Genital Herpes: Management and Etiology

00:01 So turning now to the treatment of herpes simplex infections, let’s talk about how you treat the first clinical episode.

00:11 And the duration of that therapy is 7 to 10 days, and you can use either acyclovir, valacyclovir, or famciclovir.

00:23 These agents work by being chain terminators.

00:28 So as the herpes virus is trying to make more DNA, these are false basis so the chain of DNA is broken.

00:39 If you're talking about recurrent episodes, the duration of treatment is variable, but you use the same agents for 2 to 5 days, 3 to 5 days, or 1 to 5 days.

00:55 Now, how do you manage recurrences? First of all, you have to define what’s frequent.

01:02 And if a patient has, for example, one or two episodes a year, then it’s probably prudent to treat those individual episodes and not use any kind of suppressive therapy.

01:17 So if you have a professional person who’s job is interfered by the number of recurrences, you might consider suppressive therapy, and you do that with acyclovir orally twice a day, and the efficacy has been established for 6 years, or you could use valacyclovir.

01:44 Now, the difference between valacyclovir and acyclovir is, valacyclovir is the valine ester of acyclovir.

01:53 In other words, when you take that medication, it is better absorbed.

01:57 Once in the system, it becomes acyclovir.

02:01 So it’s got better bioavailability, and as you can imagine, it’s much more expensive.

02:09 Or you could use 1 gram of valacyclovir once a day, famciclovir – twice a day.

02:17 Now what about counseling people with genital herpes? Well, their sex partners should certainly be informed that they have had herpes.

02:31 Because of asymptomatic shedding of the virus, you could infect the person when you, yourself, were not symptomatic and you can actually give a person herpes simplex genitalis during asymptomatic periods.

02:49 Certainly and obviously, persons with genital herpes should remain abstinent when any lesions or any prodromal symptoms are still present.

03:01 And that concludes my discussion of herpes simplex genitalis.