User:Sfmedstudent/Genital herpes

Antiviral medications provide clinical benefits to those who are symptomatic and is the primary means of management once infected. The main goal for the use of antiviral medications is to treat the first outbreak or to prevent genital herpes recurrences, improve quality of life, and help suppress the virus to sexual transmission to partners. Three FDA-approved antiviral medications have clinical benefits in controlling the signs and symptoms of genital herpes when used for first clinical symptoms and recurrent episodes or when used as daily suppressive therapy. These medications are acyclovir, valacyclovir, and famciclovir and have been shown to be safe with long-term use.

Acyclovir is an antiviral medication and reduces the pain and the number of lesions in the initial case of genital herpes. Furthermore, it decreases the frequency and severity of recurrent infections. It comes in capsules, tablets, and ointment. However, topical ointment with acyclovir is discouraged since it offers minimal clinical benefits.

Valacyclovir is a prodrug that is converted to acyclovir once in the body. It helps relieve the pain and discomfort and speeds healing of sores. It only comes in tablets and its advantage is that it has a longer duration of action than acyclovir.

Famciclovir is another antiviral drug that belongs to the same class. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. It has a longer duration of action than acyclovir and it only comes in tablets.

First Clinical Episode of Genital Herpes

The first time an individual experiences genital herpes, they may have prolonged clinical illness with severe genital ulceration. Furthermore, for those who have mild clinical symptoms initially may experience severe recurrent infections later. Typical recommended regimens for first clinical episodes of genital herpes may be something like:

Acylovir 400mg orally 3 times per day for 7-10 days or

Valacyclovir 1g orally 3 times per day for 7-10 days or

Famciclovir 1g orally 2 times per day for 7-10 days

A treatment longer than 10 days may be recommended if the genital ulcers have not fully healed.

Recurrent Genital Herpes

Most individuals who experience a symptomatic first episode of genital herpes will experience recurrence of genital lesions at some point in the future. Asymptomatic shedding can also occur where an individual may not have genital ulcerations present but still possibly transmit the virus to other partners. It is important for patients to have a discussion with their primary care doctor for options of receiving either episodic treatment or long-term suppressive therapies.

Suppressive therapy for recurrent genital herpes

Suppressive therapy has been shown effective in reducing recurrent genital herpes in as high as 80% which can tremendously help in improving quality of life since patients claim having minimal symptomatic episodes. [2,3] Long-term use of anti-virals like acyclovir, valacyclovir, and famciclovir have been shown to be safe and effective. Furthermore, long-term treatment of genital herpes with valacyclovir daily has shown to decrease the rates of transmission. [4] It is important for patients to to continue suppressive therapy in conjunction to consistent condom use and sexual abstinence during recurrent episodes to decrease transmission as well.

Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926; PMCID: PMC8344968. [1]

469. Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL; Collaborative Famciclovir Genital Herpes Research Group. Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. JAMA 1998;280:887–92. 10.1001/jama.280.10.887 [PubMed] [CrossRef] [Google Scholar] [2]

470. Mertz GJ, Loveless MO, Levin MJ, et al. Collaborative Famciclovir Genital Herpes Research Group. Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Arch Intern Med 1997;157:343–9. 10.1001/archinte.1997.00440240109016 [PubMed] [CrossRef] [Google Scholar] [3]

473. Corey L, Wald A, Patel R, et al.; Valacyclovir HSV Transmission Study Group. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 2004;350:11–20. 10.1056/NEJMoa035144 [PubMed] [CrossRef] [Google Scholar] [4]

Transmission of neonatal herpes to a newborn child is dependent on preventing new infection of genital herpes to the mother during late pregnancy and also avoiding exposure of the newborn to herpes lesions during delivery. There is a fairly low risk of transmission of less than 1% if the mother has had an existing history of genital herpes or if they had they were infected during the first trimester of pregnancy. [11] However, the risk of transmission can be as high as 30 to 50% in mothers who acquire genital herpes in the third trimester close to the time of delivery. [12]

Per the U.S. Preventive Services Task force, routine screening for pregnant patients without a history of genital herpes is not recommended. Serologic (blood) antibody testing in asymptomatic patients without history has been shown to frequently have false positive and false negative test results which may lead to anxiety, labeling, or false reassurance with minimal improvements in health outcomes of reducing neonatal herpes transmission.

It is important for physicians and the healthcare team to obtain a thorough medical history to ask about any history of genital herpes or signs consistent with infection like tingling or pain around the vagina before the presentation of painful genital lesions.

At the time of delivery, patients should be examined for lesions since cesarean section can be done to reduce the risk of transmission of herpes to the neonate if there is herpes present. [12] Suppressive antiviral therapy with acyclovir may also be recommended at 36 weeks until delivery for patients who had genital herpes lesions at any point throughout their pregnancy. [13] This helps to help reduce the frequency of symptomatic recurrence near term but may not definitively protect against transmission in all cases. This may be favorable particularly for patients who prefer to have a vaginal delivery instead of cesarean section.

There is currently no recommendation for asymptomatic screening for genital herpes in pregnant people. Instead, pregnant persons should notify their doctor if they show symptoms of genital herpes. If a pregnant person is symptomatic during delivery, a Cesarean section is the safest method of preventing contact between the virus and the baby. Alternatively, some physicians use the drug acyclovir to treat pregnant persons with genital herpes at the end of pregnancy to prevent the recurrence of symptoms. However, acyclovir is not approved for this purpose by the FDA. Acyclovir’s manufacturer has tracked pregnant persons who have taken the drug during pregnancy, and there is no evidence that shows any risks for the infant.

516. Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med 1991;324:1247–52. 10.1056/NEJM199105023241804 [PubMed] [CrossRef] [Google Scholar] [11]

517. Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003;289:203–9. 10.1001/jama.289.2.203 [PubMed] [CrossRef] [Google Scholar] [12]

522. Watts DH, Brown ZA, Money D, et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol 2003;188:836–43. 10.1067/mob.2003.185 [PubMed] [CrossRef] [Google Scholar] [13]

DONE PREG

Transmission of herpes to a newborn child is dependent on preventing new infection of genital herpes to the mother during late pregnancy and also avoiding exposure of the newborn to herpes lesions during delivery. There is a fairly low risk of transmission of less than 1% if the mother has had an existing history of genital herpes or if they had they were infected during the first trimester of pregnancy. However, the risk of transmission can be as high as 30 to 50% in mothers who acquire genital herpes in the third trimester close to the time of delivery. In the United States, 20-25% of pregnant people have genital herpes; however, fewer than 0.1% of babies born acquire neonatal herpes during delivery.

Per the U.S. Preventive Services Task force, routine screening for pregnant patients without a history of genital herpes is not recommended. Serologic (blood) antibody testing in asymptomatic patients without history has been shown to frequently have false positive and false negative test results which may lead to anxiety, labeling, or false reassurance with minimal improvements in health outcomes of reducing neonatal herpes transmission.

It is important for physicians and the healthcare team to obtain a thorough medical history to ask about any history of genital herpes or signs consistent with infection like tingling or pain around the vagina before the presentation of painful genital lesions.

At the time of delivery, patients should be examined for lesions since cesarean section can be done to reduce the risk of transmission of herpes to the neonate if there is herpes present. Suppressive antiviral therapy with acyclovir may also be recommended at 36 weeks until delivery for patients who had genital herpes lesions at any point throughout their pregnancy. This helps to help reduce the frequency of symptomatic recurrence near term but may not definitively protect against transmission in all cases. This may be favorable particularly for patients who prefer to have a vaginal delivery instead of cesarean section. Acyclovir’s manufacturer has tracked pregnant persons who have taken the drug during pregnancy, and there is no evidence that shows any risks for the infant.

DONE TXT

Antiviral medications provide clinical benefits to those who are symptomatic and is the primary means of management once infected. The main goal for the use of antiviral medications is to treat the first outbreak or to prevent genital herpes recurrences, improve quality of life, and help suppress the virus to sexual transmission to partners. Three FDA-approved antiviral medications have clinical benefits in controlling the signs and symptoms of genital herpes when used for first clinical symptoms and recurrent episodes or when used as daily suppressive therapy. These medications are acyclovir, valacyclovir, and famciclovir and have been shown to be safe with long-term use.

Acyclovir is an antiviral medication and reduces the pain and the number of lesions in the initial case of genital herpes. Furthermore, it decreases the frequency and severity of recurrent infections. It comes in capsules, tablets, and ointment. However, topical ointment with acyclovir is discouraged since it offers minimal clinical benefits.

Valacyclovir is a prodrug that is converted to acyclovir once in the body. It helps relieve the pain and discomfort and speeds healing of sores. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir.

Famciclovir is another antiviral drug that belongs to the same class. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. It has a longer duration of action than acyclovir and it only comes in tablets.

First Clinical Episode of Genital Herpes

The first time an individual experiences genital herpes, they may have prolonged clinical illness with severe genital ulceration. Furthermore, for those who have mild clinical symptoms initially may experience severe recurrent infections later. Typical recommended regimens for first clinical episodes of genital herpes may be something like:

Acylovir 400mg orally 3 times per day for 7-10 days or

Valacyclovir 1g orally 3 times per day for 7-10 days or

Famciclovir 1g orally 2 times per day for 7-10 days

A treatment longer than 10 days may be recommended if the genital ulcers have not fully healed.

Recurrent Genital Herpes

Most individuals who experience a symptomatic first episode of genital herpes will experience recurrence of genital lesions at some point in the future. Asymptomatic shedding can also occur where an individual may not have genital ulcerations present but still possibly transmit the virus to other partners. It is important for patients to have a discussion with their primary care doctor for options of receiving either episodic treatment or long-term suppressive therapies.

Suppressive therapy for recurrent genital herpes

Suppressive therapy has been shown effective in reducing recurrent genital herpes in as high as 80% which can tremendously help in improving quality of life since patients claim having minimal symptomatic episodes. Long-term use of anti-virals like acyclovir, valacyclovir, and famciclovir have been shown to be safe and effective. Furthermore, long-term treatment of genital herpes with valacyclovir daily has shown to decrease the rates of transmission. It is important for patients to to continue suppressive therapy in conjunction to consistent condom use and sexual abstinence during recurrent episodes to decrease transmission as well.

such as acyclovir, valacyclovir, may prevent outbreaks or shorten outbreaks if they occur. The long-term use of antivirals may also decrease the risk of further spread. The longer a person has the virus, the fewer outbreaks they experience and the harder it will be to transmit to others, due to these specialty antigens and a strengthened immune system response.