Management and treatment of herpes simplex virus.
Medical management is centered on the use of specific antiviral agents and the goal of therapy is to reduce morbidity and to prevent complications. Although the same medications are active against HSV-1 and HSV-2, the location of the lesions and the chronicity (primary or reactivation) of the infection determines the dosage and duration of antiviral agent.
Life-threatening HSV infections in immunocompromised patients require high dose intravenous acyclovir, often started empirically. Appropriate wound care is needed, and treatment for secondary bacterial skin infections may be required. In some cases, consultation with a dermatologist may be needed and in immunocompromised patients, consultation with a HIV specialist may be required.
Saline bathing and use of appropriate analgesia are recommended. Lidocaine has been safely used as a topical anesthetic in the management of genital herpes. Also, counsel patient about transmission risks, including subclinical shedding and the limited impact of condoms and antivirals.
Acylovir
- Synthetic purine nucleoside analogue with activity against a number of herpes viruses (HSV and varicella zoster). It is highly selective for virus-infected cells because of its high affinity for viral thymidine kinase enzyme. It is the most frequently used agent for HSV infections and is significantly cheaper than Valacyclovir and Famciclovir, with equal efficacy. Acyclovir is available in intravenous, oral and topical formulation. Side effects include transient renal insufficiency due to crystallization of compound in renal parenchyma and this adverse effect can be reduced by making sure the patient is well hydrated and also by slow administration of the drug.
- This is a prodrug that is rapidly converted to the active drug acyclovir. It is more expensive than acyclovir but has a greater bioavailability, and less frequency of dosing when compared to acyclovir. It is the only agent shown to reduce transmission of HSV-2 infection between partners. Oral dose of 4 g per day or greater has been associated with thrombotic thrombocytopenic purpura after extended use in HIV-positive persons.
- This prodrug inhibits viral DNA synthesis and replication when transformed into its active metabolite, penciclovir. It has excellent bioavailabilty and used against herpes simplex and varicella-zoster viruses.
- This agent is active against HSV-1 and HSV-2, but unfortunately is more toxic than acyclovir, valacyclovir, or famciclovir.
And then there is Ozone therapy. MAH and 10 pass MAH with rectal insufflation of ozone seems to be the best natural treatment for chronic herpes. Call us and let's discuss your condition and how ozone can help you.
