This study compared the efficacy of a shorter, 3-day course (for 402 patients) with that of a 5-day course (for 398 patients) of valacyclovir for persons with frequent recurrence of symptoms. A 3-day course of 500 mg of valacyclovir administered twice daily as episodic treatment of recurrent genital herpes is equivalent to a 5-day course with regard to key markers of efficacy. Orally administered antiviral therapy for genital herpes is prescribed either to alleviate the acute symptoms and signs of an outbreak (i. Patients were asked to maintain a daily diary to record data regarding lesion stages (prodromal, macule/papule, vesicle/pustule/ulcer, crust, or healed), pain severity (none, mild, moderate, or severe), adverse events, concomitant medications, and compliance with the study drug regimen. The standard course of antiviral therapy for recurrent genital herpes requires administration of multiple doses of medication for 5 days. The times at which samples were obtained for viral cultures, medications were taken, and that lesions healed and symptoms resolved were noted on the diary card. Second, the efficacy of episodic antiviral therapy is clearly greatest when the patient self-administers the medication at the first sign or symptom of reactivation; the therapy is much less effective when initiated in a clinic after recognition of lesions 8. The total dose of acyclovir given in the shorter regimen (4800 mg) was lower than that given in the standard dosing regimens (5000 mg total for 200 mg of acyclovir given 5 times per day for 5 days, and 6000 mg total for 400 mg of acyclovir given t. Based on these concerns, recent studies have focused on shorter, less complicated, and more affordable options. Herpes simplex virus (HSV) causes an incurable viral infection that affects over 40 million people in the United States, with over 600,000 cases diagnosed each year (Nadelman and Newcomer 2000). Currently, two treatment options are available to patients with recurrent genital herpes: episodic and suppressive therapy. 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).
Antiviral agents can be used to treat disease (a therapeutic strategy), to prevent infection (a prophylactic strategy), or to prevent disease (a preemptive strategy). Resistance most commonly occurs in patients with chronic and/or progressive infections who have been exposed to prolonged or repeated courses of therapy. For the episodic treatment of recurrent genital herpes, dosing options for acyclovir include 200 mg orally five times per day, or 800 mg orally two times per day, administered for 5 days (Anonymous, 2002) (Table 64. Immunocompromised patients receiving acyclovir have a shorter duration of viral shedding and more rapid healing of lesions than patients receiving placebo (Meyers et al. If antiviral medicine (cream or oral) is started before exposure to the triggering factor (sunlight), it will provide some protection. Both topical and oral treatment can contribute to the prevention of herpes labialis. In addition, herpes labialis infection can result in genital herpes through orogenital contact. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antiviral therapy can shorten the duration of symptoms and signs in primary infection which, when untreated, can be associated with significant morbidity. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Oral acyclovir for episodic treatment of recurrent genital herpes. Valacyclovir for episodic treatment of genital herpes: a shorter 3-day treatment course compared with 5-day treatment.
Genital herpes simplex is caused by infection with the herpes simplex virus (HSV). Symptomatic and asymptomatic viral shedding become less frequent over time; however, it is possible to transmit the virus more than ten years after initial infection. BASHH advises the following short courses as options for first-line therapy:. If the recurrence rate is unacceptably high, suppressive treatment can be restarted. This form of intermittent treatment is termed episodic and focuses on management of isolated, acute episodes of a chronic, clinically silent disease. Although the treatment approaches used for oral and genital HSV infections are more similar than different, randomized controlled trials (RCT) have uniformly studied these infections separately. In moderate and severe cases, antiviral treatment is often recommended for uncomplicated episodes of primary oral herpes in healthy patients (Table 1). Intermittent Episodic Therapy or Recurrent Labial Herpes+View Large Save Table Download Slide (. Unlike topical acyclovir, the oral form can prevent new lesion formation and modify accompanying constitutional symptoms, and does not cause local irritation on application. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. Systemic symptoms are common in primary disease and include fever, headache, malaise, abdominal pain and myalgia.2,3 Recurrences are usually less severe and shorter in duration than the initial outbreak.
Antiviral Therapy Of HSV-1 And -2
This study compared the efficacy of a shorter, 3-day course (for 402 patients) with that of a 5-day course (for 398 patients) of valacyclovir for persons with frequent recurrence of symptoms. A 3-day course of 500 mg of valacyclovir administered twice daily as episodic treatment of recurrent genital herpes is equivalent to a 5-day course with regard to key markers of efficacy. However, genital herpes can also be transmitted when there are no visible symptoms. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus. If the primary (initial) oral infection causes symptoms, they can be very painful, particularly in children. Patient-initiated, short-course, high-dose OAV treatment of recurrent HSV outbreaks may be as effective as the traditional, longer-course regimens. Our review focuses on episodic treatment of acute recurrent HSV outbreaks for immunocompetent persons. As we will describe in detail, the efficacy of the new short-course therapy is, at minimum, comparable to that seen with the older, longer-course trials of topical and oral antiviral therapy. In both recurrent herpes labialis and genital herpes, HSV viral titers peak in the first 24 hours following lesion onset (FIGURE 1A). This information is not intended to promote off-label use of any of the medications. The margin of safety and tolerability of all three medications is excellent. The antiviral medications available in pill form acyclovir, valacyclovir, famciclovir have been specifically developed for the treatment of genital herpes. Treatment or suppression of recurrent genital herpes recurrent genital herpes: 125 mg twice daily for 5 days. All three of these oral antiviral drugs can be taken either episodically – when a person has an outbreak or feels one coming on, or suppressively – daily to help prevent the recurrence of outbreaks.
Herpes Simplex Genital. Genital Herpes Simplex Information
The key facts about Genital Herpes are that having herpes simplex is normal and anyone who has ever had sex can get genital herpes. Genital herpes is a common viral infection caused by the herpes simplex virus (HSV). Cold sores on the mouth and genital herpes are medically the same condition. HSV can be passed on when one person has the herpes virus present on the skin and another person makes direct skin-to-skin contact with live herpes virus. The doctor should have given your partner a course of antiviral treatment. However, recurrent outbreaks are usually shorter and less severe than the first herpes episode. Episodic treatment. Home Treatment Options Treatment Options The Treatment Landscape: What’s Now, What’s Next. (acyclovir, valacyclovir, and famciclovir) to prevent recurrent genital herpes. Additionally, though, this study demonstrated that an antiviral drug can be used to effectively prevent transmission of a sexually transmitted infection opening the door to the possibility that antiviral treatment might be studied as a means to prevent the transmission of other STIs, such as HIV.