HIV:Opportunistic infections, treatment of Herpes simplex

Herpes simplex can cause skin lesions and can also affect the gastrointestinal system. An oral antiviral treatment for 5 days can be considered in cases of a first episode of herpes genitalis. The antiviral agents aciclovir (Zovirax®), famciclovir (Famvir®) and valaciclovir (Zelitrex®) are all equally effective. However, the risk of recurrences is not diminished by these. Treatment must be started as soon as possible. Topical antiviral agents are not very effective. IV administration is no better than oral treatment. Local analgesics help to diminish the pain of miction or defaecation.

Treatment of recurrences

Episodic antiviral treatment or a prolonged prophylactic treatment can be considered in addition to the symptomatic treatment.

• Episodic antiviral therapy must be started upon appearance of the first symptoms. The duration of the symptoms is diminished by only 1 to 2 days.

• Prophylactic therapy lasting 6 months to one year is indicated for patients who have more than 6 to 8 relapses per year. A formal diagnosis (culture, PCR) is advisable before starting it. The patient's physical and mental well being can be considerably improved with prophylactic therapy.

• In patients in an advanced stage of immunodepression, herpes infections are often very serious. The possibility of the existence of these should be clinically considered when persistent, painful antibiotic-resistant genital or perianal ulcers are present. In Belgium the prevalence of strains resistant to aciclovir is 5 to 10%. In this case foscarnet can be used as an alternative.

Treatment of herpes genitalis during pregnancy.

The purpose of the treatment is both to alleviate the symptoms of the mother and to diminish the risk of neonatal herpes. Approximately 85% of neonatal herpes cases are attributable to perinatal transmission of the virus during vaginal childbirth. The risk is particularly high when the woman develops a primo-infection during the third trimester of pregnancy. If herpetic lesions first appear during the first trimester of pregnancy treatment with aciclovir can be considered. However, aciclovir is not registered for use during pregnancy, though the available data show no increase in the number of deformities in the children. A Caesarean section is recommended when there are active lesions at the time of childbirth. In cases where a first episode of herpes genitalis appears during the third trimester the birth must likewise be carried out by Caesarean section. Treatment with aciclovir, orally for the mother and intravenously for the child, should be started if the birth has to take place via the vaginal route.

Category: Medical Subject Notes , Medicine Notes , Pharmacology Notes