Treatment Of Recurrent Genital Herpes Research Articles

Patients’ Preference of Valacyclovir Once-Daily Suppressive Therapy Versus Twice-Daily Episodic Therapy for Recurrent Genital Herpes

Valacyclovir is effective for suppressive and episodic treatment of recurrent genital herpes. Few data on patients' treatment strategy preferences are available. The goal was to assess patients' preference, satisfaction, and quality of life with suppressive versus episodic treatment of recurrent genital herpes. This was a multicenter, open-label, randomized, two-arm, crossover 48-week study involving 225 patients with genital herpes. Suppressive valacyclovir therapy was preferred to episodic valacyclovir treatment by 72% of patients (P < 0.001). Overall treatment satisfaction and quality of life were significantly greater during suppressive therapy (P < 0.001 and P = 0.002, respectively). The risk of recurrence during the first 24 weeks was reduced by 78% with suppressive therapy (P < 0.001). Significantly fewer patients experienced recurrences during suppressive treatment than with episodic treatment (P < 0.001). Valacyclovir was well tolerated. Suppressive valacyclovir was preferred to episodic therapy by most patients. Suppressive therapy was associated with increased treatment satisfaction, and decreased risk and lower frequency of recurrences.

Selected Topics from the Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines 2002

SUMMARY These guidelines for the treatment of patients who have sexually transmitted diseases (STDs) were developed by the Centers for Disease Control and Prevention (CDC) after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on September 26‐28, 2000. The information in this report updates the 1998 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR. 1998;47[No. RR-1]). Included in these updated guidelines are new alternative regimens for scabies, bacterial vaginosis, early syphilis, and granuloma inguinale; an expanded section on the diagnosis of genital herpes (including typespecific serologic tests); new recommendations for treatment of recurrent genital herpes among persons infected with human immunodeficiency virus (HIV); a revised approach to the management of victims of sexual assault; expanded regimens for the treatment of urethral meatal warts; and inclusion of hepatitis C as a sexually transmitted infection. In addition, these guidelines emphasize education and counseling for persons infected with human papillomavirus, clarify the diagnostic evaluation of congenital syphilis, and present information regarding the emergence of quinoloneresistant Neisseria gonorrhoeae and implications for treatment. Recommendations also are provided for vaccine-preventable STDs, including hepatitis A and hepatitis B.

Treatment of Recurrent Genital Herpes with Interferon Alpha-2α

The purpose of the present study was to evaluate the efficacy and safety of parenteral administration of interferon alpha-2α in the treatment of recurrent herpes genitalis. A total of 97 patients (66 males, 31 females, mean age 34.86 ± 16.74 years), who had at least five recurrences of genital herpes during the previous 12 months, participated in a prospective open study on the effects of treatment with interferon alpha-2α (Roferon-A; Roche). The patients were treated with interferon alpha-2α (3 × 10⁶ IU) by subcutaneous injection, three times weekly for 4 weeks, and the same schedule was repeated after 3 and 6 months. All patients were asymptomatic at the start of the study. After initiation of treatment, all patients reported to the clinic every 3 months for 2 years (the males were submitted to peoscopy and the females to Pap test and colposcopy) at the time of their recurrences. Comparison was made of the number of recurrences, duration of lesions, duration and severity of pain, and itching and burning. Prophylactic administration of interferon alpha-2α prevented recurrences of genital herpes virus infection in 51 patients (20 males and 31 females). Interferon administration shortened the healing time from 8.5 days before treatment to 2.5 days after treatment (p < 0.001). There was a significant reduction in the number of recurrences during the study period, from 7.46 before treatment to 2.64 after treatment (p < 0.001). On the basis of the overall efficacy and adverse effects, this regimen may be of value in the routine treatment of recurrent herpes.

Valaciclovir Versus Aciclovir in Patient Initiated Treatment of Recurrent Genital Herpes: A Randomised, Double Blind Clinical Trial

