antibiotic therapy.

A school health nurse is presenting information on sexually transmitted infections (STIs) to a high school class. The nurse feels confident that learning has taken place when the students report: genital cancer is associated with the STI genital herpes. most adolescents will seek early treatment to cure the STI. female adolescents are more susceptible to STIs due to their anatomy. adolescent females make up more than three-quarters of HIV diagnosis.

female adolescents are more susceptible to STIs due to their anatomy. STIs may cause chronic liver diseases and cancer due to hepatitis B (HBV) and C (HCV) infections. Genital cancer is associated with papillomavirus (HPV), and is AIDS caused by HIV. Adolescent males make up more than three-quarters of HIV diagnoses. Many health care providers fail to assess adolescent sexual behavior and STI risks or to screen for asymptomatic infection during clinic visits thus delaying treatments. STIs are not curable. Many female adolescents are more susceptible to STIs due to their anatomy.

The nurse is caring for a client diagnosed with trichomoniasis. The health care provider has prescribed a single dose of metronidazole. Which information will the nurse provide this client? "You may crush or chew this tablet if you have difficulty swallowing medications." "Avoid alcohol consumption for at least 24 hours after you take this medication." "We need to complete a pregnancy test first, to be sure you can take this medication." "Once you are healed, you need to come back to get the human papillomavirus (HPV) vaccination."

"Avoid alcohol consumption for at least 24 hours after you take this medication." Metronidazole is an antibiotic used to treat bacterial infections of the vagina. The HPV vaccine is not required for clients diagnosed with trichomoniasis. The nurse would educate the client that having one sexually transmitted infection (STI) places the client at higher risk for future STIs; however, the client does not have to receive the vaccine. A pregnancy test is not necessary, because metronidazole is safe to take during pregnancy. Clients should not consume alcohol or foods or medicines that contain propylene glycol while taking metronidazole and for at least 1 day after to avoid unpleasant side effects (tachycardia, flushed, nausea, vomiting). The nurse would instruct the client to not crush, chew, or break the extended-release tablet.

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea? painless chancre burning on urination dry, hacking cough diffuse skin rash

burning on urination Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.

The nurse is caring for clients in a community health clinic. Which clients does the nurse recognize need screening for sexually transmitted infections? Select all that apply. An incarcerated 28-year-old client. Initial examination after a sexual assault. Annual exam for a 24-year-old sexually active woman. A 35-year-old client in a committed heterosexual relationship. A pregnant woman in the third trimester.

An incarcerated 28-year-old client. A pregnant woman in the third trimester. Initial examination after a sexual assault. Annual exam for a 24-year-old sexually active woman. Those who are incarcerated are at higher risk and men younger than 30 and women younger than 35 should be tested for STIs. All pregnant women are screened at their first visit and in the third trimester. Anyone who has been sexually assaulted should be tested for STIs at the initial examination and 1 to 2 weeks after the assault. Sexually active women under 25 years old should be tested annually. Heterosexual couples in a committed relationship do not need to be screened unless there are multiple partners or one member has been diagnosed with an STI.

The nurse cares for a client recently diagnosed with syphilis who has no known drug allergies. Which medication will the nurse expect the health care provider to prescribe? miconazole doxycycline metronidazole benzathine penicillin G

benzathine penicillin G Current guidelines recommend benzathine penicillin G injection (long-acting penicillin) as the preferred treatment for syphilis. If the client is allergic to penicillin, other medications (e.g., doxycycline, tetracycline, or ceftriaxone) may be used; however, data to support the use of these medications to treat syphilis are limited. Metronidazole is the treatment for trichomoniasis, and miconazole is the treatment for candidiasis.

A client with a family history of cervical cancer is to undergo a Papanicolaou test. During the client education, what group should the nurse include as at risk for cervical cancer? clients who have not had babies clients who have genital warts clients with fibrocystic breast disease clients with irregular menstrual cycles

clients who have genital warts The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer.

The nurse administers erythromycin ophthalmic ointment to a newborn. If noted hours after administration, which finding will the nurse report to the health care provider? The father states he is allergic to penicillin. The newborn has mild redness in both eyes. The newborn has small hives on the back. The newborn is noted to blink and rub the eyes occasionally.

The newborn has small hives on the back. Erythromycin is a prophylactic agent instilled into the eyes of all newborns to prevent gonococcal ophthalmia neonatorum. After administering the eye ointment, the nurse would assess the newborn for signs of an allergic reaction which include hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or swallowing; or swelling of the mouth, face, lips, tongue, or throat. Mild redness is a common side effect and does not require reporting. Blinking and rubbing of the eye could be related to blurred vision or changes in vision the newborn is experiencing. The father being allergic to penicillin is not cause to report an already administered medication. The father being allergic does not indicate the newborn is also allergic to a medication. The newborn would be monitored more closely when given penicillin drugs.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms? azithromycin metronidazole penicillin valacyclovir

metronidazole The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole.

A community health nurse is conducting an educational session at a local community center on sexually transmitted infections (STIs). The nurse considers the session successful when participants identify which statement as correct? "Human papillomavirus is the cause of essentially all cases of cervical cancer." "At least antibiotics will cure a sexually transmitted infection." "Gonorrhea and syphilis are infections seen only in men." "STIs can't be transmitted through oral sexual intercourse."

"Human papillomavirus is the cause of essentially all cases of cervical cancer." Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which is the fourth most common cancer in women in the United States. Up to 95% of cervical squamous cell carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV. Antibiotics will only cure those STIs caused by bacterial infections. A viral STI infection is a lifetime infection. Gonorrhea and syphilis affect both men and women. Sexually transmitted infections are infections of the reproductive tract caused by microorganisms transmitted through oral sexual intercourse.

