Genital%20herpes Treatment
Pharmacotherapy
- Use is warranted in suspected or diagnosed initial genital herpes infection with lesions not yet fully crusted
- To be administered within 5 days of the start of infection and continued until new lesions are forming or if there is persistence of systemic symptoms
- Treatment within 1 day of lesion onset may end development of lesions
- Antivirals are effective in reducing severity and duration of symptoms
- Neither can eliminate the virus nor affect the risk and natural course of genital herpes infection
- Oral antivirals are more effective than topical agents in the management of the initial episode
- Choice of agent depends on cost, dosing schedule and patient preference
- Oral Aciclovir, Famciclovir, and Valaciclovir have similar efficacy
Aciclovir (Oral, IV)
- Acyclic purine nucleoside analogue that is a competitive inhibitor of viral DNA polymerase
- Limits viral replication and stops further spread of the virus to other cells
- Oral and IV are both effective in treating HSV-1 and HSV-2
- IV is usually reserved for severe disease or complications where hospitalization is necessary
- Topical agent has limited efficacy, hence not recommended
- Bioavailability is poor requiring frequent dosing
Famciclovir (Oral)
- Famciclovir is a pro-drug of Penciclovir
- Has higher bioavailability than Penciclovir and is rapidly converted to Penciclovir in GIT, blood and liver
- Penciclovir has similar mechanism of action as Aciclovir
Valaciclovir (Oral)
- L-valine ester pro-drug of Aciclovir, rapidly metabolized to Aciclovir by liver and intestine
- Has better absorption after oral administration than Aciclovir making lower doses or lesser dosing frequency possible
- Has been shown to decrease risk of transmission