How is genital herpes treated?

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Treatment of Genital Herpes: Current Approaches and Guidelines

Introduction to Genital Herpes Treatment

Genital herpes, caused by herpes simplex virus (HSV) type 1 or type 2, is a prevalent sexually transmitted infection (STI) with significant physical and psychological impacts. Although HSV is incurable, various treatment strategies are available to manage symptoms, reduce recurrence, and prevent transmission .

Antiviral Medications for Genital Herpes

Common Antiviral Drugs

The primary treatment for genital herpes involves antiviral medications. The most commonly used drugs are acyclovir, valacyclovir, and famciclovir. These medications can be administered in different regimens depending on the severity and frequency of outbreaks .

Acyclovir: Often prescribed at 400 mg twice daily for suppressive therapy or 200 mg five times daily for episodic treatment.
Valacyclovir: Typically given at 500 mg once daily for suppressive therapy or 1000 mg twice daily for episodic treatment.
Famciclovir: Administered at 250 mg twice daily for suppressive therapy or 250 mg three times daily for episodic treatment .

Single-Day Therapy

Recent studies suggest that single-day patient-initiated episodic treatment with famciclovir can be effective. This approach has shown to decrease healing time, reduce the duration of pain and other symptoms, and increase the proportion of patients who do not progress to a full outbreak.

Suppressive Therapy for Recurrent Genital Herpes

Suppressive therapy is recommended for patients with frequent or severe recurrent episodes. This approach involves daily antiviral medication to reduce the frequency of outbreaks and asymptomatic viral shedding, thereby decreasing the risk of transmission to sexual partners .

Efficacy of Suppressive Therapy

A meta-analysis has shown that suppressive therapy with acyclovir, valacyclovir, or famciclovir significantly reduces the risk of having at least one clinical recurrence compared to placebo. However, no single drug has been proven superior in head-to-head comparisons.

Intravenous and Alternative Treatments

Intravenous Acyclovir

For severe primary genital herpes, intravenous acyclovir is an effective treatment. It significantly shortens the duration of viral shedding, local and systemic symptoms, and healing time of genital lesions.

Immune-Response Modifiers

Resiquimod, an immune-response modifier, has shown promise in reducing genital recurrences in animal models. This treatment may offer advantages over current antiviral therapies by enhancing the immune response to HSV.

Management During Pregnancy

Antiviral Prophylaxis

Pregnant women with a history of genital herpes or those experiencing a first episode during pregnancy should receive antiviral prophylaxis from 36 weeks of gestation until delivery. This approach aims to reduce the risk of neonatal herpes, which can have severe consequences.

Delivery Considerations

Cesarean delivery is recommended if genital herpes lesions are present at the onset of labor or if a primary episode occurred less than six weeks before delivery. This measure helps prevent neonatal herpes transmission.

Conclusion

The management of genital herpes involves a combination of antiviral medications, suppressive therapy, and specific strategies during pregnancy to reduce the risk of transmission. While current treatments effectively manage symptoms and reduce recurrence, ongoing research into new therapies and vaccines holds promise for improved future management of this common STI.