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Vol. 100. Issue 1.
Pages 22-32 (January - February 2009)
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Vol. 100. Issue 1.
Pages 22-32 (January - February 2009)
Advances in dermatology
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Update on the Treatment of Genital Herpes
Actualización en el Tratamiento del Herpes Genital
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10184
J.M. Martín
Corresponding author
jmmart@eresmas.com

Correspondence: Servicio de Dermatología, Hospital Clínico Universitario, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.
, G. Villalón, E. Jordá
Servicio de Dermatología, Hospital Clínico Universitario, Valencia, Spain
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Abstract

Genital herpes is a chronic infection characterized by periodic reactivation. It can produce symptomatic disease in the host although asymptomatic viral excretion can also occur. It is currently the main cause of genital ulceration and an important public health problem that has substantial clinical, psychological, and economic repercussions. This review analyzes the currently available therapeutic options and regimens, which are based mainly on systemic use of antiviral agents such as aciclovir, valacyclovir, and famciclovir. In addition, special emphasis is placed on the prevention and management of this infection in specific situations, such as pregnant, pediatric, and immunocompromised patients.

Key words:
genital herpes
sexually transmitted disease
aciclovir
valac
Resumen

El herpes genital es una infección crónica que se caracteriza por una reactivación periódica, con capacidad tanto de producir una enfermedad sintomática en el huésped como de excreción viral asintomática. Hoy en día constituye la primera causa de ulceración genital y representa un importante problema de salud pública, con considerables repercusiones clínicas, psicológicas y económicas.

Se revisan y actualizan las distintas opciones y pautas terapéuticas disponibles en la actualidad, basadas fundamentalmente en el empleo por vía sistémica de los fármacos antivirales aciclovir, valaciclovir y famciclovir. Por otro lado, se pone especial énfasis en la prevención y el manejo de esta infección en situaciones particulares, como en embarazadas, en niños, o en pacientes inmunodeprimidos.

Palabras clave:
herpes genital
enfermedades de transmisión sexual
aciclovir
valaciclovir
famciclovir
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References
[1.]
J.L. Severson, S.K. Tyring.
Relation between herpes simplex viruses and human immunodeficiency virus infections.
Arch Dermatol, 135 (1999), pp. 1393-1397
[2.]
B. Milpied, M. Javier, C.H. Derancourt, J.L. Verret, E. Caumes, F. Bouscarat.
Herpes genital.
Ann Dermatol Venereol, 133 (2006), pp. S28-S30
[3.]
D.T. Fleming, G.M. McQuillan, R.E. Johnson, A.J. Nahmias, S.O. Aral, F.K. Lee, et al.
Herpes simplex virus type 2 in the United States, 1976-1994.
N Engl J Med, 337 (1997), pp. 1105-1111
[4.]
M. Velasco.
Actualización del herpes genital. Epidemiología del herpes genital.
XIII Reunión del Grupo Español para la Investigación de las Enfermedades de Transmisión Sexual,
[5.]
G.J. Mertz, J. Benedetti, R. Ashley, S.A. Selke, L. Corey.
Risk factors for the sexual transmission of genital herpes.
Ann Intern Med, 116 (1992), pp. 197-202
[6.]
M. Ferrán, R.M. Pujol.
Tratamiento del herpes zóster.
Actas Dermosifiliogr, 97 (2006), pp. 25-37
[7.]
A. España, P. Redondo.
Actualización en el tratamiento del herpes zóster.
Actas Dermosifiliogr, 97 (2006), pp. 103-114
[8.]
M.W. McKendrick, J.I. McGill, J.E. White, M.J. Wood.
Oral acyclovir in acute herpes zoster.
Br Med J, 293 (1986), pp. 1529-1532
[9.]
K.R. Beutner, D.J. Friedman, C. Forszpaniak, P.L. Andersen, M.J. Wood.
Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults.
Antimicrobiol Agents Chemother, 39 (1995), pp. 1546-1553
[10.]
C.M. Perry, D. Faulds.
Valaciclovir: A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in herpesvirus infections.
Drugs, 52 (1996), pp. 754-772
[11.]
D.L. Earnshaw, T.H. Bacon, S.J. Darlison, K. Edmonds, R.M. Perkins, RA. Vere Hodge.
