What Treatment For Genital Herpes

How To Use Acyclovir Cream

Read the Patient Information Leaflet available from your pharmacist. Consult your doctor or pharmacist if you have any questions.

Use this medication at the first sign of infection . Wash your hands with soap and water before and after applying this medication. Clean and dry the affected areas before applying the medication. Apply to the affected area and rub in gently, usually 5 times a day for 4 days for cold sores, or as directed by your doctor. Apply enough cream to cover all affected areas .

Apply to skin only. Do not apply this medication in the eyes or nose, inside the mouth, or inside the . If you do get medication in those areas, flush with plenty of water.

Dosage is based on your medical condition, type of infection, and response to treatment. Do not use this drug more often or for longer than prescribed.

Use this medication regularly to get the most benefit from it. This medication works best when the amount of drug absorbed by the skin stays at a constant level. Therefore, use this drug at evenly spaced intervals. To help you remember, use it at the same times each day.

To prevent washing off the medication, do not bathe, shower, or swim right after applying it.

If applying to genital herpes sores, use a finger cot or rubber gloves to avoid spreading the infection.

Do not apply other skin products unless told to do so by your doctor. Do not cover the area with plastic or waterproof bandages unless told to do so by your doctor.

FAST FACTS

Education Is An Integral Part Of Herpes Treatment

If you have genital herpes, its important for you to get educated about herpes and have the opportunity to ask questions in a supportive environment.

Becoming informed will help you learn to cope with the illness. It will also help you prevent sexual transmission of the illness, or transmission to an infant during a pregnancy.

Herpes has a tremendous psychosocial overlay. But knowledge about it and understanding about how well it can be managed can reduce that, says Handsfield.

Your doctor may be able to provide you with all the information you need, or you may choose to seek counseling from a mental health professional or at a clinic that specializes in sexual health, such as Planned Parenthood.

If you have a regular sexual partner, that person should also have the chance to learn about herpes and ask any questions they may have about it.

How Does Genital Herpes Affect Pregnancy

Herpes simplex virus doesnt affect fertility or your ability to conceive. Pregnant women diagnosed with HSV-2 should start a daily antiviral at 36 weeks of pregnancy as prescribed, to prevent outbreaks during delivery. If you have an active infection at the time of childbirth, you can pass the herpes virus to your baby. Neonatal herpes puts a baby at risk for blindness, brain damage, skin infections and death. Your healthcare provider will perform a cesarean section to lower this risk.

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Diagnosis Of Genital Herpes

• Culture and polymerase chain reaction

• Serologic testing

Diagnosis of genital herpes is often clinical based on characteristic lesions clusters of vesicles or ulcers on an erythematous base are unusual in genital ulcers other than those due to HSV. However, these lesions are absent in many patients.

Tests for HSV should be done to confirm the diagnosis if it is not clear.

Testing is usually done using a sample of fluid from the base of a vesicle or of a newly ulcerated lesion, if present. Absence of HSV in culture, especially in patients without active lesions, does not rule out HSV infection because viral shedding is intermittent. Also, culture has limited sensitivity PCR is more sensitive and is being used increasingly.

Direct immunofluorescence with fluorescein-labeled monoclonal antibodies is sometimes available it is specific but not sensitive.

Serologic tests can accurately detect HSV-1 and HSV-2 antibodies, which develop during the first several weeks after infection and then persist. Thus, if genital herpes is thought to be recently acquired, tests may have be repeated to allow time for seroconversion.

HSV serologic testing should be considered for the following

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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Is There A Link Between Herpes And Hiv

Genital herpes is one of the most common co-infections for people with HIV. It can be a more serious condition if youâre HIV positive – outbreaks may last longer and blisters can be more severe. If youâre having recurrent outbreaks of genital herpes, you should have an HIV test, as this may be a sign of a weakened immune system caused by HIV.

Having an STI such as genital herpes can increase your risk of getting and passing on HIV. The blisters and sores provide an easy way for HIV to get into your body and cause an infection.

People with HIV who arenât on treatment or who have a lower CD4 count are more likely to get other infections, like herpes.

If youâre taking antiretroviral treatment for HIV, itâs important to discuss this with your doctor. They can advise how treatment for herpes may interact with your HIV drugs.

How Does Genital Herpes Spread

Herpes can be spread when an infected person has lesions blisters and open sores on their body or when you do not have any symptoms. Taking antiviral medicine can help you reduce the risk of spreading genital herpes to your sexual partners. You can also:

• Inform your sexual partner that you have genital herpes.
• Use a condom every time you have sex.
• Refrain from having sex when you have symptoms.
• Abstain from performing oral sex if you have blisters or open sores around your mouth.

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How Often Do Herpes Outbreaks Occur

Outbreak frequency varies greatly from person to person. The average number of outbreaks for a person with the HSV-2 virus is four to five per year, while the average for HSV-1 is less than one outbreak per year. Usually, outbreaks are more common during the first year and become less frequent over time.

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What Does Genital Herpes Look Like

While some people with genital herpes will never have any symptoms, other people can develop symptoms within a few weeks of being infected.

Often, before the lesions appear, patients describe a prodrome, characterized by a tingling or burning sensation in the area where the lesions will develop that can be noticed during urination, along with itching or discomfort in the genital area.

