Genital herpes first episode

Genital herpes, first episode PO 250 mg 3 times a dayfor 7-10 days. 

Genital herpes (recurrent episodes) 125 mg twice daily for 5 days. Initiate therapy at the first sign or symptom if medical management of a genital herpes recurrence is indicated. 

YT Bryson, M Dillon, G Acuna, S Taylor, JD Cherry, BL Johnson, E Wiesmeier, W Growden, T Greagh-Kirk, R Keeney. Treatment of first episodes of genital herpes simplex virus infection with oral acyclovir. A randomized double-blind controlled trial in normal subjects. N Engl J Med 308 916-921, 1983. 

Tissue culture is the most specific (100%) and sensitive method (80% to 90%) of confirming the diagnosis of first-episode genital herpes. 

Oral acyclovir, valacyclovir, and famciclovir are the treatments of choice for outpatients with first-episode genital herpes. Treatment does not prevent latency or alter the subsequent frequency and severity of recurrences. 

First initial clinical episode of genital herpes 400 mg 3 times/day for 7 to 10 days or 200 mg 5 times/day for 7 to 10 days. 

Genital herpes Acyclovir is not a cure for genital herpes. There are no data evaluating whether acyclovir will prevent transmission of infection to others. Avoid contact with lesions, or avoid intercourse when lesions and/or symptoms are present to prevent infecting partners. Genital herpes can also be transmitted in the absence of symptoms. Initiate therapy at the first sign or symptom of an episode. 

Start valacyclovir treatment at the first sign of a recurrent episode of genital herpes or herpes zoster treatment is most effective when started within 48 hr after symptoms first appear... 

Acyclovir1 Oral First episode genital herpes 400 mg tid or 200 mg 5 times daily x 7-10 days... 

Famciclovir1 Oral First episode genital herpes 250 mg tid... 

Oral acyclovir, valacyclovir, and famciclovir are the treatments of choice for outpatients with first-episode genital herpes. Treatment does not prevent latency or alter the subsequent frequency and severity of recurrences. Continuous oral antiviral therapy reduces the frequency and the severity of recurrences in 70% to 90% of patients experiencing frequent recurrences. Acyclovir, valacyclovir, and famciclovir have been used to prevent reactivation of infection in patients seropositive for HSV who undergo transplantation procedures or induction chemotherapy for acute leukemia. 

Fife KH, et al. Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Smdy Group. SexTransm Dis 1997 24(8) 481-486. 

Parenteral acyclovir is the drug of choice for the treatment of initial and recuiTent mucosal or cutaneous herpes simplex infections in immunocompromised patients and for the treatment of disseminated, neonatal, encephalitic, and severe first episodes of genital herpes simplex infections in immunocompetent patients (Whidey, 1997). Ind avenous acyclovir should also be used for severe diseases such as encephalids (Brady and Bernstein, 2004). 

Of the agents available for treatment, acyclovir has had the longest period of use and has not demonstrated an increased risk of birth defects with first-trimester use. More data will need to be collected to strengthen the safety data. Both valacyclovir and famciclovir are newer, and data on safety are more limited. Most women will receive oral acyclovir therapy for first episodes of genital herpes or with recurrence. Intravenous acyclovir can be used for severe infections. 

Complications from genital herpes infections result from both genital spread and autoinoculation of the virus and occur most commonly with primary first episodes. Lesions at extragenital sites, such as the eye, rectum, pharynx, and fingers, are not uncommon. CNS involvement is seen occasionally and may take several forms, including an aseptic meningitis, transverse myehtis, or sacral radiculopathy syndrome." ... 

The role of antiviral agents in the treatment of most recurrent genital herpes episodes is controversial. Because signs and symptoms of recurrent infections generally are milder and of shorter duration than those of first-episode infections in immunocompetent hosts, demonstration of clinically important therapeutic benefits is difficult. 

First episodes of genital HSV usually respond to the topical use of acyclovir, but oral or parenteral administration is necessary to treat recurrent disease. Acyclovir treatment by any mode of administration does not eradicate latent herpes and will not prevent recurrence of the disease. Note that the drug is secreted in breast milk and—while there are no reports of human teratogenicity—acyclovir is a potential mutagen. The answer is (D). 

Corey L, Benedetti J, Critchlow C, Mertz G, Douglas J, Fife K, Fahnlander A, Remington ML, Winter C, Dragavon J (1983) Treatment of primary first-episode genital herpes simplex virus infeetions with aeyelovir results of topical, intravenous and oral therapy. J Antimicrob... 

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