Information on
Valtrex Genital Herpes Treatment
(latest Valtrex genital herpes news and articles)
The following represent a comprehensive list of articles that addresses
the use of Valtrex for the treatment of genital herpes:
Valtrex (valacyclovir HCI) Caplets Highly Effective in Reducing
Asymptomatic Viral Shedding in Genital Herpes
PR Newswire
September, 2007
Valtrex, Genital Herpes Treatment
OB/GYN News
August, 2007
Drug
Treatment of Common STDs: Herpes, Syphilis, Urethritis, Chlamydia and
Gonorrhea
American Family Physician
October, 2007
Herpes a bigger problem than you think: for many patients, herpes means
recurring episodes of skin lesions, but in the immuno-compromised,
herpes can lead to severe illness. Here are the facts you need to know
to help control these all-too-common viruses
PR Newswire
June, 2002
Atypical Presentation of
Genital Herpes Increasing, Expert Observes
OB/GYN News
June, 2007
Improving the Care of Patients with Genital Herpes
British Medical Journal
September, 2007
Valtrex
Highly Effective in Reducing Viral Shedding in Genital Herpes
PR Newswire
September, 2007
The antiviral agent Valtrex significantly
reduces asymptomatic viral shedding in genital herpes according to new
data presented today at the 38th Interscience Conference on
Antimicrobial Agents and Chemotherapy (ICAAC)*.
"Viral shedding is when the infectious genital
herpes virus is released through the skin," explains Dr. Anna Wald,
lead investigator of this new study. "Shedding can also occur when there
are no visible signs or symptoms of the infection. This is called
asymptomatic shedding."
These new findings come from a double blind,
placebo-controlled study which investigated the effect of Valtrex in
reducing viral shedding. It involved a total of 69 men and women who had
recently been infected or had recurring genital herpes infection.
Patients received Valtrex, acyclovir or placebo. Each patient received
each treatment for seven weeks and was tested daily to detect the
presence of the genital herpes virus.
During the study,
genital herpes virus was found in 86 to
94 percent of the patients involved. Viral shedding, as detected by PCR,
a very sensitive test, even on days when there were no visible signs of
genital herpes, occurred on 6.2 percent of the days in those treated
with Valtrex.
Genital herpes is the most common sexually
transmitted disease in the developed world.
It is estimated that one in five Europeans over the age of 18 years is
infected with one type of this virus, called HSV-2**. On contracting the
virus, patients suffer what is called a 'primary infection' or 'first
episode'. Following this the virus becomes inactive. Recurrent episodes
-- when patients suffer sores in the genital area, genital pain,
tenderness, burning or itching -- are common, and may occur more than
once a month in some patients.
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"Infecting their partners is one of the greatest
concerns to patients with genital herpes, and therefore we are studying
whether an antiviral drug has an effect on reducing transmission in a
different clinical trial," says Dr. Wald.
Valtrex
is currently available to both treat and suppress outbreaks of genital
herpes in adults with normal immune systems. Valtrex is generally well
tolerated with the most commonly reported side effect being headache.
The efficacy of
Valtrex
has not been established in immunocompromised patients. No drug has been
shown to cure genital herpes.
Valtrex has been approved for use in suppressing
outbreaks of genital herpes throughout Europe. Valtrex was
developed and is marketed by Glaxo Wellcome (NYSE: GLX), makers of
Zovirax. Glaxo Wellcome is a company committed to fighting disease by
bringing innovative medicines to patients and to healthcare
professionals.
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recommended by more doctors than any other genital herpes treatment
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Valtrex, Genital Herpes Treatment
OB/GYN News
August, 2007
(Valtrex GlaxoSmithKline)A shorter course (3 days) of therapy of the
antiviral for treating recurrent episodes of
genital herpes. Previously, a 5-day
course of the antiviral was approved for this indication.
* Recommended Valtrex Dosage for treatment of
genital herpes: 500 mg twice a day for 3 days.
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* Special Considerations: Side effects are
extremely uncommon with the 3-day course as well as with the 5-day
course, said Dr. Stephen Tyring.
