Genital Herpes Simplex STD Treatment
Dr. Thomas P. Habif, MD discusses Genital Herpes Simplex STD Treatment. See more at http://www.dermnet.com PLEASE RATE AND COMMENT!!!
Oral medication
Antiviral oral medication and counseling are the mainstays of management. Systemic antiviral drugs partially control symptoms and signs. They do not eradicate latent virus or affect the risk, frequency, or severity of recurrences after the drug is stopped. Topical antiviral drugs offer minimal benefit. Three antiviral medications are effective: acyclovir, valacyclovir, and famciclovir. Valacyclovir is a valine ester of acyclovir with enhanced absorption after oral administration. Famciclovir, a prodrug of penciclovir, also has high oral bioavailability. Topical therapy with acyclovir is less effective than the systemic drug, and its use is discouraged. Acyclovir, valacyclovir, and famciclovir reduce the duration of viral shedding, the time to healing, and the development of new lesions and the rate of transmission. Dosages are listed on line at www.cdc.org
Treatment of first episode infections
Many patients with first-episode herpes present with mild clinical manifestations but later develop severe or prolonged symptoms. Therefore, most patients with initial genital herpes should receive antiviral therapy. Five percent to 30% of first-episode cases of genital herpes are caused by HSV-1, but clinical recurrences are much less frequent for HSV-1 than HSV-2 genital infection. Therefore, identification of the type of the infecting strain has prognostic importance and may be useful for counseling purposes. Extensive erosions on the vulva and penis may be treated with cool water, or Burow’s compresses applied for 20 minutes several times daily. This effective local therapy reduces edema and inflammation, macerates and debrides crust and purulent material, and relieves pain. The legs may be supported with pillows under the knees to expose the inflamed tissues and promote drying.
Treatment of recurrent episode infections
Most patients with first-episode genital HSV-2 infection will have recurrent episodes. Episodic or suppressive antiviral therapy might shorten the duration of lesions or ameliorate recurrences. Treatment is most effective when started during the prodrome or within 1 day after onset of lesions. Patient-initiated episodic treatment is more effective than provider-initiated therapy in decreasing the healing time in recurrent genital HSV infections. If episodic treatment of recurrences is chosen, the patient should be provided with antiviral therapy or a prescription for the medication, so that treatment can be initiated at the first sign of prodrome or genital lesions.
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