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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Infectious Diseases - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Tristan Manalac, 12 Feb 2020
Incorporating genotyping of human adenovirus (HAdV) infections in clinical practice may inform risk stratification and treatment decisions, according to a new Singapore study.
Tristan Manalac, 25 Oct 2019
Old age and lower white cell counts are significant risk factors for poor platelet recovery among dengue patients with thrombocytopaenia, according to a recent Singapore study.
Tristan Manalac, 19 Oct 2017
White matter (WM) integrity in HIV-infected children is compromised despite early antiretroviral therapy (ART) and viral load (VL) suppression, with damage persisting at 5 years of age and evidence of new damage present, a recent study has shown.
14 Feb 2020
A 10-day or 14-day sequential therapy strategy is more cost-effective than a conventional triple therapy in the management of patients with Helicobacter pylori infection, in addition to being more effective in terms of eradication of infection, as reported in a study from Egypt.