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

Park: Recommended Managements for the Herpes Genitalia

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.

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Table 1.
Recommended treatment of initial genital herpes in Korean guidelines11
Grade of recommendation Regimen
Aa 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) guidelines4,5
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
Aa 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
Bb 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

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).

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
Aa 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.

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 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.

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