Herpes simplex treatment

, Associate Editor-In-Chief: ; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Antiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management. Counseling regarding the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission is an integral part of clinical management. Systemic antiviral drugs can partially control the signs and symptoms of herpes episodes when used to treat first clinical and recurrent episodes, or when used as daily suppressive therapy. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued. Randomized trials have indicated that three antiviral medications such as acyclovir, valacyclovir, and famciclovir provide clinical benefit for genital herpes. Valacyclovir is the valine ester of acyclovir and has enhanced absorption after oral administration. Famciclovir also has high oral bioavailability. Topical therapy with antiviral drugs offers minimal clinical benefit, and its use is discouraged.

Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescription analgesics can reduce pain and fever during initial outbreaks. Topical anesthetic treatment (such as prilocaine, lidocaine or tetracaine) can relieve itching and pain.

Docosanol

 * Docosanol prevents herpes simplex virus from fusing to cell membranes, thus barring the entry of the virus into the skin.
 * It was approved for use after clinical trials by the FDA in July 2000.
 * It was the first over-the-counter antiviral drug approved for sale in the United States and Canada

Tromantadine

 * Tromantadine is available as a gel that inhibits entry and spreading of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material.

Zilactin

 * It is a topical analgesic barrier treatment, which forms a "shield" at the area of application to prevents a sore from increasing in size and decrease viral spreading during the healing process.

Cimetidine
Cimetidine commonly used in heartburn, has been shown to lessen the severity of herpes zoster outbreaks in several different instances, and offered some relief from herpes simplex.

Vaseline

 * Vaseline or any other type of fat prevents water, or saliva, from reaching the cold sore. Since, water helps in perpetuation of the cold sore, preventing water exposure will fasten the healing process.  This is an off-label use of the drug.  It and probenecid have been shown to reduce the renal clearance of aciclovir. These compounds also reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir.

Aspirin

 * Low doses aspirin (125 mg daily) have shown to be beneficial in patients with recurrent HSV infections. However, there are lack of sufficient supporting evidences.


 * It reduces the level of the inflammatory mediators prostaglandins
 * A recent study in animals showed inhibition of thermal (heat) stress-induced viral shedding of HSV-1 in the eye by aspirin, and a possible benefit in reducing the frequency of recurrences.

Treatment of Sexual Partners
The sex partners of patients who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions. Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions and offered type-specific serologic testing for HSV infection.