Mode of antiviral action of penciclovir in MRC-5 cells infected with herpes simplex virus type 1 (HSV-1), HSV-2, and varicella-zoster virus.
Antimicrob Agents Chemother, 36 (1992), pp. 2747-2757
[12.]
Centers for Disease Control and Prevention.
Sexually transmitted diseases treatment guidelines, 2006.
MMWR, 55 (2006), pp. 16-20
[13.]
R.L. Ashley, A. Wald.
Herpes genital: review of the epidemic and potential use of type-specific serology.
Clin Microbiol Rev, 12 (1999), pp. 1-8
[14.]
S. Tyring, G. Richwald, K. Hamed.
Single-day therapy: an expert opinion on a recent development for the episodic treatment of recurrent genital herpes.
Arch Gynecol Obstet, 275 (2007), pp. 1-3
[15.]
L. Corey, A. Wald, R. Patel, S.L. Sacks, S.K. Tyring, T. Warren, et al.
Once-daily valacyclovir to reduce the risk of transmission of genital herpes.
N Engl J Med, 350 (2004), pp. 11-20
[16.]
K.H. Fife, T.J. Warren, R.D. Ferrera, D.C. Young, S.E. Justus, C.K. Heitman, et al.
Effect of valacyclovir on viral shedding in immunocompetent patients with recurrent herpes simplex virus 2 genital herpes: a US-based randomized, double-blind, placebo-controlled clinical trial.
Mayo Clin Proc, 81 (2006), pp. 1321-1327
[17.]
A. Wald, S. Selke, T. Warren, F.Y. Aoki, S. Sacks, F. Díaz-Mitoma, et al.
Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and virus shedding.
Sex Transm Dis, 33 (2006), pp. 529-533
[18.]
F. Díaz-Mitoma, G. Sibbald, S.D. Shafran, R. Boon, R.L. Saltzman.
Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial.
JAMA, 280 (1998), pp. 887-892
[19.]
M. Reitano, S. Tyring, W. Lang, C. Thoming, A.M. Worm, S. Borelli, et al.
Valacyclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study.
J Infect Dis, 178 (1998), pp. 603-610
[20.]
S.L. Sacks, F.Y. Aoki, F. Díaz-Mitoma, J. Sellors, S.D. Shafran.
Patient-initiated, twice-daily oral famciclovir for early recurrent genital herpes.
JAMA, 276 (1996), pp. 44-49
[21.]
R.J. Whitley.
New approaches to the therapy of HVS infections.
Herpes, 13 (2006), pp. 2
[22.]
M.A. Pue, M.A. Benet.
Pharmacokinetics of famciclovir in man.
Antivir Chem Chemother, 4 (1993), pp. 47-55
[23.]
S.I. Spruance, N. Bodsworth, H. Resnick, M. Conant, C. Oeuvray, J. Gao, et al.
Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis.
J Am Acad Dermatol, 55 (2006), pp. 47-53
[24.]
S. Spruance, F.Y. Aoki, S. Tyring, L. Stanberry, R. Whitley, K. Hamed.
Short-course therapy for recurrent genital herpes and herpes labialis.
J Fam Pract, 56 (2007), pp. 30-36
[25.]
F.Y. Aoki, S. Tyring, F. Díaz-Mitoma, G. Gross, J. Gao, K. Hamed.
Single-day, patient-initiated famciclovir therapy for recurrent genital herpes: a randomized, double-blind, placebo-controlled trial.
Clin Infect Dis, 42 (2006), pp. 8-13
[26.]
R. Whitley, F. Díaz-Mitoma, K. Hamed.
Single-day famciclovir therapy for recurrent genital herpes.
Curr Med Res Opin, 22 (2006), pp. 1307-1310
[27.]
D.C. Vinh, F.Y. Aoki.
Famciclovir for the treatment of recurrent genital herpes: a clinical and pharmacological perspective.
Expert Opin Pharmacother, 7 (2006), pp. 2271-2286
[28.]
D. Simpson, K.A. Lyseng-Williamson.
Famciclovir: a review of its use in herpes zoster and genital and orolabial herpes.
Drugs, 6 (2006), pp. 2397-2416
[29.]
R.C. Reichman, G.J. Badger, G.J. Mertz.
