Genital herpes recurrent infections

Genital herpes Recurrent infections (more than four episodes per yeai) Acyclovir Excellent efficacy... 

HIV-infected patients 500 mg twice daily for 7 days for recurrent orolabial or genital herpes simplex infection. 

Recurrent orolabial and genital herpes simplex infection in HIV-infected patients... 

Parenteral acyclovir is the drug of choice for the treatment of initial and recurrent 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 (Whitley, 1997). Intravenous acyclovir should also be used for severe diseases such as encephalitis (Brady and Bernstein, 2004). 

In a randomized, placebo-controUed study in 455 patients oral famciclovir (125 or 250 mg tds or 250 mg bd) used to suppress recurrent genital Herpes simplex infections, the toxicity profile of famciclovir was comparable to placebo (4). The only serious adverse effects reported as being possibly related to famciclovir were raised bilirubin concentration and lipase activity in one patient after 10 months of treatment with famciclovir 125 mg tds. However, these laboratory abnormalities resolved on therapy after 7 days and did not recur during the rest of the study. 

Kinghorn GR, Woolley PD, Thin RN, De Maubeuge J, Foidart JM, Engst R. Acyclovir vs isoprinosine (immunovir) for suppression of recurrent genital Herpes simplex infection Genitourin Med 1992 68(5) 312-16. 

A double-blind placebo-controlled trial of an ointment containing 8% lithium succinate showed that more rapid healing of herpetic ulcers occurred and viral excretion was reduced. There was a decreased duration of pain in patients with recurrent genital herpes simplex infection [80]. Lithium compounds therefore have considerable potential for topical application in cutaneous viral infections. 

Herpes Simplex. There are two types of herpes simplex vims (HSV) that infect humans. Type I causes orofacial lesions and 30% of the U.S. population suffers from recurrent episodes. Type II is responsible for genital disease and anywhere from 3 x 3 x 10 cases per year (including recurrent infections) occur. The primary source of neonatal herpes infections, which are severe and often fatal, is the mother infected with type II. In addition, there is evidence to suggest that cervical carcinoma may be associated with HSV-II infection (78—80). 

The antiviral mechanism of action of acyclovir has been reviewed (72). Acyclovir is converted to the monophosphate in herpes vims-infected cells (but only to a limited extent in uninfected cells) by viral-induced thymidine kinase. It is then further phosphorylated by host cell guanosine monophosphate (GMP) kinase to acyclovir diphosphate [66341 -17-1], which in turn is phosphorylated to the triphosphate by unidentified cellular en2ymes. Acyclovir triphosphate [66341 -18-2] inhibits HSV-1 viral DNA polymerase but not cellular DNA polymerase. As a result, acyclovir is 300 to 3000 times more toxic to herpes vimses in an HSV-infected cell than to the cell itself. Studies have shown that a once-daily dose of acyclovir is effective in prevention of recurrent HSV-2 genital herpes (1). HCMV, on the other hand, is relatively uninhibited by acyclovir. 

Acyclovir (Zovirax) and penciclovir (Denavir) are the only topical antiviral dragp currently available These dragp inhibit viral replication. Acyclovir is used in the treatment of initial episodes of genital herpes, as well as heqies simplex virus infections in immunocompromised patients (patients with an immune system incapable of fighting infection). Penciclovir is used for the treatment of recurrent herpes labialis (cold sores) in adults. 

The goals of therapy in genital herpes infection are to shorten the clinical course, prevent complications, prevent the development of latency and/or subsequent recurrences, decrease disease transmission, and eliminate established latency. 

Genitai herpes Treatment or suppression of recurrent episodes of genital herpes. Herpes simpiex Treatment of recurrent mucocutaneous herpes simplex infections in HIV-infected patients. 

Genital herpes Treatment or suppression of genital herpes in immunocompetent individuals and for the suppression of recurrent genital herpes in HIV-infected individuals. 

HIV-infected patients In HIV-infected patients with CD4 cell count at least 100 cells/mm, the recommended dosage of valacyclovir for chronic suppressive therapy of recurrent genital herpes is 500 mg twice daily. The safety and efficacy of therapy with valacyclovir beyond 6 months in patients with HIV infection have not been established. 

