Recommended Managements for the Herpes Genitalia

Heung Jae Park

doi:10.14777/kjutii.2014.9.2.68

Journal List > Korean J Urogenit Tract Infect Inflamm > v.9(2) > 1059953

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park: Recommended Managements for the Herpes Genitalia

Review

Korean J Urogenit Tract Infect Inflamm 2014;9(2):68-73.

Published online: 17 October 2014

DOI: https://doi.org/10.14777/kjutii.2014.9.2.68

Recommended Managements for the Herpes Genitalia

Heung Jae Park

Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Heung Jae Park Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 110-746, Korea Tel: +82-2-2001-2237, Fax: +82-2-2001-2247 E-mail: tigerhj@dreamwiz.com

Received 19 February 20143 March 2014 Accepted 3 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Herpes simplex virus (HSV) is a member of herpesviridae family viruses, which belong to DNA viruses. HSV-associated diseases are one of the most widespread infection and most genital herpes is caused by HSV type 2 (HSV-2). Treatment of genital herpes is complex. In addition to administration of the standard antiviral medications, an ideal management protocol should also address various aspects of the disease. Oral acyclovir, valacyclovir, and famciclovir are recommended for routine treatment. Longterm suppressive therapy is effective in reducing recurrence rate as well as the risk of transmission to others. However, antiviral drugs cannot cure HSV infection and persist during the lifetime of the host, often in latent form. Management of the sex partner, appropriate counseling, and prevention advice or education are equally important in management of genital herpes. This review provides a summary of several important recent guidelines regarding recommended management for the herpes genitalia.

Keywords: Herpes genitalis, Antiviral agents, Therapy

REFERENCES

1. Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. 2007; 57:737–63.

2. Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006; 296:964–73.

3. Lee CB, Choe HS, Hwang SJ, Lee SJ, Cho YH. Epidemiological characteristics of genital herpes and condyloma acuminata in patients presenting to urologic and gynecologic clinics in Korea. J Infect Chemother. 2011; 17:351–7.

4. Katz AR, Lee MV, Wasserman GM. Sexually transmitted disease (STD) update: a review of the CDC 2010 STD treatment guidelines and epidemiologic trends of common STDs in Hawai'i. Hawaii J Med Public Health. 2012; 71:68–73.

5. Patel R, Alderson S, Geretti A, Nilsen A, Foley E, Lautenschlager S, et al. IUSTI/WHO Europe. European guideline for the management of genital herpes, 2010. Int J STD AIDS. 2011; 22:1–10.

6. Workowski KA, Berman SM. Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines, 2010. MMWR Recomm Rep. 2010; 59:20–5.

7. Corey L, Benedetti J, Critchlow C, Mertz G, Douglas J, Fife K, et al. Treatment of primary firstepisode genital herpes simplex virus infections with acyclovir: results of topical, intravenous and oral therapy. J Antimicrob Chemother. 1983; 12(Suppl B):79–88.

8. Fife KH, Barbarash RA, Rudolph T, Degregorio B, Roth R. Valaciclovir versus acyclovir in the treatment of firstepisode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Study Group. Sex Transm Dis. 1997; 24:481–6.

9. Reyes M, Shaik NS, Graber JM, Nisenbaum R, Wetherall NT, Fukuda K, et al. Task Force on Herpes Simplex Virus Resistance. Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics. Arch Intern Med. 2003; 163:76–80.

10. Martin JM, Villalon G, Jorda E. Update on the treatment of genital herpes. Actas Dermosifiliogr. 2009; 100:22–32.

11. Korea Centers for Disease Control and Prevention, Korean Association of Urogenital Tract Infection and Inflammation. Sexually transmitted infections Korean guidelines. Seoul: Korea Centers for Disease Control and Prevention, Korean Association of Urogenital Tract Infection and Inflammation. 2011.

12. Weightman W, Turner T. Allergic contact dermatitis from lignocaine: report of 29 cases and review of the literature. Contact Dermatitis. 1998; 39:265–6.

13. Nilsen AE, Aasen T, Halsos AM, Kinge BR, Tjotta EA, Wikstrom K, et al. Efficacy of oral acyclovir in the treatment of initial and recurrent genital herpes. Lancet. 1982; 2:571–3.