No AccessJournal of UrologyUrological Survey: Abstracts: Urinary Tract Infection1 Apr 1998Valaciclovir Versus Aciclovir in Patient Initiated Treatment of Recurrent Genital Herpes: A Randomised, Double Blind Clinical Trial N.J. Bodsworth, R.J. Crooks, S. Borelli, G. Vejlsgaard, J. Paavonen, A.-M. Worm, N. Uexkull, J. Esmann, A. Strand, A.J. Ingamells, and A. Gibb N.J. BodsworthN.J. Bodsworth More articles by this author , R.J. CrooksR.J. Crooks More articles by this author , S. BorelliS. Borelli More articles by this author , G. VejlsgaardG. Vejlsgaard More articles by this author , J. PaavonenJ. Paavonen More articles by this author , A.-M. WormA.-M. Worm More articles by this author , N. UexkullN. Uexkull More articles by this author , J. EsmannJ. Esmann More articles by this author , A. StrandA. Strand More articles by this author , A.J. IngamellsA.J. Ingamells More articles by this author , and A. GibbA. Gibb More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63673-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Valaciclovir Versus Aciclovir in Patient Initiated Treatment of Recurrent Genital Herpes: A Randomised, Double Blind Clinical Trial." The Journal of Urology, 159(4), pp. 1420–1421 The International Valaciclovir HSV Study Group; Sydney Hospital, Sydney, Australia, Glaxo Wellcome Research Development, Beckenham, United Kingdom, Dermatologische Klinik und Poliklinik, Munich, Germany, Rigshospitalet, Bispebjerg Hospital, Copenhagen and Marselisborg Hospital, Aarhus, Denmark, University Central Hospital, Helsinki, Finland and Citymottagningen, Stockholm and University Hospital, Uppsala, Sweden.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 159Issue 4April 1998Page: 1420-1421 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information N.J. Bodsworth More articles by this author R.J. Crooks More articles by this author S. Borelli More articles by this author G. Vejlsgaard More articles by this author J. Paavonen More articles by this author A.-M. Worm More articles by this author N. Uexkull More articles by this author J. Esmann More articles by this author A. Strand More articles by this author A.J. Ingamells More articles by this author A. Gibb More articles by this author Expand All Advertisement PDF downloadLoading ...

Valaciclovir Versus Aciclovir in Patient Initiated Treatment of Recurrent Genital Herpes

Valaciclovir Versus Aciclovir in Patient Initiated Treatment of Recurrent Genital Herpes

Management of genital herpes.

Oral acyclovir is the therapy of choice for treatment of first-episode genital herpes, for suppression of frequently recurrent genital herpes, and, in selected patients, for episodic treatment of recurrent genital herpes. Topical acyclovir therapy is relatively or totally ineffective and is therefore discouraged. Indications for intravenous acyclovir therapy of mucocutaneous HSV infections include patients hospitalized with severe first-episode genital herpes and immunocompromised patients who have severe infections or who cannot swallow the oral preparation. The most promising investigational drugs are the oral prodrugs valaciclovir and famciclovir. Famciclovir is licensed in the U.S. for treatment of zoster but not for treatment of mucocutaneous genital herpes. When used for episodic therapy of recurrent genital herpes, both famciclovir and valaciclovir effectively reduce the duration of viral shedding, lesion healing times, and the duration of symptoms. Suppressive therapy with famciclovir has also been shown to be effective in reducing the frequency of episodes in women with frequently recurring genital herpes. Although these drugs can be given less frequently than oral acyclovir, there is yet no clear indication that they are more effective or better tolerated than oral acyclovir.

Valaciclovir – A Review of its Potential in the Management of Genital Herpes

The continued increase in prevalence of herpes simplex virus (HSV) infection indicates a need to develop improved chemotherapeutic strategies so as to enhance options for the management of genital herpes. The clinical and psycho-social impact of genital herpes and the need to encourage patients to participate in controlling their disease create several opportunities for improvement. The higher bioavailability of aciclovir from valaciclovir ensures that plasma aciclovir levels exceed the in vitro IC50 for clinical HSV strains with once- or twice-daily dosing regimens. The satisfactory outcome for valaciclovir in pre-clinical mutagenicity and carcinogenicity bioassays, plus aciclovir's highly specific mode of action, form the basis for the proposal that valaciclovir can match the excellent safety profile established for aciclovir. Controlled clinical trials of valaciclovir for the acute treatment of recurrent genital herpes have demonstrated efficacy in speeding resolution of all signs and symptoms, hastening lesion healing and terminating virus shedding. Further, these results indicate that valaciclovir provides a significant improvement in increasing the numbers of patients in whom lesion development is prevented. These benefits were achieved with twice-daily valaciclovir regimens and without compromise to safety. Studies evaluating valaciclovir in HSV infections in the immunocompromised and for long-term suppressive therapy in otherwise healthy subjects continue. To date, the valaciclovir HSV clinical development programme indicates that efficacy can be achieved with less frequent dosing without compromising safety.

Intravenous immunoglobulin vs acyclovir in treatment of recurrent genital herpes: a clinical and immunological study

Intravenous immunoglobulin vs acyclovir in treatment of recurrent genital herpes: a clinical and immunological study

Lock of efficacy of a topical human leukocyte interferon-nonoxynol-9 preparation in the treatment of recurrent genital herpes : A. Langenberg, G. Yalsecchi, C. Winter, M. Remington, A. Dunne, J. Benedetti, L. Corey. Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA

Lock of efficacy of a topical human leukocyte interferon-nonoxynol-9 preparation in the treatment of recurrent genital herpes : A. Langenberg, G. Yalsecchi, C. Winter, M. Remington, A. Dunne, J. Benedetti, L. Corey. Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, WA

Recombinant alpha-2 interferon gel treatment of recurrent herpes genitalis

Topical recombinant alpha-2 interferon treatment of recurrent genital herpes was studied in a randomized, double-blind, placebo controlled clinical trial. Three hundred and eighty-seven patients were treated at eight study centers with either interferon gel or placebo four times daily for four days. Interferon therapy caused a 26% decrease in the duration of viral shedding. For male patients, there were also significant decreases in the time to crusting (17%) and duration of pain (34%) and itching (21%). For patients with recurrent genital herpes, treatment with topical interferon was found to be effective in decreasing the duration of viral shedding and, for males, pain, itching and time to crusting.

