Most cases of recurrent genital herpes are caused by HSV-2, and approximately 50 million persons in the United States are infected with this type of genital herpes (318). Intravenous (IV) acyclovir therapy should be provided for patients who have severe HSV disease or complications that necessitate hospitalization (e. Acyclovir can be safely used to treat women in all stages of pregnancy, along with those who are breastfeeding (317,377). Single-day therapy for HSV infection is appealing for multiple reasons. In addition to burning and paresthesias at the affected site, both men and women may also experience dysuria and systemic symptoms such as fever, malaise, and localized inguinal adenopathy (Whitley et al 1998; Nadelman and Newcomer 2000). Acyclovir was the first antiviral agent to be used in the treatment of herpes infections, traditionally as a 5-day course (Reichman et al 1984). This drug is available in topical, oral, and intravenous (IV) forms (Nadelman and Newcomer 2000). Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. Antiviral medicines such as aciclovir, famciclovir, and valaciclovir are used to treat genital herpes infection. However, an antiviral medicine may be advised for recurrent episodes of genital herpes in the following situations:. For most women with recurrent genital herpes, it is felt to be safe to have a normal vaginal delivery.
Common severe infections include encephalitis, meningitis, neonatal herpes, and, in immunocompromised patients, disseminated infection. Treatment is symptomatic; antiviral therapy with acyclovir, valacyclovir, or famciclovir is helpful for severe infections and, if begun early, for recurrent or primary infections. Both types of herpes simplex virus (HSV), HSV-1 and HSV-2, can cause oral or genital infection. Give IV acyclovir to patients with serious infections. For severe HSV infections (especially disseminated HSV), IV aciclovir may also be used. Aciclovir is excreted in the breast milk, therefore it is recommended that caution should be used in breast-feeding women. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. The diagnosis of genital HSV infection may be made clinically, but laboratory confirmation is recommended in patients presenting with primary or suspected recurrent infection. 1 Topical acyclovir reduces the duration of viral shedding and the length of time before all lesions become crusted, but this treatment is much less effective than oral or intravenous acyclovir.1. Dosage 200 mg five times daily for 10 days, given within six days of lesion onset.
The diagnosis of neonatal HSV can be difficult, but it should be suspected in any newborn with irritability, lethargy, fever or poor feeding at one week of age. All newborns suspected to have or who are diagnosed with HSV infection should be treated with parenteral acyclovir. After two days of negative bacterial cultures, intravenous antibiotics (ampicillin and cefotaxime Claforan ), and clinical improvement, he was discharged home. Acyclovir should be given to all pregnant women with active genital HSV infection near term or at the time of delivery. In a pregnant woman with HSV infection (usually HSV-2), the virus can pass to the baby during delivery, causing infections of the newborn’s skin, mouth, lungs or eyes. It can be recurrent, a condition known as Mollaret’s meningitis. Acyclovir also comes in a cream for application to the skin. If a newborn baby is infected with herpes, the infection is treated with an antiviral medication given intravenously. Intravenous, oral, and topical antiviral medications are available for treatment of HSV and are most effective if used at the onset of symptoms. Oral therapy can be given at the time of the episode or as chronic suppressive therapy. In patients who are immunocompromised and have recurrent HSV infections, acyclovir-resistant HSV strains have been identified, and treatment with intravenous foscarnet or cidofovir may be used. Seroprevalence of herpes simplex virus types 1 and 2 in pregnant women in the United States.
