Herpes 911

Herpes is a recurrent life-long viral infection with no cure.4 Once a patient is infected with the virus it remains dormant in the body and has reoccurring flares of active disease. Although there is no cure, there are medications available that help treat the symptoms of active disease and decrease the re-occurrence of flares.4
HSV-2 is more commonly known as “genital herpes” (found below the belt). Many patients infected with HSV-2 are not diagnosed because they are often asymptomatic (without symptoms). Although a patient may be asymptomatic, which means their infection is dormant and not active, they may still be shedding the virus through their genital tract and spreading infection. When the HSV-2 virus becomes active, it usually presents as multiple painful vesicular or ulcerative lesions in and around the genital area. Diagnosis should always be confirmed with both virologic and type-specific serologic tests such as ELISA and Immunoblot IgG. 1
Systemic oral antiviral medications can partially control the signs and symptoms of herpes episodes and also decrease the reoccurrence of episodes. Antivirals that are used to help control herpes outbreaks are acyclovir, valacylovir, and rarely famciclovir. Valacylovir is often most convenient for patients to use because it is only dosed once to twice daily where acyclovir has to be taken up to five times daily. 1 According to the literature, twice-daily valacylovir 1000mg was just as effective and well tolerated compared with 5 times daily acyclovir 200mg for the treatment of recurrent genital herpes infections.3 Also once daily valacyclovir 1000mg (1gram) has demonstrated significant reductions in viral shedding. 2 Recommended regimens for herpes simplex 2 active episodes are 1:
•-Acyclovir 400 mg orally three times a day for 7-10 days
•-Acyclovir 200 mg orally five times a day for 7-10 days
•-Famciclovir 1 g orally twice a day fro 7-10 days
•-Valacyclovir 1 g twice a day for 7-10days

Patients might also be on continues suppressive therapy if outbreaks occur often (> 6 recurrences per year). Options for continues suppressive therapy include 1:
•Acyclovir 400 mg orally twice a day

•Famciclovir 250 mg orally twice a day

•Valacyclovir 500 mg orally once a day

•Valacyclovir 1.0 gram orally once a day

The goal in the management of herpes is to relieve the symptoms and to prevent complications, recurrences, and disease transmission.4 It is important to use latex and polyurethane condoms during sexual actively to prevent transmission of the disease. Oral contraceptives and other forms of birth control such as lamb-skin condoms, and intrauterine devices will not protect against transmission of sexual transmitted disease such as HSV2. 1 For more information please refer to the CDC at: http://www.cdc.gov/std/herpes/STDFact-herpes.htm
References :
1.Centers for Disease Control and Prevention, Workowski KA, Berman SM. Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines.MMWR Morb Mortal Wkly Rep. 2006; 55:14-30.
2. Martens Ma, Fife Ke, Leone Pe, Dix Ly, Brennan Cl. Once Daily Valacyclovir for Reducing Viral Shedding in Subjects Newly Diagnosed with Genital Herpes. Infectious Diseseas in Obstetrics and Gynecology. 2009: 2009:1-7.
3. Tyring St, Douglas Jo, Corey La, Corey la, Spruance Sp, Esmann Jo. A randomized, Placebo-controlled Comparison of oral Valacyclovir and Acyclovir in Immunocompetent Patients with Recurrent Genital Herpes Infections. Arch Dermatol. 1998;134: 185-191.
4. Knodel Le. Sexually Transmitted Diseases. In: Dip
iro JT, Talbert RT, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: A Pathophysiologic Approach. Sixth ed. New York: McGraw-Hill; 2005. P. 2097-2116