Genital infections, treatment

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. 

Spiramycin is a 16-membered macrolide found in nature and used mainly in Europe. It is prescribed usually at divided doses of 1-2 g/day for the treatment of various odontogenic, upper and lower respiratory tract, and genital infections. 

This macrolide can be used effectively for the treatment of nongonococcal genital infections [331, 332]. In the therapy of H. py/on-associated peptic ulcer disease, combination therapy of spiramycin, metronidazole, and antacid/bismuth resulted in ulcer healing rates of 89-91% and bacteriological eradication rates of... 

Dylewski, J., Clecner, B., Dubois, J., St-Pierre, C., Murray, G., Bouchard, C., and Phillips, R. (1993). Comparison of spiramycin and doxycycline for treatment of Chlamydia trachomatis genital infections. Antimicrob. Agents Chemother. 37, 1373-1374. 

Treatment of Polymicrobial Infections. Treatment of intra-abdominal, hepatic, and brain abscesses, and some genital tract infections may require the use of a drug combination to eradicate these typically mixed aerobic-anaerobic infections. These and other mixed infections may be caused by two or more different microorganisms that are sufficiently different in antibiotic sensitivity that no single agent can provide the required coverage. 

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. 

Amikacin is indicated for the treatment of genital tract infections in the mare by intra-uterine infusion. 

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

Kross RD. 1997. Method and composition for prevention and treatment of female lower genital tract microbial infections. U.S. Patent No. 5,667.817. September 16, 1997. 

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. 

It is used in the treatment of severe anaerobic infections caused by bacteroides and other anaerobes. It is also used in combination with aminoglycoside in the treatment of abdomen and GIT wounds, infections of female genital tract, pelvic abscesses, aspiration pneumonia and septic abortion. It is also used for prophylaxis of endocarditis. It is also used along with primaquine in Pneumocystis carinii pneumonia in AIDS patients and with pyrimethamine for toxoplasmosis. 

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. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

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. 

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. 

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