What Antivirals Are Used For Herpes

What Happens If You Leave Herpes Untreated

According to the CDC , genital herpes can lead to painful sores, which can be worse in people with weaker immune systems. A person may also spread the virus to other parts of their body.

In pregnant people, herpes may lead to miscarriage or make early delivery more likely. A person can also pass herpes on to their baby before or during birth. This can cause neonatal herpes, which can be fatal.

Pregnant people with herpes may need to receive herpes treatment toward the end of their pregnancy and have a cesarean delivery if they have herpes symptoms when they give birth.

It is important that people speak with a doctor about treating herpes.

Antivirals For Herpesviruses: Nursing Pharmacology

Notes

Content Reviewers:

Herpesviruses are a family of DNA viruses that include or HSV types 1 and 2, or VZV, or CMV for short, or EBV, and human herpesvirus or HHV 6, 7, and 8.

Certain herpesvirus infections can be treated with a class of antiviral medications called , which include medications that end in the suffix -clovir.

The main drugs used to treat infections include , , and , which are given orally, as well as and , which can also be administered topically or in addition to orally.

Once administered, act by inserting into the replicating viral DNA. As a result, viral DNA synthesis is halted, ultimately stopping viral replication.

Now, clients taking may experience headache and nausea. These medications can also cause a skin rash, pruritus, nephrotoxicity, and hypersensitivity reactions like and .

and can cause neurological side effects, including agitation, , confusion, and more rarely, clients can develop , and even encephalopathy or .

How Long Do Antivirals Take To Work

Cold sores will heal on their own in seven to 10 days, but using an antiviral cold sore medication can speed up the healing process.10 Taking famciclovir or valacyclovir can shorten the period that you experience cold sore symptoms by one to two days.10 Using a topical cream generally requires daily application for five days to relieve symptoms.10 Ultimately, the choice of antiviral cold sore medication is up to you! Always consult your doctor before trying a new medication.

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How Effective Are Topical Herpes Treatments

Studies have found that topical creams and ointments like and arent so great at preventing lesions from oral herpes . Theyre also really expensive and usually have to be applied several times a day.

Two new topical medications for oral herpes may hold more promise, but they come at a cost.

• includes acyclovir 5% cream and 1% hydrocortisone and works better than either ingredient alone. Interestingly, Xerese cream has been shown not only to shorten healing time but also to make it less likely that the lesions will return. Unfortunately, Xerese is expensive and rarely covered by insurance. But it is a combination of 2 cheaper generic creams, so talk to your doctor about making your own combination.

• is a different form of acyclovir that can also be used to treat an oral herpes outbreak. It is an adhesive tablet that you place on your gums. Sitavig delivers a high concentration of acyclovir directly to your lip, the site of the cold sore. But again, itll cost you.

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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Antivirals For Herpes Simplex Viruses

The bottom line

• Aciclovir, valaciclovir, and famciclovir are similarly effective in healing lesions, and in reducing duration of symptoms and of viral shedding, in genital herpes

• Long term suppressive treatment is safe and effectively reduces recurrences in genital and orolabial herpes however, it does not completely eliminate recurrences or risk of transmission of genital herpes simplex virus infection to sexual partners

• In older patients, and those with impaired renal function or taking nephrotoxic drugs, monitor renal function closely and consider using lower doses owing to the risk of renal toxicity, intravenous aciclovir requires good hydration

• Suppressive aciclovir or valaciclovir in the last weeks of pregnancy reduces clinical disease in the mother and transmission to the baby at the time of delivery but does not completely eliminate the risk of neonatal transmission

• Neonates with central nervous system infection require high dose intravenous aciclovir for 21 days, and suppressive treatment with valaciclovir improves neurodevelopmental outcomes

Management Of Sex Partners

The sex partners of persons who have symptomatic genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated in the same manner as patients who have symptomatic genital herpes. Asymptomatic sex partners of patients who have symptomatic genital herpes should be asked about a history of genital symptoms and offered type-specific serologic testing for HSV-2. For partners without genital herpes, no data are available on which to base a recommendation for PEP or PrEP with antiviral medications or that they would prevent acquisition, and this should not be offered to patients as a prevention strategy.

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How Do Hsv Antivirals Work

Herpes simplex virus antivirals are used to treat herpes simplex virus 1 and 2 . Acyclovir is the antiviral most commonly used to treat HSV infections. It works by inhibiting DNAsynthesis and therefore prevents replication of the virus. HSV-1 is transmitted by oral-to-oral contact, mainly causes oral herpes known as cold sores, and may also cause genital herpes. HSV-2 is a sexually transmitted disease that causes genital herpes. Herpes infections are highly contagious oral and genital herpes is usually asymptomatic, and if symptomatic, painful blisters or ulcers appear at the site of infection. HSV-2 infection increases the risk of acquiring and transmitting human immunodeficiency virus infection.

Acyclovir is converted into acyclovir monophosphate by viral thymidine kinase enzyme, which is then converted into acyclovir triphosphate by the hostcell kinases. The formed ACV-TP competitively inhibits and inactivates HSV DNA polymerase and prevents viral DNA synthesis and replication of the 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

*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

*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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Drug Treatment For Genital Herpes

If you are infected with genital herpes, your doctor may prescribe oral antiviral drugs to help ease your symptoms during both a first episode and recurrent episodes. Your doctor may also suggest taking antiviral drugs daily as a suppressive therapy to reduce symptoms and protect partners.

