genital%20herpes
GENITAL HERPES
Genital herpes is a recurrent lifelong disease with no cure, caused by herpes simplex virus (HSV).
HSV-2 is usually the cause but HSV-1 may occur in up to 1/3 of new cases.
HSV-1 tends to cause fewer recurrences & milder disease than HSV-2.
The incubation period is 2 days-2 weeks after exposure.

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
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