Treatment of recurrent genital herpes simplex infections with oral acyclovir A controlled trial.
JAMA, 251 (1984), pp. 2103-2107
[30.]
K.H. Fife, J. Almekinder, S. Ofner.
A comparison of one year of episodic or suppressive treatment of recurrent genital herpes with valacyclovir.
Sex Trasm Dis, 34 (2007), pp. 297-301
[31.]
Z.A. Brown, C. Gardella, A. Wald, R.A. Morrow, L. Corey.
Genital herpes complicating pregnancy.
Obstet Gynecol, 106 (2005), pp. 845-856
[32.]
J. Del Boz, L. Affumicato, T. Martín, D. Moreno-Pérez, A. Vera.
Herpes simple zosteriforme neonatal.
Actas Dermosifiliogr, 99 (2008), pp. 157-169
[33.]
L. Requena.
Diagnóstico y diagnóstico diferencial del herpes zóster.
Actas Dermosifiliogr., 97 (2006), pp. 17-24
[34.]
Z. Brown.
Preventing herpes simplex virus transmission to the neonate.
Herpes, 11 (2004), pp. 175A-A186
[35.]
Z.A. Brown, J. Benedetti, R. Ashley, S. Burchett, S. Selke, S. Berry, et al.
Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor.
N Engl J Med, 324 (1991), pp. 1247-1252
[36.]
Z.A. Brown, S. Selke, J. Zeh, J. Kopelman, A. Maslow, R.L. Ashley, et al.
The acquisition of herpes simplex virus during pregnancy.
N Engl J Med, 337 (1997), pp. 509-515
[37.]
Z.A. Brown.
HVS-2 specific serology should be offered routinely to antenatal patients.
Rev Med Virol, 10 (2000), pp. 141-144
[38.]
D.H. Watts, Z. Brown, D. Money, S. Selke, M.L. Huang, S.L. Sacks, et al.
A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and caesarean delivery.
Am J Obstet Gynecol, 188 (2003), pp. 836-843
[39.]
K.M. Stone, R. Reiff-Eldridge, A.D. White, J.F. Cordero, Z. Brown, E.R. Alexander, et al.
Pregnancy outcomes following systemic prenatal acyclovir exposure: conclusions from the international acyclovir pregnancy registry, 1984-1989.
Birth Defects Research (Part A), 70 (2004), pp. 201-207
[40.]
J.S. Sheffield, L.M. Hollier, J.B. Hill, G.S. Stuart, G.D. Wendel Jr.
Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review.
Obstet Gynecol, 102 (2003), pp. 1396-1403
[41.]
L.L. Scott, L.M. Hollier, D. McIntire, P.J. Sánchez, G.L. Jackson, G.D. Wendel Jr.
Acyclovir suppression to prevent genital recurrent herpes at delivery.
Infect Dis Obstet Gynecol, 10 (2002), pp. 71-77
[42.]
J.S. Sheffield, J.B. Hill, L.M. Hollier.
Valacyclovir prophylaxis to prevent recurrent herpes at delivery: a randomized clinical trial.
Obstet Gynecol, 108 (2006), pp. 141-147
[43.]
W.W. Andrews, D.F. Kimberlin, R. Whitley, S. Cliver, P.S. Ramsey, R. Deeter.
Valacyclovir therapy to reduce recurrent genital herpes in pregnant women.
Am J Obstet Gynecol., 194 (2006), pp. 774-781
[44.]
G. Fonnest, de la Fuente, I. Fonnest, T. Weber.
Neonatal herpes in Denmark 1977-1991.
Acta Obstet Gynecol Scand, 76 (1997), pp. 335-358
[45.]
A.M. Kesson.
Management of neonatal herpes simplex virus infection.
Paediatr Drugs, 3 (2001), pp. 81-90
[46.]
L.L. Scott, P.J. Sánchez, G.L. Jackson, F. Zeray, G.D. Wendel.
Acyclovir suppression to prevent caesarean delivery after first-episode genital herpes.
Obstet Gynecol, 87 (1996), pp. 69-73
[47.]
S. Braig, D. Luton, O. Sibony, C. Edlinger, C. Boissinot, P. Blot, et al.
Acyclovir prophylaxis in late pregnancy prevents recurrent genital herpes and viral shedding.