*Comment: Dr. Tyring was one of the
investigators in a randomized, double-blind study that compared 3-day
and 5-day courses of 500 mg of Valtrex twice per day in treating
recurrent episodes of genital herpes in otherwise healthy adults who had
at least three to four outbreaks a year. The patients started taking the
drug at the first sign of an outbreak and were evaluated daily during
each outbreak.
"This is a marked step forward in terms of
convenience," and it saves money said Dr. Tyring, who is a consultant to
GlaxoSmithKline and serves on the company's speakers' bureau.
Suppressive therapy with daily medication remains appropriate for people
who have more frequent or more severe outbreaks and for those who have a
partner who does not have genital herpes, he noted.
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Drug Treatment of Common STDs:
Genital Herpes, Syphilis, Urethritis,
Chlamydia and Gonorrhea
American Family
Physician
October, 2007
In 2007, the Centers for Disease Control and
Prevention released guidelines for the treatment of sexually transmitted
diseases. Several treatment advances have been made since the previous
guidelines were published. Part I of this two-part article describes
current recommendations for the treatment of genital ulcer diseases,
urethritis and cervicitis. Treatment advances include effective
single-dose regimens for many sexually transmitted diseases and improved
therapies for herpes infections. Two single-dose regimens, 1 g of oral
azithromycin and 250 mg of intramuscular ceftriaxone, are effective for
the treatment of chancroid. A three-day course of 500 mg of oral
ciprofloxacin twice daily may be used to treat chancroid in patients who
are not pregnant. Parenteral penicillin continues to be the drug of
choice for treatment of all stages of syphilis.
Valtrex antiviral medication has been shown to provide clinical benefit
in the treatment of genital herpes.
Several advances have been made in the treatment
of sexually transmitted diseases (STDs). These advances have been
incorporated into the "1998 Guidelines for the Treatment of Sexually
Transmitted Diseases," published by the Centers for Disease Control and
Prevention (CDC).(1)
Improved therapies are now available for the
treatment of genital herpes and human papillomavirus (HPV) infections.
New regimens have been approved for the use of Valtrex in the treatment
of genital herpes. Patient-applied therapies are now recommended for
management of HPV.
Genital Ulcer Diseases (genital
herpes)
Before a genital herpes ulcer is treated, an
accurate diagnosis with appropriate testing is essential. Concomitant
testing for human immunodeficiency virus (HIV) infection should be
considered.
Genital Herpes
Genital herpes is a recurrent, incurable viral
disease. Patient counseling should include information about recurrent
episodes, asymptomatic viral shedding, perinatal transmission and sexual
transmission. Episodic antiviral therapy during outbreaks may shorten
the duration of the lesions, and suppressive antiviral therapy may
prevent recurrences.
During the first clinical episode, the goal of
systemic antiviral drug therapy, like Valtrex is to control the signs
and symptoms of genital herpes. Daily suppressive therapy is recommended
for use in patients who have six or more recurrences per year.
Clinical experience with with Valtrex in the treatment of genital herpes
has been substantial.
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Syphilis
Syphilis is a systemic disease caused by the
sexual transmission of Treponema pallidum. It can present as primary,
secondary or tertiary disease. Primary disease presents with one or more
painless ulcers or chancres at the inoculation site. Secondary disease
manifestations include rash and adenopathy. Cardiac, neurologic,
ophthalmic, auditory or gummatous lesions characterize tertiary
infections. Latent disease may be detected by serologic testing, without
the presence of signs and symptoms. Early latent disease is defined as
disease acquired within the preceding year. All other cases of latent
syphilis are considered late latent disease or disease of unknown
duration.
The recommended treatment regimens have not
changed since the 1993 CDC Guidelines. Parenteral penicillin G is still
the preferred drug for treating all stages of syphilis, including
disease in pregnant women. Table 1 outlines the different penicillin
preparations and the proper dosages and durations of therapy, depending
on the stage of syphilis at patient presentation. Patients with early
disease and penicillin allergy may be desensitized first and then
treated with penicillin or treated with another recommended regimen.
Patients with HIV infection require treatment with penicillin at all
stages of syphilis. Treatment may be associated with the
Jarisch-Herxheimer reaction. This reaction is an acute febrile illness
that may occur within the first 24 hours of therapy and includes
symptoms such as headache and myalgias. Concomitant antipyretic therapy
may be beneficial.
