Genital herpes. A guide to pharmacological therapy

Area of Science:

• Virology
• Pharmacology
• Dermatology

Background:

• Genital herpes simplex virus (HSV) infection management relies heavily on aciclovir.
• Current research explores related antiviral compounds for HSV treatment.

Purpose of the Study:

• To review the current pharmacological therapies for genital HSV infection.
• To discuss the efficacy and controversies surrounding aciclovir in managing initial and recurrent episodes.
• To address specific considerations for HSV management in pregnancy and immunocompromised individuals.

Main Methods:

• Review of existing literature on aciclovir and related compounds for genital HSV.
• Analysis of treatment protocols for initial, recurrent, and severe HSV infections.
• Examination of therapeutic strategies for special populations, including pregnant women and immunocompromised patients.

Main Results:

• Oral aciclovir is the standard for initial genital HSV; intravenous therapy is for severe cases.
• Topical aciclovir offers limited benefit for systemic symptoms; no preparation prevents recurrences.
• Early episodic oral aciclovir shows promise for aborting recurrent episodes.
• Suppressive oral aciclovir is effective for frequent recurrences, with dose adjustments and interruptions recommended.
• Management in pregnancy is controversial; prompt suppressive therapy is crucial for immunocompromised hosts.

Conclusions:

• Aciclovir remains the cornerstone of genital HSV pharmacological therapy.
• Optimizing episodic and suppressive oral aciclovir regimens is key for managing recurrent infections.
• Emerging aciclovir resistance in immunocompromised patients necessitates alternative treatments like foscarnet.