The genital herpes is a common sexual transmitted disease, mainly caused by the herpes virus type 2 (HSV-2 - herpes simplex virus), but can also be caused by HSV-1.
The genital herpes is a recurrent vesicular rash of the skin and mucous in the area between navel and buttocks before of which usually appear prodromal symptoms such as itching, burning and stinging.
Primary infection may include generalized symptoms similar to flu, such as fever, headache, malaise and muscle pain, which appear 2-20 days after the exposure. It may also developed lymphadenopathy during the second and third week.
Usually the relapses don't include systemic symptoms and are less serious than the initial event. During relapse, lesions appear in the same area but are fewer in number and are treated faster. Usually, the lesions during relapse occured as papules grouped on an erythematous base, which developed into vesicles with thin walls, ulcers and then into soft crusts. In 3-4 days formed the dry crusts which allow the healing.
During the healing may occur residual hypopigmentation, hyperpigmentation and scarring.
As there is no cure for genital herpes, the treatment aims to reduce the number of relapses using suppressive therapy and to induce the rapid healing when relapse occurs.
Additionally, treatment aims to reduce the infectivity reducing the spread of the virus and reduce the complications, such as urinary retention and aseptic meningitis.
In the past used acyclovir, both oral and topical use, as first line therapy for the treatment of relapse. Because of the low bioavailability of acyclovir doses should be taken frequently. The typical dosage of an oral acyclovir for relapse is 200mg five times a day for 5 days. Also found other effective dosage regimens, including the 400mg three times a day for 5 days, 800mg three times a day for 2 days and 800mg twice a day for 5 days.
The frequent dosing of acyclovir led to the development of valacyclovir and famciclovir (prodrugs of acyclovir and penciclovir, respectively) as alternative treatments with improved bioavailability.
The use of topical acyclovir shouldn't recommended because it is less effective than oral acyclovir.
It has proven that valaciclovir is effective in doses of 500mg twice a day for 3 days or 1000mg once a day for 5 days. For the oral valacyclovir, has also studied the 2000mg dosing regimen twice a day for 1 day, which has proven to be more convenient. However, required further comparative research studies.
Famciclovir is effective when taken at a dose of 1000 mg twice a day for 1 day. It can also be taken at a dose of 125mg twice a day for 5 days.
The acyclovir, valacyclovir and famciclovir can be also used as suppressive therapy.
In immunocompromised people relapses are more frequent and may develop more serious lesions, while is needed higher treatment period with higher doses than those used in immunocompetent people. For severe cases, may be required intravenous therapy. In this patient population have been used sedative regimens. Long-term therapy may lead to selection of resistant viruses. In case of resistance to acyclovir may be required intravenous treatment with foscarnet.
Another important aspect in their treatment of genital herpes is the psychosocial impact. The recurrent nature of genital herpes can have significant emotional and psychological effects to patients. The advisory psychological support can help them in dealing with the infection and the prevention of sexual and perinatal transmission. The doctor can greatly help patients to better manage the disease, informing them about its progress.