What Are The Symptoms Of Herpes Simplex
Many people with the infection never experience any herpes symptoms. If you do notice symptoms, youll experience them differently depending on whether youre having your first herpes outbreak or a repeat outbreak. Recurring symptoms are usually milder than the first outbreak. Symptoms dont last as long with later outbreaks. Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.
People who do have herpes symptoms may experience:
- Cold sores around their lips, mouth or tongue. They may look crusty or like fluid-filled blisters.
- Tingling, itching or burning.
- Pain while urinating.
What Are Antiviral Medications For Herpes
There are three antiviral medications that are FDA-approved for the treatment of genital herpes:
- Acyclovir: The oldest antiviral medication for herpes is acyclovir. It has been available since 1982 in a topical form and sold since 1985 in pill form. Acyclovir has been shown to be safe in persons who have used it continuously for as long as 10 years.
- Valacyclovir: A newer drug, valacyclovir, actually uses acyclovir as its active ingredient. This medication delivers acyclovir more efficiently so that the body absorbs much of the drug, which has the advantage of taking the medication fewer times during the day.
- Famciclovir: Famciclovir uses penciclovir as its active ingredient to stop HSV from replicating. Like valacyclovir, it is well absorbed, persists for a longer time in the body, and can be taken less frequently than acyclovir.
Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.
How Do Dermatologists Diagnose Herpes Simplex
During an outbreak, a dermatologist often can diagnose herpes simplex by looking at the sores. To confirm that a patient has herpes simplex, a dermatologist may take a swab from a sore and send this swab to a laboratory.
When sores are not present, other medical tests, such as blood tests, can find the herpes simplex virus.
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Home Remedies And Lifestyle
At-home treatments for herpes are used to relieve pain. They do nothing to alter the course of the infection but can make you more comfortable as the herpes sores begin to heal.
There are several things you can do if have an outbreak of oral or genital herpes:
- Use a cold compress. Place a cloth-covered ice pack on the sores for 15 minutes several times daily to reduce pain. Keep the ice pack moving to prevent frostbite.
- Do not touch or scratch. Avoid touching and rubbing the sores. Doing so can spread the infection to other areas of the skin.
- Keep the sores clean. Herpes sores can become infected with bacteria if touched with soiled hands. Wash your hands thoroughly with soap and water after going to the bathroom or before applying medications.
- Reduce stress. Stress can increase your sensitivity to pain during a herpes outbreak. You can reduce stress by performing gentle exercises or practicing mind-body therapies like meditation, yoga, and guided imagery.
To reduce the risk of spreading herpes, avoid kissing and sharing objects that come into contact with saliva, like drinking straws and eating utensils.
It’s important to note that oral herpes can be spread to the genitals, and that genital herpes can be spread to the mouth. To reduce the risk of infection, use condoms and dental dams during oral sex. Better yet, avoid sex altogether if you are having an active herpes outbreak .
Treatment Of Common Cutaneous Herpes Simplex Virus Infections
DAVID H. EMMERT, M.D., Lancaster General Hospital, Lancaster, Pennsylvania
Am Fam Physician. 2000 Mar 15 61:1697-1704.
Herpes simplex virus infection is increasingly common in the United States. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes. Acyclovir therapy remains an effective and often less expensive option. Famciclovir and valacyclovir offer improved oral bioavailability and convenient oral dosing schedules but are more expensive than acyclovir. Patients who have six or more recurrences of genital herpes per year can be treated with one of the following regimens: acyclovir, 400 mg twice daily valacyclovir, 1 g daily or famciclovir, 250 mg twice daily. These regimens are effective in suppressing 70 to 80 percent of symptomatic recurrences. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.
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How Effective Are Medications For Herpes
Prescription antiviral medications have proven effectiveness in managing HSV symptoms.
A 2017 study comparing the antiviral medications acyclovir, famciclovir, penciclovir and valacyclovir to treat herpes simplex labialis found all antiviral medications were effective to shorten healing time for lesions and reducing pain. The comparison study found valacyclovir had the fastest healing time and pain reduction.
Where Can I Get Medications For Herpes
The most common antiviral medications used to manage herpes simplex symptoms are available by prescription. If you have symptoms such as a cold sore or genital herpes, call your doctors office. They will first diagnose if you have herpes simplex. Then they will prescribe an appropriate medication to manage your symptoms.
Only docosanol is an antiviral medication available over the counter as a cream to manage oral symptoms such as cold sores or fever blisters.
If you have mild symptoms from a recurring oral herpes infection, you may be able to use nonprescription methods or some home remedies to manage your symptoms.
