Genital herpes is a ubiquitous disease. In fact, according to the Centers for Disease Control and Prevention (CDC), more than 1 in 6 of all adolescents and adults in the US have genital herpes. Further complicating this issue is the fact that we are frequently unable to fully get rid of this infection, borrowing one of my favorite quotes: “Unlike love, herpes lasts forever.” That does not mean we are completely defenseless, though, we have treatments that significantly reduce the symptoms and improve the quality of life for these patients, and that is the topic of this article.
Read More: Genital Herpes Overview
The medications most commonly used in the treatment of genital herpes are:
- Acyclovir 400 mg thrice daily (standard dosage)
- Valacyclovir 500 mg twice daily
- Famcyclovir 250 mg thrice daily
Even though these medications are equally effective, acyclovir is usually the preferred medication, particularly because it is much cheaper than its competitors. The duration of treatment varies by whether the patient has a first outbreak, a repeat episode or is suffering from a severe form of the disease:
- A duration of 10 days is usually sufficient for a first clinical episode of herpes simplex virus (HSV) infection.
- Recurrent episodes are usually treated for five days.
- Patients with 4-6 episodes or more per year, or with severe distress during episodes might choose to undergo suppressive therapy, which means treatment for longer periods of time (months to years).
Of course, not all episodes fit the molds of our guidelines. For example, it is acceptable to use double (800 mg) dose acyclovir for five days for severe episodes or use a shorter two-day course with double the dosage to shorten the treatment duration.
The disease affects each patient differently. A subset of the population might have heavier and more frequent outbreaks; thus, it is recommended to monitor patients for frequency and judge the costs/benefits of suppressive therapy accordingly.
Another vulnerable group includes patients with concomitant Human Immunodeficiency Virus (HIV) infections. The risk of disseminated HSV infection in these patients is high enough that suppressive therapy is almost always warranted.
Read More: Genital Herpes Symptoms
Antiviral resistant HSV has become an issue lately. Since the three medications mentioned above are overall similar in structure, resistance to acyclovir usually means resistance to all three of them, in these cases, the medications used are:
- Foscarnet 40–80 mg/kg IV every 8 hours until clinical resolution is attained
- Intravenous cidofovir 5 mg/kg once weekly
- Topical Imiquimod or cidofovir over five days
The future for patients at risk of contracting HSV is clearly bright. There are multiple vaccine candidates currently being researched for prevention, some already in the later phases of clinical development, and showing significant promise.
Read More: Genital Herpes
References:
https://www.cdc.gov/std/herpes/stdfact-herpes.htm
https://www.who.int/reproductivehealth/publications/rtis/genital-HSV-treatment-guidelines/en/
https://www.cdc.gov/std/tg2015/herpes.htm
https://www.sciencedirect.com/science/article/pii/S0264410X16002978?via%3Dihub