Eur J Obstet Gynecol Reprod Biol, 96 (2001), pp. 55-58
[48.]
L.S. Parvey, L.T. Chien.
Neonatal herpes simplex virus infection introduced by fetal-monitor scalp electrodes.
Pediatrics, 65 (1980), pp. 150-153
[49.]
A. Sauerbrei, P. Wutzler.
Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 1: Herpes simplex virus infections.
Med Microbiol Immunol, 196 (2007), pp. 95-102
[50.]
C.G. Prober, W.M. Sullender, L.L. Yasukawa, D.S. Au, A.S. Yeager, A.M. Arvin.
Low risk of herpes simplex virus infections in neonates exposed to the virus at the time of vaginal delivery to mothers with recurrent genital herpes simplex virus infections.
N Engl J Med, 316 (1987), pp. 240-244
[51.]
M.D. Libman, A. Dascal, M.S. Kramer, J. Mendelson.
Strategies for the prevention of neonatal infection with herpes simplex virus: a decision analysis.
Rev Infect Dis, 13 (1991), pp. 1093-1104
[52.]
C. Hutto, A. Arvin, R. Jacobs, R. Steele, S. Stagno, R. Lyrene, et al.
Intrauterine herpes simplex virus infections.
J Pediatr, 110 (1987), pp. 97-101
[53.]
R.K. Khaddar, T. Bradri, A. Ben Hassen, S. Bouraouri, A Souissi, N. Ben Tekaya, et al.
Genital primary herpetic infection in an infant: clinical features, diagnosis and management.
Dermatol Online J, 11 (2005), pp. 22
[54.]
A. Taieb, S. Body, I. Astar, P. DuPasquier, J. Maleville.
Clinical epidemiology of symptomatic primary herpetic infection in children A study of 50 cases.
Acta Paediatr Scand, 76 (1987), pp. 128-132
[55.]
C. Anderson.
Childhood sexually transmited diseases: one consequence of sexual abuse.
Public Health Nurs, 12 (1995), pp. 41-46
[56.]
E.K. Bagdades, D. Pillay, S.B. Squire, C. O’Neil, M.A. Johnson, P.D. Griffiths.
Relationship between herpes simplex virus ulceration and CD4 cell counts in patients with HIV infection.
AIDS, 6 (1992), pp. 1317-1320
[57.]
L.B. Strick, A. Wald, C. Celum.
Management of herpes simplex virus type 2 infection in VIH type 1-infected presons.
Clin Infect Dis, 43 (2006), pp. 347-356
[58.]
G.J. Mertz.
Epidemiology of genital herpes infections.
Infect Dis Clin North Am., 7 (1993), pp. 825-839
[59.]
N. O’Farrell, S.J. Tovey.
High accumulative incidence of genital herpes amongst HIV-1 seropositive heterosexuals in south London.
Int J STD AIDS., 5 (1994), pp. 415-418
[60.]
M.C. Heng, S.Y. Heng, S.G. Allen.
Co-infection and synergy of human immunodeficiency virus-1 and herpes simplex virus-1.
Lancet, 343 (1994), pp. 255-258
[61.]
P. Vogel, K.J. Smith, H.G. Skeleton, D. Cuozzo, K.F. Wagner.
Verucous lesions of herpes simplex in HIV-1 patients.
Int J Dermatol, 32 (1993), pp. 680-682
[62.]
B. Monteagudo, V.M. López-Mouriño, P. Ordóñez, C. Durana, C. de las Heras, J.M. Cacharrón.
Úlceras herpéticas perianales en un paciente con infección por el virus de inmunodeficiencia humana no diagnosticado previamente.
Actas Dermosifiliogr, 97 (2006), pp. 479-480
[63.]
P. Couppie, F. Sarazin, E. Clyti, M. El Guedj, T. Vaz, E. Clyti, et al.
Increased incidence of genital herpes after HAART initiation: a frequent presentation of immune reconstitution inflammatory syndrome (IRIS) in VIH-infected patients.
AIDS Patient Care STDS, 20 (2006), pp. 143-145
[64.]
M. Augenbraun, J. Feldman, K. Chirgwin, J. Zenilman, L. Clarke, J. De Hovitz, et al.
Increased genital shedding of herpes-simplex virus type 2 in HIV-women.