Examples include:
- pain relievers such ibuprofen or acetaminophen to help with pain
- cold compress or ice to soothe burning or itching
- zinc oxide topical cream, which may help soothe itching or burning
Before trying over the counter medications or supplements, be sure to talk with your doctor or pharmacist about your symptoms.
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Treatment Options For Genital Herpes
Acyclovir was the first antiviral agent to be used in the treatment of genital herpes, and as such, is the most extensively studied of the antiviral agents currently available. This drug is available in topical, oral, and intravenous forms . In the distant past, topical acyclovir was used to treat recurrent genital herpes, but its ineffectiveness has been known for quite some time. A randomized, placebo-controlled, double-blind study found that after application of topical acyclovir 6 times daily for 5 days, only the duration of virus shedding from lesions was reduced compared to placebo. Differences between time to lesion crusting, lesion healing, new lesion formation, and cessation of pain were non-significant .
Intravenous acyclovir remains the most effective form of treatment for a primary genital herpes infection, leading to significant reduction in time to cessation of viral shedding and pain. Time to lesion healing is also 6 days faster than with placebo alone . However, as IV administration of acyclovir requires hospitalization, this route is reserved for patients with life-threatening disease or systemic complications .
Oral agents
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Binding And Entry Inhibition
Other antiviral drugs act on the host cell to inhibit the virus . The advantage to this approach is that resistance to the drug is less likely to appear, especially because these drugs are not subject to TK activation and ACV resistance mutations in that locus while random mutations occur in both viruses and hosts, the mutation rate in viruses is much higher than it is in host cells . On the other hand, targeting a host cell function may lead to higher toxicity, potentially limiting therapeutic use to only viral strains that are resistant to safer therapies.
n-Docosanol.
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Antiviral Uses In Preventing Flu
Here, your doctor may be able to prescribe an antiviral and that is if you come in close contact with other people or family members who may have the flu and you may further want to avoid getting the flu infection, the centers for disease control and prevention also abbreviated as CDC however discourages this kind of practice, this is simply because it can lead to drug resistance strains of this virus. People at risk of severe flu are recommended by CDC to take the antibiotics. These people are such as the pregnant mothers or people who have asthma related diseases, heart disease or heart attack do gain the antiviral treatment soon as the symptoms of the flu start to show. The most effective way to prevent flu is vaccination.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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How Long Do You Need To Take Antiviral Drugs
Treatment length varies depending on the antiviral drug and viral infection. You may need one dose of an IV drug or a week of oral medicine.
People who have chronic ailments like HIV may take daily antivirals for life. This drug regimen keeps the virus from becoming active. It can prevent the virus from infecting others.
Who Can And Cannot Take Aciclovir
Aciclovir can be taken by most adults and children.
Aciclovir is not suitable for some people.
To make sure aciclovir is safe for you, tell your doctor if you:
- have had an allergic reaction to aciclovir or any other medicine in the past
- have kidney problems
- are over 65 years old
- are pregnant, trying to get pregnant or breastfeeding
If your immune system is weakened , talk to your doctor about the best type of aciclovir for you.
They may recommend tablets rather than the cream.
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Articles Ongenital Herpes Treatment
Scientists have studied alternative treatments, like herbal extracts and nutritional supplements, based on some genital herpes patients’ claims that they help relieve symptoms. Some study results have been promising, others discouraging.
Many people say that an extract of the echinacea plant helps boost the immune system’s ability to fight the genital herpes infection. Some say it decreases the frequency and severity of genital herpes outbreaks. Researchers in the U.K. compared the effect of echinacea with that of a placebo. They gave echinacea to 50 people with genital herpes for six months and a placebo for another six months. There was no significant difference in the number of herpes outbreaks during the two periods.
Another study showed that an ointment containing propolis, a waxy substance that honeybees make, may help genital herpes sores heal. Sores healed faster for people using the propolis ointment than in those using ointments containing the antiviral drug acyclovir or a placebo. The ointment was applied to herpes sores four times a day. After 10 days, 24 of the 30 people using propolis ointment said their sores healed, compared with 14 of the 30 people using acyclovir ointment and 12 of the 30 using a placebo.
Researchers have also found that the herb Prunella vulgaris, and an edible mushroom, Rozites caperata , contain chemicals that fight both the oral herpes virus and the genital herpes virus .
Treatment Of Primary Infection
Antiviral therapy is recommended for an initial genital herpes outbreak, especially if the patient has systemic symptoms or is immunocompromised.2 Oral acyclovir is effective in reducing symptoms1 . Intravenous administration may be required in immunocompromised patients and those with severe disseminated infection.1 Topical acyclovir reduces the duration of viral shedding and the length of time before all lesions become crusted, but this treatment is much less effective than oral or intravenous acyclovir.1
Effect of Acyclovir Treatment on Primary Genital Herpes
| Symptom/sign |
|---|
|
Time until all lesions are crusted |
|
Time until all lesions are healed |
*Dosage = 200 mg five times daily for 10 days, given within six days of lesion onset.
