Herpes simplex genitalis antiviral treatment of first episode genital herpes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D., Lakshmi Gopalakrishnan, M.B.B.S.
Overview
All patients with a first-episode genital herpes require antimicrobial therapy. Medical therapies for first-episode genital herpes include either oral acyclovir, oral famciclovir, or oral valacyclovir. Intravenous antiviral agents may be administered among patients with severe first-episode genital herpes.
Medical Therapy
- All patients with a first-episode genital herpes require antimicrobial therapy.[1]
- Treatment aims to manage present lesions but not cure the disease or prevent future occurrences.
- Antiviral chemotherapy offers clinical benefits to the majority of symptomatic patients and is the mainstay of management.
- Topical therapy with antiviral drugs offers minimal clinical benefit, and its use is discouraged.
First Clinical Episode of Genital Herpes
Symptomatic Management
- Many patients with first-episode herpes have mild clinical manifestations, but they are often predisposed to developing severe or prolonged symptoms.
- Symptomatic therapy includes the following:[1]
- Saline bathing
- Analgesia
- Topical anaesthetic agents such as 5% lidocaine ointment may be applied prior to micturition (risk of potential sensitization)
Antimicrobial Therapy
- 1. Mild/Moderate genital HSV infection[1]
- 1.1. First episode of genital herpes
- Preferred regimen: Acyclovir 400 mg PO tid for 7–10 days OR Acyclovir 200 mg PO five times a day for 7–10 days OR Famciclovir 250 mg PO tid for 7–10 days OR Valacyclovir 1 g PO bid for 7–10 days
- Note (1): Treatment can be extended if healing is incomplete after 10 days of therapy
- Note (2): Dose-adjustment is often necessary among patients with impaired renal function
- 2. Severe genital HSV infection
- 2.1. First episode of genital herpes
- Preferred regimen: Acyclovir 5-10 mg/kg IV q8h for 2-7 days or until clinical improvement THEN (Acyclovir 400 mg PO tid for at least 10 days OR Acyclovir 200 mg PO five times a day for at least 10 days OR Famciclovir 250 mg PO tid for at least 10 days OR Valacyclovir 1 g PO bid for at least 10 days)
- Note: Dose-adjustment is often necessary among patients with impaired renal function
Management of Complications
- Hospitalization may be required for urinary retention, meningism, and severe constitutional symptoms.[1]
- If catheterization is required, suprapubic catheterization is preferred to reduce the risk of ascending infection and the pain associated with the procedure. Suprapubic catheterization also allows normal micturition to be restored without multiple removals and re-catheterisations.[1]