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
12 Jun 2019
Urogenital infections remain a major reason for women to visit their family physician and their subsequent referral to obstetrics and gynaecology or urology specialists. The association between abnormal vaginal microbiota and an increased risk of contracting sexually transmitted diseases (STDs), as well as an increased rate of preterm labour, indicates the need to better understand and manage urogenital health in women. Probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”. As such, there is a sound rationale for using probiotics to maintain female vaginal and bladder health.
Audrey Abella, 27 Mar 2020
The angiotensin receptor blocker (ARB) losartan did not improve inflammation, T-cell immune recovery, or fibrotic activity among older persons living with HIV (PLHIV) and viral suppression, according to data presented at CROI 2020.