Genital%20herpes Treatment

• 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