Randomized, Double-Blind, Placebo-Controlled, Clinic-Initiated, Canadian Multicenter Trial of Topical Edoxudine 3.0% Cream in the Treatment of Recurrent Genital Herpes

Treatment for recurrent genital herpes using edoxudine 3% cream for 5 days was evaluated in 200 patients in a randomized, multicenter, double-blind, placebo-controlled, clinic-initiated trial. Lesion tenderness was predictive of and more sensitive and longer-lasting than the symptom of pain. Among patients receiving placebo, times to crusting (P = .043), cessation of investigator-observed signs (P = .005), lesion-associated signs (P = .02), and groin signs (P = .05) were longer in women. Edoxudine reduced viral shedding in men (mean 2.7 vs. 3.4 days, P = .009) and women (2.0 days vs. 3.5 days, P = .0001). Loss of investigator-observed signs (4.4 vs. 6.2 days, P = .002), investigator-observed lesion tenderness (P = .01), lesion signs (P = .02), groin adenopathy (P = .01), and tenderness (P = .01) occurred earlier in women taking edoxudine. Edoxudine was well-tolerated and reduced several signs of herpes in women. Its clinical role in recurrent genital herpes remains to be fully determined.

Randomized, Double-Blind, Placebo-Controlled, Patient-Initiated Study of Topical High- and Low-Dose Interferon- with Nonoxynol-9 in the Treatment of Recurrent Genital Herpes

To explore further topical antiviral therapy for recurrent genital herpes, 188 culture-proven patients were randomized to receive treatment with topical interferon-alpha in high-dose (10(6) IU/g with 1% nonoxynol-9 in 3.5% methylcellulose) or low-dose (10(3) IU/g with 0.1% nonoxynol-9 in 3.5% methylcellulose) treatments or placebo (3.5% methylcellulose, alone), applied three times daily for 5 days. Of these, 105 experienced prodromal symptoms within the study period and applied the medication, of whom 99 could be evaluated for efficacy. Patients were followed with daily clinical assessments and cultures until reepithelialization. The median time to negative virus culture in high-dose recipients was 2.5 days compared with 3.9 days for placebo recipients (P = .023), and a significant dose response was observed (P = .016). Antiviral effects were more prominent in men than women. High-dose recipients also had reduced median duration of symptoms to 2.7 days from 3.7 days for placebo recipients (P = .03), with a significant dose-response relationship (P = .047). Effects on duration of symptoms were more prominent in women. Times to complete reepithelialization in those who applied the drug during the prodromal phase were 5.8 days for high-dose recipients compared with 6.5 days for placebo recipients (P = .053). A multivariate ranked linear model analysis of four efficacy variables (crusting, healing, virus shedding, symptom duration) also favored the high-dose gel (P = .015). High-dose topical interferon-alpha preparation is effective for patients with recurrent genital herpes. Applied early in the course of a recurrent episode, this treatment is safe and may provide a topical alternative to other types of therapy in the future.

Herpes simplex virus glycoprotein immunotherapy of recurrent genital herpes: Factors influencing efficacy

Recombinant herpes simplex virus type 1 (HSV-1) glycoproteins B (gB) and D (gD) were used as immunotherapeutic agents for the treatment of recurrent genital herpes in guinea pigs. Administration of a gBgD vaccine eight to 21 days after intravaginal HSV-2 inoculation significantly increased the titer of anti-HSV antibodies ( P<0.005) while significanlty reducing the frequency of subsequent herpetic recurrences ( P<0.05). The effectiveness of gBgD immunotherapy was influenced by both the co-administration of adjuvant, the type of adjuvant, and by the timing and route of administration. These data demonstrate that recurrent HSV disease in animals with established latent infection may be favorably altered by the administration of immunogenic viral proteins.

Herpes simplex virus glycoprotein treatment of recurrent genital herpes reduces cervicovaginal virus shedding in guinea pigs

Treatment of previously infected guinea pigs with herpes simplex virus (HSV) glycoproteins reduces the frequency and severity of subsequent genital recurrences. An effective vaccine should also reduce episodes of viral shedding. In this study, HSV glycoproteins B and D treatment of animals experiencing recurrent genital herpes reduced the frequency of both clinical recurrences and cervicovaginal viral shedding. When virus was shed, however, the peak viral titer and duration of shedding was unaltered.