A nurse is caring for a client with vaginitis. What teaching(s) should the nurse provide to the client to prevent recurrent vaginal infections? Select all that apply. Avoid using deodorant tampons. Take a bubble bath once a week. Avoid douching. Clean the perineal area from back to front. Wear only cotton panties and ventilated pantyhose.

Avoid douching. Avoid using deodorant tampons. Wear only cotton panties and ventilated pantyhose. The nurse should teach the client ways to help prevent vaginitis. Prevention activities include avoiding douching to prevent altering the vaginal environment; using condoms to avoid spreading the organism; urinating with knees spread wide apart; avoiding tights, nylon underpants, and tight clothes; wiping from front to back after using the toilet; washing only with hypoallergenic bar soap, avoiding liquid soaps or body washes; avoiding powders, bubble baths, and perfumed vaginal sprays; wearing clean cotton underpants; and washing and drying the vulvar area gently after baths or showers.

The nurse is assessing a female client diagnosed with primary stage genital herpes simplex virus. Which finding will the nurse report to the health care provider? cloudy fluid-filled blisters on the genitals discomfort during urination reddened perineum loss of genital hair

loss of genital hair Genital herpes simplex virus (HSV) is characterized by blisters and sores of the vulva, vagina, and perineal areas. The nurse would report symptoms not expected or associated with the client's current diagnosis. Alopecia is a symptom of syphilis, not of primary genital HSV. This should be reported as additional assessment and testing may be needed to determine the cause. Findings of the primary stage of a genital HSV infection include fluid-filled blisters (either clear or cloudy); red skin behind the blisters; ruptured blisters that turn into sores; painful urination; and perineal pruritis.

A nurse is caring for a client positive for human immunodeficiency virus (HIV). The client is on triple-combination highly active antiretroviral therapy (HAART). What should the nurse include in the teaching plan when educating the client about the treatment? Select all that apply. Unpleasant side effects such as nausea and diarrhea are common. Provide written materials describing diet, exercise, and medications. Successful antiretroviral therapy may prevent acquired immunodeficiency syndrome (AIDS). Exposure of fetus to antiretroviral agents is completely safe. Ensure that the client understands the dosing regimen and schedule.

Unpleasant side effects such as nausea and diarrhea are common. Provide written materials describing diet, exercise, and medications. Ensure that the client understands the dosing regimen and schedule

The nurse is caring for a client diagnosed with candida vaginitis. The nurse knows additional teaching is needed when the client makes which statement? "I should wear cotton underwear to prevent future infections." "Low blood sugar levels are a way to control vaginal infections." "Eating yogurt can may help limit future infections." "Douching is an effective way to cleanse the vaginal area after intercourse."

"Douching is an effective way to cleanse the vaginal area after intercourse." An acidic environment helps protect against ascending infections in the vagina. Douching can alter the pH of the vagina, causing an alkaline environment where candida infections thrive. The client should be cautioned against using douches, hygiene sprays, or deodorants that might upset the acid balance. Cotton underwear promotes vaginal dryness, which will help prevent vaginal infections. Probiotics can help balance vaginal bacteria and limit infections. Foods such as yogurt and fermented foods contain probiotics. Infections also thrive when blood glucose levels are high; therefore, clients with diabetes must maintain balanced levels to promote healing and limit infections.

A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching? "This drug will help reduce my risk for a recurrence after discontinuing it." "The severity of future attacks will be much less after using this drug." "This drug will help to suppress any symptoms of the infection." "If I use this drug, I will be cured of the infection."

"This drug will help to suppress any symptoms of the infection." No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. Advances in treatment with acyclovir 400 mg orally three times daily for 7 to 10 days, famciclovir 250 mg orally three times daily for 7 to 10 days, or valacyclovir 1 g orally twice daily for 7 to 10 days have resulted in an improved quality of life for those infected with herpes simplex virus (HSV). However, according to the CDC, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.

A school health nurse is providing education to a group of adolescents regarding the proper procedure for male condom use. The nurse knows the teaching has been effective when which statement is made by a student? "It is important to put the condom on just before the penis is erect." "Use only petroleum-based lubricants, such as body lotion or massage oil." "Withdraw the penis erect, holding the condom firmly against the penis." "Ensure your condom is always available, so store condoms in your wallet."

"Withdraw the penis erect, holding the condom firmly against the penis." The teaching guidelines for proper condom use include: ensure the condom has been stored in a cool, dry place away from direct sunlight. Do not store condoms in wallet; put the condom on before any genital contact; put the condom on when penis is erect; ensure adequate lubrication during intercourse. If external lubricants are used, use only water-based lubricants. Oil-based or petroleum-based lubricants, such as body lotion or massage oil, can weaken latex condoms. Withdraw while penis is still erect, and hold condom firmly against base of penis. Remove carefully to ensure no semen spills out.

A pregnant client arrives at the community clinic reporting fever blisters and cold sores on the lips, eyes, and face. The health care provider has diagnosed it as the primary episode of genital herpes simplex virus (HSV), for which antiviral therapy is recommended. Which information should the nurse offer the client when educating her about managing the infection? Kissing during the primary episode does not transmit the virus. Antiviral drug therapy cures the infection completely. Safety of antiviral therapy during pregnancy has not been established. Recurrent HSV infection episodes are longer and more severe.

Safety of antiviral therapy during pregnancy has not been established. The nurse should inform the client that there is no evidence to suggest that antiviral therapy is completely safe during pregnancy. HSV cannot be cured completely, even with timely antiviral drug therapy, and there may be recurrences. The viral shedding process continues for 2 weeks during the primary episode, and kissing during this period may transmit the disease. Recurrent HSV-infection episodes are shorter and milder.