Information from Mertz GJ, Critchlow CW, Benedetti J, Reichman RC, Dolin R, Connor J. Double-blind placebo-controlled trial of oral acyclovir in first-episode genital herpes simplex virus infection. JAMA 1984 252:114751.
Effect of Acyclovir Treatment on Primary Genital Herpes
| Symptom/sign |
|---|
|
Time until all lesions are crusted |
|
Time until all lesions are healed |
*Dosage = 200 mg five times daily for 10 days, given within six days of lesion onset.
Information from Mertz GJ, Critchlow CW, Benedetti J, Reichman RC, Dolin R, Connor J. Double-blind placebo-controlled trial of oral acyclovir in first-episode genital herpes simplex virus infection. JAMA 1984 252:114751.
Famciclovir is not FDA-labeled for this indication.
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Genital Herpes During Pregnancy
Prevention of neonatal herpes depends both on preventing acquisition of genital herpes during late pregnancy and avoiding exposure of the neonate to herpetic lesions and viral shedding during delivery. Mothers of newborns who acquire neonatal herpes often lack histories of clinically evident genital herpes . The risk for transmission to the neonate from an infected mother is high among women who acquire genital herpes near the time of delivery and low among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy . Women who acquire HSV in the second half of pregnancy should be managed in consultation with maternal-fetal medicine and infectious disease specialists.
All pregnant women should be asked whether they have a history of genital herpes or genital symptoms concerning for HSV infection. At the onset of labor, all women should be questioned thoroughly about symptoms of genital herpes, including prodromal symptoms , and all women should be examined thoroughly for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not eliminate the risk for HSV transmission to the neonate , women with recurrent genital herpetic lesions at the onset of labor should have a cesarean delivery to reduce the risk for neonatal HSV infection.
Acyclovir 400 mg orally 3 times/dayORValacyclovir 500 mg orally 2 times/day
Can I Treat Herpes Simplex At Home
Avoiding known triggers, such as illness or stress, can help reduce how often you have herpes outbreaks.
How can I ease my symptoms during an outbreak of HSV-1 ?
- Over-the-counter creams such as L-lysine, benzocaine or docosanol .
- Applying ice to blisters or sores.
How can I ease my symptoms during an outbreak of HSV-2 ?
- Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
- Keep your genitals dry. Wear cotton or other nonsynthetic underpants and avoid tight-fitting clothes. Moist sores take longer to heal.
- Soak in a warm bath.
- Take nonsteroidal anti-inflammatory drugs to relieve pain.
- Topical 1% or 2% lidocaine may be used as a topical analgesic.
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Current Antivirals And Novel Botanical Molecules Interfering With Herpes Simplex Virus Infection
- 1Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y MicrobiologÃa, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- 2Centro de BiotecnologÃa, Universidad de Concepción, Concepción, Chile
- 3Departamento de Ciencia y TecnologÃa de Alimentos, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
Mechanism Of Action And Pharmacokinetics
The bioavailability of penciclovir following oraladministration of famciclovir is about 70%. Peak concentrations of drug afterintravenous administration of 10 mg/kg are approximately six-fold higher thanthose attained after oral doses of 250 mg. Food delays absorption but does notaffect the final plasma drug concentration. Following oral administration,little or no famciclovir is detected in plasma or urine. The plasma half-life ofpenciclovir is about 2.5 hours, and almost three-quarters is recovered unchangedin the urine. Measurable penciclovir concentrations are not detectable in plasmaor urine following topical administration of penciclovir cream. A 12-hour dosinginterval is recommended for those with creatinine clearances between 30 and 50ml/min per 1.73 m2, and a 24-hour interval for those with creatinineclearances less than 30 ml/min per 1.73 m2 .
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Current Drugs Used Against Hsv
At present, there are numerous antiviral drugs for the treatment of HSV infections. Some commonly known anti-herpetic drugs that are currently being used include acyclovir , penciclovir, and famciclovir, which inhibit HSV-1 and HSV-2 infection by interfering with the viral DNA polymerase and hence, viral genome replication . These drugs are also used to treat other herpesvirus infections, such as VZV and cytomegalovirus . Although several of these drugs, which are described in more detail below, help reduce disease and minimize potential severe damage, as well as to limit the spread of these viruses onto other individuals, most of these compounds only modestly reduce cutaneous manifestations caused by herpes simplex viruses, particularly when used in the form of creams that are applied topically to the skin .