Genital herpes treatment

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. 

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

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... 

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. 

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. 

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. 

Famciclovir, which is the pro-drug of penciclovir, is indicated in acute genital herpes simplex and in the treatment of varicella zoster. Famciclovir is available as tablets. Valaciclovir is the ester of aciclovir. 

Famciclovir is the prodrug of penciclovir and is indicated in the treatment of chickenpox and genital herpes. 

Oral Treatment of initial episodes and management of recurrent episodes of genital herpes. 

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

When valacyclovir is used as suppressive therapy in immunocompetent individuals with genital herpes, the risk of heterosexual transmission to susceptible partners is reduced. Instruct patients to use safer sex practices with suppressive therapy (see current Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines). 

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. 

Leung DT and Sacks SL. Current recommendations for the treatment of genital herpes. Drugs 2000 60 1329-1352. 

Dosage in hemodialysis patients For adults with herpes zoster, give 250 mg after each dialysis treatment for adults with genital herpes, give 125 mg after each dialysis treatment. 

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... 

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

Inhibition of glycosylation in virus-infected cells usually has dramatic effects on virus multiplication. This discovery prompted promulgation of a new concept in the experimental therapy of virus-induced diseases. Local treatment of the affected regions with 2-deoxy-D-arabtno-hexose led50n s02 to significant improvements in human-genital herpes infections, or Herpes simplex virus infection of the eye. 

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. 

Indication Treatment of herpes zoster (shingles) Treatment of genital herpes... 

Acyclovir is useful in the treatment of herpes. Oral herpes is caused by the herpes simplex virus 1 (HSV-1), and genital herpes is caused by the herpes simplex virus 2 (HSV-2). More than 90 percent of the world s population is infected with the oral herpes virus, though there are many infected people who do not exhibit symptoms. Genital herpes is the most prevalent nondurable sexually transmitted disease. In the United States, there are about 30 million people infected with HSV-2 and an estimated 200,000 to 500,000 new cases each year. 

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. 

Acyclovir (ACV) is not a true nucleoside, because the guanine residue is attached to an open-chain structure, but it mimics deoxyribose well enough for the compound to be accepted as a substrate by a thymidine kinase specified by certain herpes-type viruses. The normal thymidine kinase in mammalian cells does not recognize ACV as a substrate, however, so only virus-infected cells convert ACV to its monophosphate. Once the first phosphate has been added, the second phosphate is added by cellular guanylate kinase several other cellular kinases can add the third phosphate. The triphosphate is a more potent inhibitor of the viral DNA polymerases than of cellular DNA polymerases and also inactivates the former but not the latter. The net result is that ACV has been an effective treatment of, and prophylaxis for, genital herpes. Also it can result in dramatic relief of pain associated with shingles caused by reactivation of latent varicella-zoster virus, and has been successful in many patients with herpes encephalitis. 

Famciclovir Famvir Treatment and suppression of herpesvirus infections, including herpes simplex (genital herpes] and herpes zoster (shingles]... 

Oral famciclovir is effective for the treatment of first and recurrent genital herpes attacks and for chronic daily suppression (Table 49-1). It is also used to treat acute herpes zoster (shingles). In controlled trials in immunocompetent patients with zoster, famciclovir was similar to acyclovir in rates of cutaneous healing but was associated with a shorter duration of postherpetic neuralgia. Comparison of famciclovir to valacyclovir for treatment of herpes zoster in immunocompetent patients showed similar rates of cutaneous healing and pain resolution. However, neither drug decreased the incidence of postherpetic neuralgia. 

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