Newer agents of this class are famciclovir and cidofovir. Famciclovir is a prodrug of penciclovir with improved oral bioavailability. It is labelled for the suppression of recurrent episodes of genital herpes in immunocompetent adults and for the treatment of recurrent mucocutaneous herpes simplex infections in HIV-infected patients. 

Oral acyclovir is useful in the treatment of HSV-1 and HSV-2 infections, such as genital herpes, herpes encephalitis, herpes keratitis, herpes labialis, and neonatal herpes. In initial episodes of genital herpes, oral acyclovir has been found to reduce viral shedding, increase the speed of healing of lesions, and decrease the duration of pain and new lesion formation. Acyclovir appears to be less effective in the treatment of recurrent herpes genitalis but may be used for the long-term suppression of recurrent HSV. 

Intravenous acyclovir is used in the treatment of herpes simplex encephalitis, neonatal HSV infection, and mucocutaneous HSV infection in immunocompromised individuals. Acyclovir ointment is used in the treatment of initial genital herpes but is not effective for recurrent disease. Ophthalmic acyclovir formulations, although not available in the United States, are effective in the treatment of herpes keratoconjunctivitis. 

Famciclovir is indicated for the treatment of acute herpes zoster (shingles) it is at least as effective in reducing pain and healing time. Famciclovir is generally as effective as acyclovir in the treatment of HSV. In immunocompetent patients, famciclovir is approved for the treatment and prophylaxis of recurrent genital herpes. For HIV-infected individuals, famciclovir is approved for the treatment of all recurrent mucocutaneous HSV infections. 

Treatment of herpes simplex virus infection of the skin and mucous membrane, including initial and recurrent genital herpes. 

Topical acyclovir is substantially less effective than oral therapy for primary HSV infection. It is of no benefit in treating recurrent genital herpes. 

Genital herpes simplex Recurrent infection (2 4 episodes per year) Acyclovir Excellent... 

Echinacea has been used investigationally to enhance hematologic recovery following chemotherapy. It has also been used as an adjunct in the treatment of urinary tract and vaginal fungal infections. These indications require further research before they can be accepted in clinical practice. E purpurea is ineffective in treating recurrent genital herpes. 

Indications PO - acute treatment of herpes zoster (shingles) Initial episodes and the management of genital herpes Treatment of chickenpox (varicella) IV - treatment of initial and recurrent mucosal and cutaneous herpes simplex (HSV-1 and HSV-2) in immunocompromised patients Treatment of herpes simplex encephalitis Treatment of neonatal herpes infections Treatment of varicella-zoster (shingles) infections in immunocompromised patients... 

PFA has recently undergone clinical evaluation in humans for the treatment of recurrent genital herpes, hepatitis B viral infection, and acquired immunodeficiency syndrome (AIDS), as well as cytomegalovirus (CMV) infection of bone marrow and renal transplant patients. 

Valacyclovir Valtrex Treatment of initial and recurrent herpesvirus infections, including herpes simplex (genital herpes] and herpes zoster (shingles]... 

Amsterdam JD, Maislin G, Potter L, Giuntoli R. Reduced rate of recurrent genital herpes infections with lithium carbonate. Psychopharmacol Bull 1990 26(3) 343-7. 

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. 

A large, multicenter, double-blind, randomized, placebo-controUed, parallel-design study showed oral valacyclovir and oral acyclovir equally effective in the self-initiated treatment of recurrent genital herpes infection (Valaciclovir International Study Group). 

Chosidow O, Drouault Y, Leconte-Vavriac F, et al. Famciclovir vs. aciclovir in immunocompetent patients with recurrent genital herpes infections a parallel-groups, randomized, double-blind clinical trial. BrJ Dermatol 2001 144(4) 818-824. 

Valacyclovir is indicated for the treatment of herpes zoster (shingles), for the treatment of initial and recurrent episodes of genital herpes, and for the suppression of recurrent genital herpes in immunocompetent and HIV-infected patients. It is also indicated for the reduction of transmission of genital herpes in immunocompetent individuals, and for the treatment of cold sores. Valacyclovir appears to be equally effective in treating herpes zoster and recurrent genital herpes in immunocompetent adults. Valacyclovir has shown efficacy in the prophylaxis of cytomegalovirus infections in transplant patients (Perry and Faulds, 1996). 

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