Immunocompromised patient genital herpes

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. 

Severe initial clinical episodes of genital herpes in patients who are not immunocompromised. 

Aciclovir is phosphorylated preferentially by herpes simplex virus-coded thymidine kinase and following further phosphorylation aciclovir triphosphate interferes with herpes virus DNA polymerase and viral DNA replication. Aciclovir topical cream is indicated in the management of initial genital herpes and in limited non-life threatening mucocutaneous herpes simplex virus infections in immunocompromised patients. 

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... 

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). 

Oral famciclovir is used for the treatment of immrmo-competent patients with herpes zoster infections and for the treatment and suppression of recuri ent genital HSV. It is also indicated for the treatment of recuri ent mucocutaneous herpes simplex in both immrmocompetent and immunocompromised patients. Famciclovir is fairly well tolerated. Adverse effects include headache, dizziness, nausea, and diarihea (Scholar and Pratt, 2000). 

Vidarabine Vidarabine is an adenine analog and has activity against HSV, VZV, and CMV. Its use for systemic infections is limited by rapid metabolic inactivation and by marked toxic potential. However, it has been used intravenously for severe HSV infections, including those resistant to acyclovir, and it also prevents the dissemination of varicella-zoster virus in immunocompromised patients. Vidarabine is used topically for herpes keratitis, but it has no effect on genital lesions. Toxic effects with systemic use include gastrointestinal irritation, paresthesias, tremor, convulsions, and hepatic dysfunction. Vidarabine is teratogenic in animals. 

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