14. Sacks SL, Aoki FY, Diaz-Mitoma F, Sellors J, Shafran SD. Patient-initiated, twice-daily oral famciclovir for early recurrent genital herpes. A randomized, double-blind multicenter trial. Canadian Famciclovir Study Group. JAMA. 1996; 276:44–9.

15. Spruance SL, Tyring SK, DeGregorio B, Miller C, Beutner K. A large-scale, placebo-controlled, dose-ranging trial of peroral valaciclovir for episodic treatment of recurrent herpes genitalis. Valaciclovir HSV Study Group. Arch Intern Med. 1996; 156:1729–35.

16. Spruance SL, Overall JC Jr, Kern ER, Krueger GG, Pliam V, Miller W. The natural history of recurrent herpes simplex labialis: implications for antiviral therapy. N Engl J Med. 1977; 297:69–75.

17. Mertz GJ, Loveless MO, Levin MJ, Kraus SJ, Fowler SL, Goade D, et al. Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Collaborative Famciclovir Genital Herpes Research Group. Arch Intern Med. 1997; 157:343–9.

18. Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL. Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. Collaborative Famciclovir Genital Herpes Research Group. JAMA. 1998; 280:887–92.

19. Reitano M, Tyring S, Lang W, Thoming C, Worm AM, Borelli S, et al. Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. International Valaciclovir HSV Study Group. J Infect Dis. 1998; 178:603–10.

20. Romanowski B, Marina RB, Roberts JN. Valtrex HS230017 Study Group. Patients' preference of valacyclovir once-daily suppressive therapy versus twice-daily episodic therapy for recurrent genital herpes: a randomized study. Sex Transm Dis. 2003; 30:226–31.

21. Goldberg LH, Kaufman R, Kurtz TO, Conant MA, Eron LJ, Batenhorst RL, et al. Longterm suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group. Arch Dermatol. 1993; 129:582–7.

22. Fife KH, Crumpacker CS, Mertz GJ, Hill EL, Boone GS. Recurrence and resistance patterns of herpes simplex virus following cessation of ＞ or = 6 years of chronic suppression with acyclovir. Acyclovir Study Group. J Infect Dis. 1994; 169:1338–41.

23. Mindel A, Faherty A, Carney O, Patou G, Freris M, Williams P. Dosage and safety of longterm suppressive acyclovir therapy for recurrent genital herpes. Lancet. 1988; 1:926–8.

24. Lebrun-Vignes B, Bouzamondo A, Dupuy A, Guillaume JC, Lechat P, Chosidow O. A metaanalysis to assess the efficacy of oral antiviral treatment to prevent genital herpes outbreaks. J Am Acad Dermatol. 2007; 57:238–46.

25. Geretti AM. Genital herpes. Sex Transm Infect. 2006; 82(Suppl 4):iv31–4.

26. Corey L, Wald A, Patel R, Sacks SL, Tyring SK, Warren T, 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.

27. Erard V, Wald A, Corey L, Leisenring WM, Boeckh M. Use of longterm suppressive acyclovir after hematopoietic stem-cell transplantation: impact on herpes simplex virus (HSV) disease and drug-resistant HSV disease. J Infect Dis. 2007; 196:266–70.

28. Kaliaperumal K. Recent advances in management of genital ulcer disease and anogenital warts. Dermatol Ther. 2008; 21:196–204.

29. Bernstein DI, Aoki FY, Tyring SK, Stanberry LR, St-Pierre C, Shafran SD, et al. GlaxoSmithKline Herpes Vaccine Study Group. Safety and immunogenicity of glycoprotein D-adjuvant genital herpes vaccine. Clin Infect Dis. 2005; 40:1271–81.

30. Rajcani J, Durmanova V. Developments in herpes simplex virus vaccines: old problems and new challenges. Folia Microbiol (Praha). 2006; 51:67–85.

Table 1.