Urethritis
Urethritis is an infection characterized by
mucopurulent or purulent discharge and burning during urination.
Neisseria gonorrhoeae and C. trachomatis are the most common bacterial
pathogens associated with urethritis. Empiric treatment is recommended
in high-risk patients and those unlikely to return for follow-up.
Treatment guidelines are outlined in Table 2.
Several regimens for the management of patients
with nongonococcal urethritis are outlined in Table 2. Oral azithromycin
is recommended as single-dose therapy.(5-7) Improved compliance and the
ability to observe therapy are advantages associated with single-dose
regimens.
Chlamydial Infection
Chlamydial genital infections are common among
adolescents and young adults who are sexually active. C. trachomatis
infection may be associated with pelvic inflammatory disease (PID),
ectopic pregnancy and infertility. Since chlamydial infection is often
asymptomatic and the sequelae can be serious, routine screening for
disease during annual examinations is recommended. Single-dose therapy
with azithromycin is as effective as a seven-day course of doxycycline
(Vibramycin). Doxycycline is less expensive, but azithromycin may be
cost-beneficial because it provides single-dose, directly observed
therapy. Erythromycin and ofloxacin (Floxin) also may be used to treat
C. trachomatis. Erythromycin is less efficacious than azithromycin and
doxycycline, and its adverse gastrointestinal effects may decrease
patient compliance. Ofloxacin is as effective as the recommended
regimens but offers no dosing or cost advantages. Doxycycline and
ofloxacin are contraindicated in pregnant women. In addition, the safety
and efficacy of azithromycin in pregnant women has not been established;
therefore, a seven-day course of either erythromycin or amoxicillin is
recommended in this group. Since neither regimen is considered highly
effective, cultures should be repeated in three weeks.
Gonococcal Infection
Men with a gonococcal infection experience
symptoms that require treatment, but women often are asymptomatic until
complications of the infection, such as PID, occur. For this reason,
screening is recommended in high-risk patients. Co-infection with C.
trachomatis often occurs in patients with gonococcal infections. The
cost of doxycycline therapy for C. trachomatis is less expensive than
testing for the organism, so empiric treatment of co-infection is
becoming routine. Also, dual therapy with doxycycline and azithromycin
may decrease the development of antimicrobial-resistant N. gonorrhoeae,
because most gonococci are susceptible to both drugs.
Quinolone-resistant N. gonorrhoeae has been reported in the United
States and is becoming more widespread in Asia. At this time,
fluoroquinolone regimens can be used with confidence, but continued
monitoring of emerging resistance will be important.
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Herpes a bigger problem than you think:
for many patients, herpes means recurring episodes of skin lesions, but
in the immuno-compromised, herpes can lead to severe illness. Here are
the facts you need to know to help control these all-too-common viruses.
PR Newswire
June, 2007
Genital Herpes infections
are on the rise. The prevalence of just one type--herpes
simplex virus type 2 (HSV-2)--has grown by 30% since the late
1970s, and it's estimated that as many as 1 million Europeans contract
it each year. (1) One reason for the increase is changing sexual
practices; another is wider use of aggressive chemotherapies for cancer
and immunosuppressive therapies for organ transplantation that make
individuals more susceptible to infection.
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Occasionally, you will care for a patient whose
admission diagnosis includes a genital herpes virus. But the majority of
the time your patient will be admitted for other reasons, and a dormant
herpes virus may be reactivated as a result of the stresses of the
underlying illness, invasive procedures, or hospitalization itself. In
order to care for these patients properly, you need to understand the
key differences among the eight human genital herpes viruses, how they
are transmitted, and the symptoms and illnesses they may cause. This
knowledge is also essential for teaching patients how to manage their
illness and reduce the risk of further transmission of the virus.
