Genital Herpes: Management and Etiology

by John Fisher, MD

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    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.

    About the Lecture

    The lecture Genital Herpes: Management and Etiology by John Fisher, MD is from the course Genital and Sexually Transmitted Infections. It contains the following chapters:

    • Genital Herpes – Management
    • Genital Herpes – Etiology

    Included Quiz Questions

    1. A 7-10 day course of Acyclovir 400mg orally three times a day.
    2. A 7-10 day course of Valacyclovir 1g orally twice a day.
    3. A lifetime course of Valacyclovir 500mg daily by mouth.
    4. A 5 day course of Acyclovir 800mg orally twice a day.
    5. A 3 day course of Valacyclovir 500mg twice a day by mouth.
    1. Viral shedding and transmission can occur even if the person carrying the pathogen is completely asymptomatic.
    2. Viral shedding and transmission only occur if the person carrying the pathogen has active lesions.
    3. Viral shedding and transmission only occur if the person carrying the pathogen has prodromal symptoms or active lesions.
    4. Transmission of Herpes Simplex only occurs through sharing blood products.
    5. Transmission of genital herpes is very rare.
    1. She should try suppressive therapy with Acyclovir 400mg orally twice a day.
    2. She should try suppressive therapy with Acyclovir 200mg orally 5 times a day.
    3. She needs to come to clinic for physical examination each time these symptoms occur to get a 5 day course of treatment.
    4. She should abstain from intercourse at all times because the likelihood of her transmitting the virus even when asymptomatic is very high.
    5. Advise her than unfortunately there is only symptomatic treatment for prodromal symptoms of recurrent genital herpes with non-steroidal anti-inflammatory medications or topical creams.

    Author of lecture Genital Herpes: Management and Etiology

     John Fisher, MD

    John Fisher, MD

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