Recommended treatment of initial genital herpes in Korean guidelines¹¹

Grade of recommendation	Regimen
A^a	Recommended regimens for first clinical episode of genital herpes
	- Valacyclovir 1 g orally twice a day for 7-10 days, or
	- Famciclovir 250 mg orally three times a day for 7-10 days, or
	- Acyclovir 400 mg orally three times a day for 7-10 days, or
	- Acyclovir 200 mg orally five times a day for 7-10 days
A	Intravenous (IV) acyclovir therapy should be provided for patients who have severe herpes simplex virus disease that necessitate hospitalization. The recommended regimen is acyclovir 5-10 mg/kg IV every 8 hours for 2-7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy.
A	It's more effective to initiatethe antiviral therapy as early as possible after onset of the clinical episode. - Valacyclovir within 3 days - Famciclovir within 5 days - Acyclovir within 5-7 days

Valacyclovir, famciclovir, acyclovir are all effective in reducing the severity and duration of episode. Choice should be made by individual clinicians, taking cost of therapy and likely compliance into account.

^a :Evidence at level Ia (metaanalysis of randomized controlled trials) or Ib (at least one randomized controlled trial). Adapted from sexually transmitted infections Korean guidelines, with permission.

Table 2.

Recommended treatment of recurrent genital herpes in European and Centers for Disease Control and Prevention (CDC) guidelines^4,5

European guidelines (2010)
5 days regimen	Acyclovir	200 mg, five times a day
		400 mg, three times a day
	Valacylcovir	500 mg, twice a day
	Famciclovir	125 mg, twice a day
Short-course regimen	Acyclovir	800 mg, three times a day for 2 days
	Famciclovir	1 g, twice a day for 1 day
	Valacylcovir	500 mg, twice a day for 3 days
CDC guidelines (2010)
	Acyclovir	400 mg, three times a day for 5 days
		800 mg, twice a day for 5 days
		800 mg, three times a day for 2 days
	Famciclovir	125 mg, twice a day for 5 days
		1 g, twice a day for 1 day
		500 mg once, followed by 250 mg twice a day for 2 days
	Valacyclovir	500 mg, twice a day for 3 days
		1 g, once a day for 5 days

Modified from the European guideline for the management of genital herpes and sexually transmitted disease treatment guidelines of CDC.

Table 3.

Recommended treatment of recurrent genital herpes in Korean guidelines¹¹

Grade of recommendation	Regimen
A^a	Recommended regimens for recurrent genital herpes
	- Valacyclovir 500 mg orally twice a day for 5 days, or
	- Valacyclovir 1 g orally once a day for 5 days, or
	- Famciclovir 125 mg orally twice a day for 5 days, or
	- Acyclovir 400 mg orally three times a day for 5 days, or
	- Acyclovir 800 mg orally three times a day for 2 days
B^b	It's more effective to initiate the antiviral therapy as early as possible after onset of the clinical episode.
	- Valacyclovir within 12 hours
	- Famciclovir within 6 hours

^a :Evidence at level Ia (metaanalysis of randomized controlled trials) or Ib (at least one randomized controlled trial).

^b :Evidence at level IIa (at least one well-designed controlled study without randomization), IIb (at least one other type of well-designed quasi-experimental study) or III (well-designed non-experimental descriptive studies). Adapted from sexually transmitted infections Korean guidelines, with permission.

Table 4.

Recommended suppressive treatment of recurrent genital herpes in Korean guidelines¹¹

Grade of recommendation	Regimen
A^a	Suppressive therapy for recurrent genital herpes
	- Valacyclovir 500 mg orally once a day (≤9 episodes per year), or
	- Valacyclovir 1,000 mg orally once a day (≥10 episodes per year), or
	- Famciclovir 250 mg orally twice a day, or
	- Acyclovir 400 mg orally twice a day
A	Safety and efficacy have been documented among patients receiving daily therapy with:
	- Valacyclovir for 1 year
	- Famciclovir for 4 months
	- Acyclovir for 6 years

Suppressive therapy for recurrent genital herpes was not included in the health insurance allowance benefit in Korea.

Table 5.

CDC recommended episodic and suppressive treatment of genital herpes in persons with HIV⁶

Episodic infection (for 5-10 days)	Acyclovir	400 mg, three times a day
	Famciclovir	500 mg, twice a day
	Valcyclovir	1 g, twice a day
Daily suppressive therapy	Acyclovir	400-800 mg, twice to three times a day
	Famciclovir	500 mg, twice a day
	Valcyclovir	500 mg, twice a day

CDC: Centers for Disease Control and Prevention, HIV: human immunodeficiency virus. Adapted from the sexually transmitted disease treatment guidelines of CDC.

TOOLS

Similar articles