Prophylactic Oral Acyclovir in Recurrent Genital Herpes

Mindel, Adrian; Faherty, A.; Hindley, D J; Weller, Ivd; Sutherland, Sheena; Fiddian, A P; Adler, M W

doi:10.1016/s0140-6736(84)90237-x

Cited by 118 publications

(31 citation statements)

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“…However, serodiscordant couples could be counselled about the risk of HSV acquisition and advised to use condoms and avoid cunnilingus (if the man is HSV-1 positive and his partner is not). In addition, the man could consider using antiviral suppression therapy, which has been shown to decrease the frequency of recurrences [25][26][27] and viral shedding, 28 and may reduce the likelihood of transmission. This approach may be welcomed by some couples 29 but is unlikely to have much public health impact 9 and in HSV-2 low prevalence populations the costs will probably outweigh the benefits.…”

Section: Discussionmentioning

confidence: 99%

Neonatal herpes prevention: a minor public health problem in some communities

Mindel

Taylor²,

Tideman³

et al. 2000

Sexually Transmitted Infections

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Background: Neonatal herpes is a condition with high morbidity and mortality. The greatest risk occurs when the mother acquires herpes simplex virus (HSV) towards the end of pregnancy. A study from Seattle has suggested that the risk of acquisition of HSV during pregnancy was 3.7%. In Australia, HSV-2 infection is less common in pregnant women than in the United States. Consequently we conducted a study to establish HSV seroprevalence and the rate of HSV seroconversion in this population. Methods: The study was conducted at Westmead Hospital, Sydney, between June 1995 and April 1998. Women completed a questionnaire covering risk factors for the acquisition of genital herpes. A serum sample during pregnancy and a specimen of cord blood were obtained and tested for antibodies to HSV-2 using a type specific indirect enzyme linked immunosorbent assay (ELISA). Equivocal results were resolved by western blot. A subset of the paired sera was tested for antibodies to HSV-1. The data were analysed using SPSS. Results: 326 of the 2616 (12.5%) women were HSV-2 seropositive. Three women (0.15%) acquired HSV-2 infection during pregnancy. None of the three babies of these mothers developed neonatal herpes. 416 maternal cord pairs were tested for HSV-1 antibodies and 330 (79.3%) were positive. No HSV-1 seroconversions occurred. Conclusions: In this population, HSV acquisition was uncommon (0.34% per year) and neonatal herpes was rare. A cost eVective analysis suggested that type specific serology to screen pregnant women and their partners in low prevalence communities was not cost eVective. (Sex Transm Inf 2000;76:287-291)

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Section: Discussionmentioning

confidence: 99%

Neonatal herpes prevention: a minor public health problem in some communities

Mindel

Taylor²,

Tideman³

et al. 2000

Sexually Transmitted Infections

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“…Four studies (16,22,35,57) More than 90% of persons with frequently recurring genital herpes have a significant reduction in the number of clinical recurrences while on suppressive therapy. Compared with untreated recurrences, breakthrough recurrences are associated with milder symptoms, shorter duration of viral shedding, and shorter duration of lesions.…”

Section: Emergence Of Resistancementioning

confidence: 99%

Acyclovir prophylaxis for herpes simplex virus infection

Gold¹,

Corey²

1987

Antimicrob Agents Chemother

100

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ACV is an effective agent for the treatment and prophylaxis of HSV infections in both IC and immunologically normal individuals. The drug is well tolerated in both populations and is not significantly associated with clinical or laboratory toxicities. Because of the great potential benefit and low risk, organ transplant recipients and patients with hematologic malignancies undergoing induction chemotherapy should be screened routinely for HSV antibodies; seropositive individuals should receive prophylactic ACV during the period of most profound immunosuppression. Immunologically normal individuals with frequently recurring genital HSV or serious complications associated with outbreaks are candidates for long-term suppression with ACV.

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“…Acute treatment with the systemic formulations not only markedly shortened the duration of virus shedding and lesion healing (which were the objective clinical endpoints), but also conferred measurable benefit on the severity and duration of systemic symptoms and the more subjective pain-related aspects (de Ruiter and Thin, 1994). With prolonged use over periods of months or years, oral aciclovir has also been shown to reduce markedly the frequency of genital herpes recurrences and to enhance the quality of life of patients (Douglas et al, 1984;Mindel et al, 1984;Carney et et., 1993). Recently,in a placebo-controlled crossover study, the use of oral aciclovir was demonstrated to suppress subclinical HSV shedding as well as genital herpes recurrences, and, in theory, could reduce transmission (Wald, A., et al, Abstract, 34th Interscience Conference on Antimicrobial Agents and Chemotherapy, Orlando, 4-7 October 1994).…”

Section: Aciclovir -The Current Standardmentioning

confidence: 99%

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

Crooks

1995

Antivir Chem Chemother

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SummaryThe 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 IC so 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.Keywords: valaciclovir; aciclovir; HSV.

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Prophylactic Oral Acyclovir in Recurrent Genital Herpes

Cited by 118 publications

References 0 publications

Neonatal herpes prevention: a minor public health problem in some communities

Neonatal herpes prevention: a minor public health problem in some communities

Acyclovir prophylaxis for herpes simplex virus infection

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

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