Genital Herpes a lifelong infection with latent
stages
Herpes viruses take their name from the Greek word
herpein, which means "to creep"--a reflection of the way common herpes
skin lesions spread. Not all herpes viruses cause lesions, but they all
have this in common: Once infected with a herpes virus, an individual
carries the virus for life. The initial (primary) infection is followed
by latent periods and subsequent recurrent infections. The primary
infection is usually more severe than a recurrent infection. When the
virus becomes latent, it efficiently hides from the humoral or antibody
component of the immune system by expressing few, if any, proteins that
can trigger an antigen-antibody response. Cell-mediated immunity also
plays a key role in keeping herpes viruses suppressed. After the
recurrence, the virus retreats into the body and once again
"hibernates."
A
herpes virus can reactivate when the
individual's immune system is compromised as the result of hormonal
fluctuations, stress, trauma, immunosuppression, and even changes in
weather. When it's reactivated, the virus attaches to, and enters, a
host cell through a receptor site, where it takes over the cell's
genetic material to produce additional herpes virus. The "new"
herpesvirus is then released from the cell and may enter the
bloodstream, leading to viremia and dissemination to distant tissues.
Herpes viruses can be spread from one person to
another only when active viral replication is occurring--that is, either
during the primary infection or a recurrent infection. (2) For
transmission to occur, a fresh virus-containing body fluid from an
infected person must directly be inoculated onto tissues such as oral,
genital, or anal mucosa. The likelihood of transmission depends on the
quantity of virus shed. Although the quantity is higher during
symptomatic infections, patients are capable of transmitting the virus
during asymptomatic infections as well. (2) A patient will have more
episodes of asymptomatic viral shedding than of symptomatic viral
shedding over his lifetime. As a result, there are more opportunities
for transmission to occur during asymptomatic infections.
Herpes viruses can't survive for long periods of
time outside of the host. Surfaces, such as toilet seats that aren't
actually contaminated with body fluids, pose minimal risk of infection.
The most common herpes viruses are as follows:
How herpes viruses are transmitted, risk factors
for infection, and conditions that can trigger a recurrent infection are
the main points to stress when educating patients. The table on page 34
will help with your discussions on transmission (among other things).
The following information will help you better understand-and thus
discuss-risk factors for each, and what can trigger a recurrent
infection in several herpes viruses.
Human herpes virus type 1 (HHV-1) is more commonly
known as
herpes simplex virus type 1 (HSV-1).
HSV-1 is responsible for common fever blisters and
cold sores. It is less commonly a cause of encephalitis. Risk factors
for infection with HSV-1 include frequent intimate contact with an
infected person, including contact with mucosal surfaces or abraded
skin, and sharing eating utensils, razors, and towels. (4,5) The sero
prevalence (percentage of individuals with antibodies to a particular
pathogen) of HSV-1 is approximately 20% - 40% in children; by age 50,
80% - 90% of people have the virus. (2,5)
HHV-2 is commonly known as herpes simplex virus
type 2 (HSV-2). HSV-2 causes genital herpes.
There's also a possible link between HSV-2 and cervical cancers. (2)
Risk factors for infection with HSV-2 include having multiple sex
partners and having other sexually transmitted diseases. The sero
prevalence of HSV-2 is up to 5% in children, 20% - 50% in adults. (2)
With both HSV-1 and HSV-2, the virus enters the
body through small breaks in the skin and mucous membranes, and both can
cause lesions in the facial and/or genital areas. The dormant virus will
periodically reactivate at or near the original site of infection.
Fever, fatigue, menstruation, stress, and illness can trigger the
reactivation. Exposure to sun can also trigger recurrences of HSV-1,
while skin irritation can trigger recurrences of HSV-2.
Both HSV-1 and HSV-2 can be transmitted even if
lesions are not visible, as long as asymptomatic shedding of the virus
is occurring. However, the greatest risk of infection is from the time a
blister first appears until it's completely scabbed over.
Diagnosing and treating a herpes virus infection
Laboratory confirmation for genital herpes caused
by HSV-1 or HSV-2 may exclude other illnesses, assist with treatment
options, and relieve anxiety. The virus culture is the "gold standard"
for diagnosis for these two herpes viruses. In May 2007, the Centers for
Disease Control and Prevention (CDC) released revised sexually
transmitted diseases screening and treatment guidelines for HSV-1 and
HSV-2;.
