Herpes simplex genitalis antiviral treatment of first episode genital herpes: Difference between revisions
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*General advice: | *General advice: | ||
:*Saline bathing | :*Saline bathing | ||
:*Analgesia | :*[[Analgesia]] | ||
:*Topical anaesthetic agents such as [[Lidocaine|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. | :*Topical anaesthetic agents such as [[Lidocaine|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. | ||
*Anti-viral therapy: | *Anti-viral therapy: | ||
:*Oral antiviral drugs are indicated within 5 days of the start of the episode and while new lesions are still forming. | :*Oral antiviral drugs are indicated within 5 days of the start of the episode and while new lesions are still forming. | ||
:*Antiviral therapy does not alter the natural history of the disease. | :*Antiviral therapy does not alter the natural history of the [[disease]]. | ||
:*Topical agents are less effective than oral agents. Combined oral and topical treatment is of no benefit. | :*Topical agents are less effective than oral agents. Combined oral and topical treatment is of no benefit. | ||
:*Intravenous therapy is indicated only when the patient cannot swallow or tolerate oral medication because of vomiting. | :*Intravenous therapy is indicated only when the patient cannot swallow or tolerate oral medication because of vomiting. | ||
| Line 26: | Line 26: | ||
:*[[Famciclovir]] 250 mg orally three times a day for 7-10 days ''OR'' | :*[[Famciclovir]] 250 mg orally three times a day for 7-10 days ''OR'' | ||
:*[[Valacyclovir]] 1 g orally twice a day for 7-10 days | :*[[Valacyclovir]] 1 g orally twice a day for 7-10 days | ||
==Management of Complications== | ==Management of Complications== | ||
*Hospitalisation may be required for urinary retention, meningism, and severe constitutional symptoms. | *Hospitalisation may be required for urinary retention, meningism, and severe constitutional symptoms. | ||
Revision as of 19:19, 6 March 2013
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Herpes simplex genitalis antiviral treatment of first episode genital herpes On the Web |
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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.
Principles of Management of Genital Herpes[1]
- 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[1]
- 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.
- Anti-viral therapy:
- Oral antiviral drugs are indicated within 5 days of the start of the episode and while new lesions are still forming.
- Antiviral therapy does not alter the natural history of the disease.
- Topical agents are less effective than oral agents. Combined oral and topical treatment is of no benefit.
- Intravenous therapy is indicated only when the patient cannot swallow or tolerate oral medication because of vomiting.
- There is no evidence for benefit from courses longer than five days. However, it may be prudent to review the patient after 5 days and continue therapy if new lesions are still appearing at this time.
CDC Recommended Regimens:
- Acyclovir 400 mg orally three times a day for 7-10 days OR
- Acyclovir 200 mg orally five times a day for 7-10 days OR
- Famciclovir 250 mg orally three times a day for 7-10 days OR
- Valacyclovir 1 g orally twice a day for 7-10 days
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
- ↑ 1.0 1.1 Centers for Disease Control and Prevention. Workowski KA, Berman SM (2006) Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 55 (RR-11):1-94. PMID: 16888612