Comparison of Uniphyl tablets and inhaled albuterol as maintenance therapy in asthmatic adults

A new dosage regimen of orally administered acyclovir, 800 mg twice daily for five days, for the treatment of recurrent genital herpes was compared with the standard dosage of 200 mg given five times per day. A double-blind study of 157 patients was used to evaluate the safety and efficacy of both regimens. The new regimen was well tolerated, more convenient, and as effective as the standard dosage. In male patients, the new regimen may be more effective than the standard regimen of 200 mg given five times per day to treat lesions that are already present.

Treatment of recurrent genital herpes with topical alpha interferon gel combined with nonoxynol 9

A double-blind, placebo-controlled study was done to evaluate the efficacy of an alpha interferon preparation in 128 patients with recurrent genital herpes. The preparation containing 10(5) or 10(7) U alpha interferon with nonoxynol 9 in a cream base (Exovir-HZ) was applied three times daily for 5 days. The treatment did not cause any adverse reactions. Patients treated with either interferon concentration became negative for viral culture at a faster rate than placebo recipients. The end of new lesion formation, scabbing, and the healing of lesions were all superior in patients treated with 10(5) U to those treated with 10(7) U interferon. End of new lesion formation and scabbing were also statistically different in patients treated with 10(7) U from those patients treated with placebo. Results suggest that topical interferon might be useful in relieving symptoms of severe cases of genital herpes.

Oral acyclovir for episodic treatment of recurrent genital herpes: Efficacy and safety

This multicenter double-blind study of 157 patients was designed to evaluate the safety and efficacy of a new dosage regimen of oral acyclovir (800 mg twice a day for 5 days) for the treatment of recurrent genital herpes. The new regimen was compared with the standard dosage of 200 mg given five times a day to patients treated for three consecutive episodes (one episode with physician-initiated therapy and two with patient-initiated therapy) and followed up for three untreated episodes. The new regimen was well tolerated and effective. In male patients it may be more effective than the standard regimen of 200 mg given five times a day to treat vesicles that are already present.

Treatment of Recurrent Genital Herpes Simplex Infections with Oral Acyclovir. A Controlled Trial

Two hundred fifty patients were entered into a multicenter trial to evaluate the efficacy and toxicity of orally administered acyclovir for treatment of recurrent genital herpes. The study consisted of part A, in which patients entered the study within 48 hours of the onset of lesions, and part B, in which patients self-initiated therapy as soon as possible after the onset of a recurrent episode. In both parts, patients received either acyclovir (200 mg) or placebo, five times daily for five days. In both parts, the duration of virus shedding and the time to crusting and healing of lesions were shorter among acyclovir recipients than among placebo recipients. In part B, fewer acyclovir recipients formed new lesions during the study medication period than did placebo recipients. When parts A and B were compared directly, the duration of virus shedding and the times required for crusting and healing of lesions were significantly shorter among acyclovir recipients in part B than among acyclovir recipients in part A. No significant differences in the duration of itching and pain or in the times of subsequent recurrence were noted between acyclovir and placebo groups in either part A or part B. No significant toxic or adverse reactions were seen in acyclovir recipients. Oral acyclovir shortens the duration of virus shedding and the duration of lesions in patients with recurrent genital herpes. These effects are more pronounced when therapy is self-initiated by patients early in the course of a recurrent episode. ( JAMA 1984;251:2103-2107)

Treatment of Recurrent Genital Herpes Simplex Infections With Oral Acyclovir

Two hundred fifty patients were entered into a multicenter trial to evaluate the efficacy and toxicity of orally administered acyclovir for treatment of recurrent genital herpes. The study consisted of part A, in which patients entered the study within 48 hours of the onset of lesions, and part B, in which patients self-initiated therapy as soon as possible after the onset of a recurrent episode. In both parts, patients received either acyclovir (200 mg) or placebo, five times daily for five days. In both parts, the duration of virus shedding and the time to crusting and healing of lesions were shorter among acyclovir recipients than among placebo recipients. In part B, fewer acyclovir recipients formed new lesions during the study medication period than did placebo recipients. When parts A and B were compared directly, the duration of virus shedding and the times required for crusting and healing of lesions were significantly shorter among acyclovir recipients in part B than among acyclovir recipients in part A. No significant differences in the duration of itching and pain or in the times of subsequent recurrence were noted between acyclovir and placebo groups in either part A or part B. No significant toxic or adverse reactions were seen in acyclovir recipients. Oral acyclovir shortens the duration of virus shedding and the duration of lesions in patients with recurrent genital herpes. These effects are more pronounced when therapy is self-initiated by patients early in the course of a recurrent episode.