For other herpes viruses, serology for antigen or
antibody testing may be obtained. Other methods for identifying a
specific herpes virus include immunofluorescence assay, enzyme-linked
immunosorbent assay (ELISA), polymerase chain reaction (PCR), and some
DNA hybridization techniques. The Tzanck smear can be used as a quick
test for a herpes virus infection, but it cannot differentiate between
the eight virus types.
Treatment will vary depending on the type of
infection (primary vs. recurrent), and will lessen the severity and
duration of symptoms of some herpes virus infections if given early in
the course of illness. Uncomplicated HSV-1, HSV-2, infections can be
treated very effectively with an oral agent such as Valtrex.
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Helping patients, protecting yourself against
the herpes virus
You must be mindful of your risk of exposure. As a
healthcare worker, you have an increased risk for becoming infected with
a herpes virus. Herpetic whitlow, a painful infection of the hand by
HSV-1 or HSV-2, can result from healthcare workers' contact with herpes
simplex on their unprotected hands.
When treating a patient with a herpes virus,
always practice standard precautions, which will minimize your risk of
infection. For certain herpes viruses, additional personal protective
equipment and precautions are required to prevent direct contact with
infectious body secretions, lesions, or contaminated patient care
equipment.
Whenever you anticipate contact with a patient's
blood or other body fluids, mucous membranes, or open skin, always wear
gloves. But because gloves may develop a micro-tear and allow your hands
to become contaminated with body fluids, always wash your hands after
removing gloves. Handwashing is the simplest and most effective means of
preventing the spread of infection.
Given the widespread prevalence of herpes viruses,
if you aren't already caring for patients with a herpes virus, you will
be soon. Knowing the key features of each of the human herpes viruses
will not only help you to care for these patients, but it will also help
you to educate them so that they can reduce their risk of recurrence and
reduce the likelihood that they will spread the virus to others.
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Atypical Presentation of Genital Herpes
Increasing, Expert Observes
OB/GYN News
June, 2007
Genital herpes in women doesn't always involve
genital ulcers. Increasingly, patients are presenting with small tears
in the genital area and complaints of dryness and tingling, Dr. Kimberly
A. Workowski said at the annual meeting of the European Society for
Gynecology.
Often these tiny fissures are misdiagnosed as
monilial infections, estrogen deficiency or simple vaginal dryness. A
good history and a herpes culture are important in any patient that
presents with these types of tears, said Dr. Workowski of the department
of medicine at Emory University in Atlanta.
In other cases, lesions may appear only on the
cervix, rather than on the external genitalia. These patients may
complain of perfuse vaginal discharge, and small ulcers may be seen on
the cervix during a speculum examination.
When doing a culture, remember that it is
isolation of the cell culture, not the fluid, that is important. Use a
swab to collect cells at the base of the lesion, inoculate the cells
quickly into the tissue culture medium, and immediately put it on ice or
in the refrigerator. The herpes virus is not particularly hardy and will
die unless it is quickly overlaid in the tissue culture cells, Dr.
Workowski stressed.
Also, use a swab without a wooden stick, because
wood is toxic to tissue culture cells, she advised.
Patients with a positive diagnosis of genital
herpes should be counseled about recurrences and about risk for
transmission of the virus to partners. Most patients will have
recurrences in the first year. Fortunately there are oral medications
like Valtrex that can decrease both the severity and the frequency of
genital herpes outbreaks.
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Sexual transmission of the virus usually occurs
through subclinical shedding, which is quite common.
A recent study reported in the New England Journal
of Medicine found that women with herpes who were cultured every day for
30 days were shedding virus on an average of 5% of the days, said Dr.
Workowski, who is also chief of the guidelines unit of the epidemiology
and surveillance branch, division of sexually transmitted diseases
prevention at the Centers for Disease Control and Prevention in Atlanta.
Patients should be told they could potentially be
shedding virus at any time, regardless of the presence of ulcers, and
that the only way to prevent transmission is abstinence, she said.
Patients also should be warned that condoms
don't cover all areas that could be affected by herpes and therefore do
not provide adequate coverage against transmission of the virus. Valtrex
reduces subclinical shedding by up to 85%.
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Improving the Care of Patients with
Genital Herpes
British Medical Journal
September, 2007
Up to 50% of first episode
genital herpes in the United Kingdom is
attributable to herpes simplex type 1 virus, although recurrences are
far more likely after infection with herpes simplex type 2 virus.
