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: Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Newly acquired genital herpes can cause a prolonged clinical illness with severe genital ulcerations and neurologic involvement. Patients with first-episode herpes who have mild clinical manifestations initially can develop severe or prolonged symptoms. Therefore, all patients with first episodes of genital herpes should receive antiviral therapy.
Medical Therapy
- All patients with a first-episode genital herpes require antimicrobial therapy.
- Antiviral chemotherapy offers clinical benefits to the majority of symptomatic patients and is the mainstay of management.
- Systemic antiviral drugs can partially control the signs and symptoms of herpes episodes when used to treat first clinical episodes and recurrent episodes or when used as daily suppressive therapy. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.
- 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 later develop severe or prolonged symptoms. Therefore, patients with initial genital herpes should receive antiviral therapy.
- General advice:
- Saline bathing
- Analgesia
- Topical anaesthetic agents such as 5% lidocaine ointment may be useful to apply especially prior to micturition but should be used with caution because of the 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
- Hospitalisation may be required for urinary retention, meningism, and severe constitutional symptoms.
- If catheterisation is required, suprapubic catheterisation is preferred to prevent theoretical risk of ascending infection, to reduce the pain associated with the procedure, to allow normal micturition to be restored without multiple removals and re-catheterisations
References
- ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in:
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