Remember, though, that antiviral drugs do not wipe out the virus completely. It continues to live in your body, so if you stop taking the drugs that suppress it, you may have more frequent or more intense symptom outbreaks, and the risk of your transmitting the virus to others rises.

Three antiviral drugs, all taken by mouth, are used to treat genital herpes:

What Other Information Should I Know

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to acyclovir.

Do not let anyone else take or use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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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 .

How To Cope With Side Effects

What to do about:

• headaches make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Paracetamol is safe to take with aciclovir if you need a painkiller. Speak to your doctor if this does not help or your headaches are severe.
• feeling dizzy if aciclovir makes you feel dizzy, stop what youâre doing and sit or lie down until you feel better. Do not drive, ride a bike, or use tools or machinery if you feel dizzy.
• feeling or being sick stick to simple meals and do not eat rich or spicy food. It might help to take your medicine after you have eaten. If youâre being sick, try small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.
• diarrhoea drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• skin being sensitive to sunlight stay out of bright sun and use a high factor sun cream even on cloudy days. Do not use a sun lamp or sun beds.
• burning or stinging feeling after applying the cream this usually goes away after a short time. Ask a pharmacist or your doctor for advice if it continues to be a problem.
• itchy, dry or flaking skin try using an unscented moisturiser. Do not apply the moisturiser at the same time as your aciclovir cream.

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Treatment For Oral Herpes

The antiviral medications available in pill form have been specifically developed for the treatment of genital herpes. However, it is not uncommon for healthcare providers to prescribe the antiviral drugs to those who have frequent or severe outbreaks of oral herpes.

A recent study found valacyclovir to be effective for treating oral herpes in a one-day treatment of 2 grams taken at the first sign of a cold sore, and then again about 12 hours later.

There are two topical antiviral medications prescribed for the treatment of oral HSV symptoms: acyclovir ointment and penciclovir cream. Both work to speed up the healing process and reduce the viral activity. These topical drugs are put directly on the lesions themselves, but can also be used at the onset of prodrome.

Other topical treatments for oral herpes are available over-the-counter , but are not antiviral compounds like acyclovir and penciclovir. Some also contain ingredients that numb the area and induce temporary relief from the discomfort of an outbreak. Unfortunately, some OTC treatments may actually delay the healing time of symptoms because they can further irritate the area with repeated applications. There is only one OTC FDA-approved cream, called Abreva®, which has been clinically proven to help speed the healing process.

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.

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Avoid The Following While You Are Using Acyclovir Buccal Delayed

• Do not chew gum, touch, or press the buccal tablet after it has been applied.
• Do not wear upper dentures.
• Do not brush your teeth until it dissolves. If your teeth need to be cleaned while the tablet is in place, rinse the mouth gently.

Shake the suspension well before each use to mix the medication evenly.

Your symptoms should improve during your treatment with acyclovir. Call your doctor if your symptoms do not improve or if they get worse.

Take or use acyclovir until you finish the prescription, even if you feel better. If you stop taking acyclovir too soon or skip doses, your infection may not be completely treated or may become more difficult to treat. The delayed-release buccal tablet is applied as a one-time dose.

Aciclovir Tablets And Liquid

Doses will vary, depending on why youâre taking aciclovir. Your doctor will tell you how much to take and how often.

A single dose is generally between 200mg and 800mg, and may be lower for children.

Youâll usually take aciclovir 2 to 5 times a day. Try to space the doses evenly throughout the day.

If you take aciclovir:

• 4 times a day you could take it first thing in the morning, at midday, in the late afternoon and at bedtime
• 5 times a day for example, you could take it at 7am, 11am, 3pm, 7pm and 11pm

You can take aciclovir with or without food. Drink plenty of water while taking this medicine to help keep your kidneys working well.

Keep taking the medicine until itâs all finished or until your doctor or pharmacist tells you to stop taking it.

For treating a viral infection, youâll usually take aciclovir for 5 to 10 days. For prevention, you may need to take it for a long time.

Tablets: swallow the tablets whole with some water. If you find tablets difficult to swallow, you can dissolve them in water. Add a tablet to a small glass of water and stir. Drink all the liquid to make sure you get the full dose.

Liquid: use the measuring spoon or plastic syringe that came with your medicine. If you do not have a measuring spoon or syringe, ask your pharmacist for one. Do not use a kitchen teaspoon as you will not get the right amount of medicine.

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Statistics About Herpes Simplex Virus

Herpes simplex virus in immunocompetent people is rarely resistant to Acyclovir . But in immunocompromised people 3.5% to 10% of herpes simplex cases are resistant to Acyclovir. In clinical surveys researchers report of up to 36% of cases of herpes simplex that are resistant to Acyclovir. You can see that an alternative treatment against herpes involving smaller molecules that treats regular herpes and also resistant herpes would be very useful.

Dr. Evilevitch is doing research together with the National Institutes of Health in the United States in order to develop an oral medication that will treat resistant herpes.

A New Antiviral Drug Combats Herpes and Resistant Herpes

I Sometimes Get Twinges And Pains Around My Buttocks Or Down One Leg What Does This Mean

Occasionally, herpes simplex virus can cause burning skin sensations, deep aches or sudden twinges in the genital area. When they occur in the thighs or buttocks, they are sometimes compared to sciatica. These symptoms are called prodromes or prodromal symptoms. They are a sign that the virus is trying to reactivate and there may be virus on the skin surface. Sometimes sores will follow, but very often your immune response overcomes the virus before visible signs appear. For email version or posted version of more information on treating genital herpes, select tips to prevent recurrences on the subscription form.

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