Abstract
The frequent occurrence of genital herpes continues to be a serious clinical problem. Although not life threatening, the physical symptoms of the disease, and the ensuing psychosocial complications, can be overwhelming to patients. The life cycle of the herpes simplex virus is complex, comprising multiple stages. Following infection, the virus establishes life-long latency in its host and can reactivate at any time as a recurrent infection. Successful management of genital herpes simplex infections involves patient education and psychological support, as well as antiviral agents. The antiviral agent famciclovir has been shown to shorten the course and decrease the severity of episodes of recurrent genital herpes. In addition, famciclovir has been shown to be effective in suppressing recurrent genital herpes. A review of the clinical experience with famciclovir in the treatment of genital herpes is presented.
Highlights
The frequent occurrence of genital herpes continues to be a serious clinical problem
Recurrences are shorter and less intense than primary infections and are generally more severe in women than in men. 7’8 In addition, while men appear to have a higher rate of symptomatic recurrence, asymptomatic recurrence is more frequent in women,s,9 Women infected with herpes simplex virus (HSV)-2 require careful gynecological management, including frequent Pap tests, for the remainder of their lives because HSV-2 antibodies have been associated with cytological abnormalities of the cervix,z,4,6
The efficacy of famciclovir for the treatment of first-episode genital herpes was evaluated in three studies, which enrolled a total of 951 patients
Summary
Tients may experience the reactivation of a previously asymptomatic genital herpes infection. 250 mg, twice daily (P < 0.001).z9 The meta-analysis of two year-long clinical trials, in which 369 patients were enrolled (236 receiving famciclovir, 250 mg, twice daily; 133 receiving placebo), showed that 80% fewer genital herpes outbreaks occurred in famciclovir-treated patients (median number of recurrences was 1) than in placebo-recipients (median number of recurrences was 4.9) (Data on file, SmithKline Beecham Pharmaceuticals) These and other studies show that once-daily dosing is less effective at preventing outbreaks than is multidosing,z9-31. Preclinical studies have shown that treatment with famciclovir was more effective than valacyclovir in reducing the incidence of clinical manifestations of HSV-1 infections in mice.[33,34] In addition, the famciclovirtreated mice showed markedly reduced evidence of latent virus present in explanted ganglia.[33,4] Based on these results, as well as preliminary clinical data that support these observations, clinical trials have been initiated to further examine the effects of famciclovir on latency/reactivation after administration to patients with first-episode genital herpes. Preclinical studies have shown that treatment with famciclovir was more effective than valacyclovir in reducing the incidence of clinical manifestations of HSV-1 infections in mice.[33,34] In addition, the famciclovirtreated mice showed markedly reduced evidence of latent virus present in explanted ganglia.[33,4] Based on these results, as well as preliminary clinical data that support these observations, clinical trials have been initiated to further examine the effects of famciclovir on latency/reactivation after administration to patients with first-episode genital herpes. s
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