Herpes Simplex Virus (HSV) Infections
Antiviral agents used to treat herpes simplex virus infections are nucleoside analogs. Intravenous (IV) acyclovir is indicated for the treatment of encephalitis, any form of neonatal disease, severe infection in patients who are immunocompromised, and occasional cases of severe orolabial or genital disease. Treatment Oral Health and Nutraceuticals: Can Green Tea Treat Herpes? Anyone infected with either virus, regardless of their HIV status, can experience oral or genital herpes flare-ups. Genital herpes: Sores on the penis in males or near or in the vagina in women. Intravenous acyclovir is used to treat serious flare-ups or outbreaks that effect internal organs (especially HSV infection of the central nervous system). HIV-positive patients with suppressed immune systems usually a CD4 cell count less that 100 who have been receiving long-term acyclovir for the treatment and prevention of recurrent herpes flare-ups have been known to develop drug-resistant herpes. Primary infection may be accompanied by systemic symptoms, including fever, headache, myalgia, and aseptic meningitis. Severe outbreaks can require use of intravenous acyclovir. (12) A recent metaanalysis concluded that HSV-2 infection increases the risk of HIV-1 acquisition approximately 3-fold in both men and women, and that primary HSV-2 infection may have an even greater effect on HIV-1 susceptibility. Antiviral medications given for episodic outbreaks or as long-term suppressive treatment provide important clinical benefits to patients. Oral sex with an infected partner can transmit HSV-1 to the genital area. Some women with new or recurrent herpes may also be prescribed antiviral medication during pregnancy. They usually receive several weeks of intravenous acyclovir treatment, often followed by several months of oral acyclovir. Aciclovir is the most widely prescribed antiviral drug in the world. It has been shown to stop the growth of Herpes simplex virus (HSV), Varicella zoster virus (VZV) (the cause of chickenpox and shingles), Epstein Barr Virus (EBV, the cause of glandular fever), and to a lesser extent Cytomegalovirus (CMV). In zoster infections, it also reduces the severity and duration of pain, and may prevent post-herpetic neuralgia. Intravenous aciclovir achieves higher blood levels compared to oral aciclovir. The primary episode of genital HSV infection can be associated with a multitude of constitutional symptoms and signs, such as fever, malaise, and headache. Risk of recurrence after treatment of first-episode genital herpes with intravenous acyclovir. Famciclovir suppression of asymptomatic and symptomatic recurrent anogenital herpes simplex virus shedding in women: a randomized, double-blind, double-dummy, placebo-controlled, parallel-group, single-center trial.
Neonatal Herpes Simplex Virus Infections
A. Primary Infection;- Man is the only natural host to HSV, the virus is spread by contact, the usual site for the implantation is skin or mucous membrane. (ara-A) – intravenous ara-A can be used for the treatment of neonatal herpes and HSE. As with primary HSV-1 infection, recurrent infection may occur in the absence of clinical symptoms. Women are also more likely to have meningeal symptoms and dysuria. Given the decreased propensity of HSV-1 to reactivate at the genital site, however, it is likely that oral-genital contact accounts for most genital HSV-1 infections (126). Recurrent aseptic meningitis due to HSV-2 may occur with or without symptomatic herpetic mucocutaneous disorder. A woman aged 33 years presented with a 4-day history of intractable headache, photophobia, nausea, and neck and back discomfort. Her symptoms resolved shortly after treatment with intravenous acyclovir, and no further episodes were observed during a suppressive regimen of daily acyclovir in the ensuing 3 years. However, some antiviral drugs have been used to treat HSV infections, and some doctors may attempt to use antiviral drugs on other acute viral infections. No antiviral drugs to date are used to treat arboviral infections. Herpes encephalitis can cause rapid death if not diagnosed and treated promptly. The recommended treatment is acyclovir (Zovirax) given by IV for two to three weeks.
If the primary (or initial) oral HSV-1 infection causes symptoms, they can be very painful, particularly in small children. Intravenous acyclovir is the treatment of choice for encephalitis and should be started immediately if this complication is suspected. Men, however, have twice as many recurrent infections as women. Topical 5 lidocaine jelly can be used as a local anesthetic for pain. Although any herpes virus can cause encephalitis, the herpes simplex virus is the most important cause of encephalitis. Corticosteroids may be given to reduce brain swelling. Women may also be superinfected by yeast vaginitis during the course of the illness. The strategy for managing recurrent episodes consists of episodic treatment to ameliorate or shorten the duration of illness or suppressive treatment to reduce the frequency of recurrences. In patients with severe disease or with disseminated infection such as meningitis, IV acyclovir should be given. These anti-HSV drugs may result in additional clinical and public health benefits for persons with HIV-1 and HSV-2 coinfection by decreasing HIV-1 levels in the blood and genital tract. A, Severe chronic vulvar HSV-2 coinfection in an HIV-infected woman with a CD4+ cell count of 130 cells/mm3 (photograph courtesy of Steven Kuntz). For treatment of severe or disseminated disease, intravenous acyclovir should be used. III trial, called the HERPEVAC Trial for Women, which began in November 2002. Most countries have approved it for use in HSV infections due to its antiviral action, and more significantly, the ability to stimulate the body’s immune response. There are three major pills commonly prescribed to treat herpes: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Severe cases may be treated with intravenous (IV) acyclovir. Primary infection may be associated with constitutional symptoms, often with urinary retention (in women), with or without aseptic meningitis (30 women; 10 men) and takes longer to resolve than recurrent disease. Pregnant women: may develop disseminated infection if primary infection occurs during pregnancy. Usually seen in those with significant anti-HSV medication exposure. Acute meningitis: acyclovir 10 mg/kg IV q8h X 7-10d.