Ann Intern Med, 123 (1995), pp. 845-847
[65.]
K.H. File, C.S. Crumpacker, G.J. Mertz, E.L. Hill, G.S. Boone.
Recurrence and resistance patterns of herpes simplex virus following cessation of >or=6 years suppression with acyclovir. Acyclovir Study Group.
J Infect Dis, 169 (1994), pp. 1338-1341
[66.]
Centers for Disease Control Prevention.
Sexually transmitted diseases treatment guidelines 2002.
MMWR, 51 (2002), pp. 1-84
[67.]
D.R. Snydman.
Infection in solid organ transplantation.
Transpl Infect Dis, 1 (1999), pp. 21-28
[68.]
C.A. Dykewicz.
Preventing opportunistic infections in bone marrow transplant recipients.
Transpl Infect Dis, 1 (1999), pp. 40-49
[69.]
T. Celkan, A. Ozkan, H. Apak, I. Ildiz.
Antiviral prophylaxis with continuous low dose acyclovir in childhood cancer.
Leuk Lymphoma, 47 (2006), pp. 1418-1420
[70.]
R.C. Reichman, G.J. Badger, M.E. Guinan.
Topically administered acyclovir in the treatment of recurrent herpes simplex genitalis: a controlled trial.
J Infect Dis, 147 (1983), pp. 336-340
[71.]
L. Abbo, V. Vicek, G. Dickinson, N. Shresthe, S. Doblecki, P.A. Haslett.
Selective defect in plasmacyoid dendritic cell function in a patient with AIDS-associated atypical genital herpes simplex vegetans treated with imiquimod.
Clin Infect Dis, 44 (2007), pp. e25-e27
[72.]
C.F. Brummitt.
Imiquimod 5% cream for the treatment of recurrent, acyclovir-resistant genital herpes.
Clin Infect Dis, 42 (2006), pp. 575
[73.]
J. Gilbert, M.M. Drehs, J.M. Weinberg.
Topical imiquimod for acyclovir-unresponsive herpes simplex virus 2 infection.
Arch Dermatol, 137 (2001), pp. 1015-1017
[74.]
T.W. Schacker, M. Conant, C. Thoming, T. Stanczak, Z. Wang, M. Smith.
Imiquimod 5-percent cream does not alter the natural history of recurrent herpes genitalis: a phase II, randomized, double-blind, placebo-controlled study.
Antimicrob Agents Chemother, 46 (2002), pp. 3243-3248
[75.]
K. Javaly, M. Wohlfeiler, R. Kalayjian.
Treatment of mucocutaneous herpes simplex virus infections unresponsive to acyclovir with topical foscarnet cream in AIDS patients: a phase I/II study.
J Acquir Immune Defic Syndr, 21 (1999), pp. 301-306
[76.]
M. Ghislanzoni, M. Cusini, R. Zerboni, E. Alessi.
Chronic hypertrophic acyclovir-resistant genital herpes treated with topical cidofovir and with topical foscarnet at recurrence in an VIH-positive man.
J Eur Acad Dermatol Venereol, 20 (2006), pp. 887-889
[77.]
M. Pechere, W. Wunderly, L. Trellu-Toutous, M. Harms, J.H. Saura, J. Krischer.
Treatment of acyclovir-resistant herpetic ulceration with topical foscarnet and antiviral sensitivity analysis.
Dermatology, 197 (1998), pp. 278-280
[78.]
F. Bevilacqua, A. Marcello, M. Toni, M. Zavattoni, M. Cusini, R. Zerboni, et al.
Acyclovir resistance/susceptibility in herpessimplex virus type 2 sequential isolates from an AIDS patient.
J Acquir Immune Defic Syndr, 4 (1991), pp. 967-969
[79.]
L.J. Waters, S.E. Barton, F.C. Boag.
Betadine for herpes simplex infection.
Int J STD AIDS, 17 (2006), pp. 854-855
[80.]
D. Palliser, D. Chowdhury, Q.Y. Wang.
An si-RNA-based microbicide protects mice from lethal herpes simplex virus 2 infection.
Nature, 439 (2006), pp. 89-94
[81.]
D.C. Johnson.
Silencing herpes simplex virus with a vaginal microbicide.
N Engl J Med, 354 (2006), pp. 970-971
Copyright © 2009. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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