Antiviral therapy can shorten the duration of symptoms and signs in primary infection which, when untreated, can be associated with significant morbidity. Risk of recurrence after treatment of first-episode genital herpes with intravenous acyclovir. Valacyclovir is the valine ester of acyclovir and has enhanced absorption after oral administration. Almost all persons with symptomatic first-episode genital HSV-2 infection subsequently experience recurrent episodes of genital lesions; recurrences are less frequent after initial genital HSV-1 infection. Suppressive anti-HSV therapy in persons with HIV infection does not reduce the risk for either HIV transmission or HSV-2 transmission to susceptible sex partners (71,366). This article concentrates on the management issues specific to genital herpes infection during pregnancy. Is this a first episode (primary infection) or a recurrence? Diagnosis and treatment are important to reduce symptoms, reduce viral shedding and to reduce the risk of recurrence or asymptomatic viral shedding around the time of delivery. Refer, diagnose and treat as for first trimester, then continue suppressive aciclovir therapy. Localised infections may progress to CNS or disseminated infection if not treated with intravenous aciclovir.
Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. Systemic symptoms are common in primary disease and include fever, headache, malaise, abdominal pain and myalgia. 1 Topical acyclovir reduces the duration of viral shedding and the length of time before all lesions become crusted, but this treatment is much less effective than oral or intravenous acyclovir.1. J. Double-blind placebo-controlled trial of oral acyclovir in first-episode genital herpes simplex virus infection. As with primary HSV-1 infection, recurrent infection may occur in the absence of clinical symptoms. Recurrent genital HSV-2 infection is clinically very different from first episode infections. Genital HSV-2 recurrences can be either symptomatic (recognized by the patient) or asymptomatic (unrecognized throughout the time of recurrence) (181). With high-dose acyclovir therapy, the mortality rate for disseminated neonatal HSV disease is 29 (112). Genital ulcer disease, including that caused by HSV-2, has been recognized as a risk factor for HIV transmission since the early years of the HIV epidemic (93, 105). The standard course of antiviral therapy for recurrent genital herpes requires administration of multiple doses of medication for 5 days. To assess the efficacy of a shorter course of antiviral therapy, patients with recurrent genital herpes simplex virus type 2 (HSV-2) infection were enrolled in a randomized, double-blind, placebo-controlled study of acyclovir (800 mg given by mouth 3 times per day t. Risk of recurrence after treatment of first episode genital herpes with intravenous acyclovir.
A first episode of genital or oral herpes in a patient already seropositive for HSV is termed a nonprimary initial infection, and these infections tend to be less severe. The disease course after initial infection is variable; some patients have recurrent infections, and others never experience a second episode. The efficacy of topical acyclovir cream used as treatment in primary or recurrent episodes of genital herpes varies between RCTs and overall does not appear to be as reliable as oral acyclovir. Intermittent suppressive therapy is also useful in special populations to decrease the risk of virus transmission to noninfected individuals. Neonatal infection: risk 40 if primary genital HSV infection in mother during third trimester. 1) recurrent genital symptoms or atypical symptoms with negative HSV PCR or culture. Elective Cesarean section and suppressive therapy with acyclovir (400mg TID) at or beyond 36 weeks of gestation are recommended for women with first episode genital lesions during third trimester. Benign recurrent lymphocytic meningitis: acyclovir 10 mg/kg IV q8h X 7-10d. Herpes during pregnancy. Severe or disseminated infections may be treated with acyclovir intravenously:. Of greatest concern is the risk of primary infection acquired at birth which could lead to herpetic meningitis. J Perinatol 2001; Acyclovir suppression to prevent clinical recurrences at delivery after first episode genital herpes in pregnancy: an open-label trial.