Many patients and clinicians are unaware that oral
sex is a common route of transmission of genital herpes infections.
Transmission from asymptomatic individuals in
monogamous relationships can occur after several years, causing severe
psychological distress.
The majority of patients with genital herpes
simplex virus infections have symptoms and signs unrecognized by either
themselves or their clinicians.
Oral antiviral treatment, Valtrex, should be
given for primary or first episode genital herpes, and long term oral
suppressive antiviral treatment is highly effective in reducing
recurrences of symptoms in selected patients.
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More than 28 000 cases of genital herpes were
reported from clinics dealing with sexually transmitted diseases in
England last year, and sero prevalence studies suggest that there are
many more unrecognized infections. Patients often present having had
frequent painful attacks of genital ulceration for many years, although
effective antiviral drugs are available that dramatically reduce
morbidity if used appropriately. In addition patients often believe that
they are infectious only during symptomatic episodes, despite evidence
that most transmission occurs from asymptomatic shedding of the
virus.[This poor understanding may result in unnecessary morbidity for
patients and their partners and inhibits efforts to reduce the spread of
genital herpes.We have concentrated on the clinical management of
genital herpes. Sources of information included the UK national
guidelines, relevant references from Medline, data from recent
international meetings, and personal experience of treating patients
with genital herpes.
Clinical Course of Genital Herpes
Herpes simplex virus is classified into types 1
and 2. Herpes simplex virus type 1 is widespread in the population and
is the cause of herpes labialis; nevertheless, most infected individuals
remain asymptomatic. Herpes simplex virus type 2 is mostly acquired
sexually. Genital herpes can result from infection with either viral
type.
After initial infection both types establish
latency in the dorsal root ganglion, which innervates the affected
epithelium. Latent virus is never cleared and is not affected by
antiviral treatment. Reactivation results in either symptomatic disease
or asymptomatic shedding of the virus. The initial infection may or may
not cause symptoms and it is followed by sero conversion, with type
specific antibodies becoming detectable 4-6 weeks after infection. The
proportion of first episode genital herpes in the United Kingdom due to
herpes simplex virus type 1 is increasing (up to 50% in some centres.
Possible reasons for this are a falling rate of orally acquired herpes
simplex virus type 1 infection in childhood leading to increased
susceptibility in sexually active adolescents, and an increase in the
practice of oral sex by young people. Recurrent episodes of genital
herpes simplex virus type 1 are much less frequent than those
experienced by patients infected with herpes simplex virus type 2, who
account for 95% of recurrent cases.
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Clinical Spectrum of Genital Herpes
Primary or first episode genital herpes
classically presents with blisters and sores, with local tingling and
discomfort . Some patients also report dysthesia or neuralgic type pain
in the buttocks or legs and malaise with fever. Recent data, however,
suggest that only 37% of patients who acquire herpes simplex virus type
2 have symptoms, although overt disease may follow.
Recurrences are generally milder than primary
infection. It now seems that the clinical spectrum of disease can
include atypical rashes, fissuring, excoriation and discomfort of the
anogenital area, cervical lesions, urinary symptoms, and extragenital
lesions. Additionally, the common occurrence of asymptomatic shedding of
the virus has been reported. This refers to the presence of the virus on
epithelial surfaces in the absence of signs or symptoms and it occurs
intermittently in most people infected with herpes simplex virus type
In a prospective study of women with herpes simplex virus type 2
monitored by daily self swabbing, shedding of the virus was found on 28%
of days by the sensitive technique of polymerase chain reaction and 8.1%
of days by virus isolation. The days on which shedding occurs cluster
together and are more common in women with frequent recurrences of
symptoms, especially in the first year of infection. The rate of
shedding is much lower for infections caused by herpes simplex virus
type 1.
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Diagnosis of Genital Herpes
Genital herpes infection can be diagnosed by using
virus culture, antigen detection, and polymerase chain reaction. Virus
culture is the test of choice since it is relatively rapid (results
within seven days), allows typing of the isolate (which is important for
prognosis), and is widely available. Antigen detection with commercial
assays is rapid, but kits cannot discriminate between the two viral
types and this method has reduced specificity and sensitivity compared
with virus isolation. All patients with genital herpes should have at
least one virologically confirmed diagnosis. Type specific antibody
tests may help identify those infected (with or without symptoms) with
either virus type or both, but the limitations and role of these assays
in diagnosis and management of genital herpes are not fully
established.[13] The assays may, however, be complementary to virus
culture for investigating patients with undiagnosed recurrent genital
ulceration, demonstrating sero conversion in pregnancy, and
investigating asymptomatic partners.[14]
Genital Herpes Treatment
Patients presenting with first episode genital
herpes often have widespread anogenital ulceration and severe pain,
occasionally with retention of urine. The antiviral agents Valtrex
hasl been shown to be effective in reducing the severity and duration of
symptoms. Most patients with severe genital herpes feel depressed
and tearful, even when ignorant of their diagnosis. Reassurance about
the self limiting nature of the initial attack and support about future
management is extremely effective in reducing distress. Information
about the clinical course of the infection needs to be given early, but
follow up for screening for other sexually transmitted infections, and
ongoing counseling when patients have recovered, are required.
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Recurrent Genital Herpes
After genital herpes has been diagnosed, patients
(particularly those with herpes simplex virus type 2 infection) should
be asked to keep a diary of recurrences and offered an appointment for
long term follow up. Most recurrent attacks are much less severe than
a first episode or primary attack.
The options for treatment are bathing in saline,
short courses of antiviral treatment for individual recurrences
(episodic treatment), or Valtrex suppressive antiviral treatment. The treatment modality depends on the severity and frequency of attacks
and should be decided between the patient and doctor. Episodic treatment
reduces symptoms and needs to be started as soon as possible after
onset of symptoms. Ideally, patients should hold a stock of antiviral
drugs for self treatment.
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Addressing Patients' Concerns About
Genital Herpes
When patients are told they have genital herpes
they commonly ask several questions--namely, how did I get this, how
long have I had it, has my partner been unfaithful, is it incurable, and
am I infectious?
It is helpful to discuss the possibility that
infection can have been present without recognizable signs in them or
their partners, so that recent infidelity is not necessarily implied.
Positive strategies for treatment should be emphasized. Knowledge that
the tendency is for attacks to decrease with time (even if they are
frequent initially) is often reassuring, as is information on the
frequency of the infection in the population.
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One of the most difficult areas is how to discuss
the diagnosis with present or future partners. It should be emphasized
again that a current partner may already have the virus, although they
may be unaware of this. If this is so (type specific antibody testing
may be helpful in this situation) super infection is not thought to
occur, and therefore safer sex precautions are probably not required
unless otherwise indicated. For uninfected partners or those whose
status is not known, methods to reduce the likelihood of passing on
infection should be advised whether partners are aware of the diagnosis
or not. This should include the avoidance of sexual contact during
periods when any suggestive symptoms are present, and it is our practice
to advise the use of condoms, although good data on their efficacy are
lacking. Patients need reassurance that genital herpes is not
transmitted by non-sexual contact and that no special precautions need
be taken within the family other than normal hygiene measures.
As the ramifications of genital herpes are
complex, the subject may need to be discussed on several occasions in a
calm unhurried way and written information and sources of further
support provided.
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Genital Herpes Treatment Conclusions
Genital herpes is a common infection that is
frequently unrecognized or misdiagnosed. In our experience patients
diagnosed with genital herpes often have received suboptimal treatment
and poor advice concerning transmission. Many patients feel stigmatized
and psychologically distressed as well as being in considerable pain.
Effective counseling and adequate antiviral treatment (including Valtrex
suppressive treatment) can make a major difference to their quality of
life:
* All patients with primary or first episode
genital herpes should receive oral antiviral and supportive treatment,
preferably Valtrex.
* Suppressive Valtrex, antiviral treatment
should be considered for those patients with more than three attacks a
year
* Oral Valtrex is an effective agent for both
first episode genital herpes and suppressive treatment* Clear written information should be given to
all patients infected with herpes simplex virus
* All patients should receive counselling on
prevention of transmission and implications of infection with herpes
simplex virus during pregnancy
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