You can also have the following symptoms:

• Blisters on the mouth or lips
• Fever, headache or pain in the joints
• Trouble urinating

The symptoms of genital herpes often go away and come back as recurring outbreaks. For most people, the first outbreak is the worst, and can last from two to three weeks. Future flare-ups are often less severe and do not last as long. Still, some people shed the virus regularly. The following triggers can make outbreaks more likely to occur:

• Viral or bacterial infections
• Menstrual periods

Recurrent genital herpes is most common in the first year after the initial infection and decreases as time goes on.

In many cases, anti-herpes medicine can help patients. When a person experiences a prodrome and suspects a recurrence is going to happen, they begin taking anti-herpes medications that lessen symptoms and shorten the time of the outbreak.

When Treatments For Genital Herpes Are Given

• Initial treatment. If you have symptoms such as sores when you’re first diagnosed with genital herpes, your doctor will usually give you a brief course of antiviral therapy to relieve them or prevent them from getting worse. Your doctor may keep you on the drugs longer if the sores don’t heal in that time.

After the first treatment, work with your doctor to come up with the best way to take antiviral therapies. There are two options:

• Intermittent treatment. Your doctor may prescribe an antiviral drug for you to keep on hand in case you have another flare-up this is called intermittent therapy. You can take the pills for two to five days as soon as you notice sores or when you feel an outbreak coming on. Sores will heal and disappear on their own, but taking the drugs can make the symptoms less severe and make them go away faster.
• Suppressive treatment. If you have outbreaks often, you may want to consider taking an antiviral drug every day. Doctors call this suppressive therapy. For someone who has more than six outbreaks a year, suppressive therapy can reduce the number of outbreaks by 70% to 80%. Many people who take the antiviral drugs daily have no outbreaks at all.

There is no set number of outbreaks per year that doctors use to decide when someone should start suppressive therapy. Rather, more important factors are how often the outbreaks happen and if they are severe enough to interfere with your life.

Continued

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Genital Herpes And Pregnancy

Women with herpes before pregnancy can usually expect to have a healthy baby and a vaginal delivery.

If you have genital herpes during pregnancy, there’s a risk your baby could develop a serious illness called neonatal herpes.

This can be fatal, but most babies recover with antiviral treatment.

The risk of your baby getting neonatal herpes is low if you have had genital herpes before.

It’s higher if you get genital herpes for the first time in pregnancy.

What Are Recurrences Of Herpes And How Likely Are They

Recurrences are repeat symptoms which appear at or close to the place where the infection was first noticed. These are often fairly minor and may be no more than a small spot that heals in a few days. They may be accompanied by sensations itches or nerve twinges. They are unlikely to be as severe as first symptoms and may be almost unnoticed.

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How Can I Prevent Herpes Outbreaks

If you have lots of herpes outbreaks, your doctor may tell you to take medicine every day this is called suppressive therapy. It can help prevent future herpes outbreaks, and lower your chances of giving herpes to your partners.

Whether or not you take medicine to treat herpes, taking care of yourself by eating healthy foods, getting enough sleep, and avoiding stress might help keep future outbreaks from popping up.

No one knows for sure what triggers genital herpes outbreaks. Other infections, surgery, sex, your period, skin irritations, and stress may cause outbreaks. Sunburns, injuries to your lips, or other infections can cause oral herpes flare-ups. Try to avoid getting sunburned if you have oral herpes.

Genital herpes outbreaks usually happen less often and become shorter and weaker after a few years whether or not you get treated.

What Is Life Like For Someone Who Has Genital Herpes

The virus that causes genital herpes stays inside your body forever. While many people carry this virus, some dont know that they have it because they never have an outbreak.

If you have an outbreak, taking an antiviral medicine can shorten the outbreak and relieve symptoms. Some people have several outbreaks. For most people, the outbreaks become less severe and occur less often with time.

Anyone who has been infected with the virus, however, can spread the virus to others during sex. Even if you never have an outbreak, you can still spread the virus.

Related AAD resources

Centers for Disease Control. Genital Herpes – CDC Fact Sheet . Last accessed December 19, 2016.

Fatahzadeh M and Schwartz RA. Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol 2007 57:737-63.

Madkan V Sra K, et al. Human herpesviruses. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008:1075-6.

Marques AR, Straus SE, Herpes simplex. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008: 1199-1204.

US Preventive Task Force. Serologic screening for genital herpes infection: US Preventive Services Task Force recommendation statement. JAMA. 2016 316:2525-30.

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What Should I Do If I Have Genital Herpes

If you have genital herpes:

• See a doctor or nurse as soon as possible for testing and treatment.
• Take all of the medicine. Even if symptoms go away, you need to finish all of the antiviral medicine.
• Tell your sex partner so they can be tested and treated if necessary.
• Avoid any sexual contact while you are being treated for genital herpes or while you have an outbreak.
• Remember that genital herpes is a lifelong disease. Even though you may not have a genital herpes outbreak for long periods of time, you can still pass the virus to another person at any time. Talk with your doctor or nurse about how to prevent passing the virus to another person.

Clinical Trials: Key To Genital Herpes Research

Although these new genital herpes treatments are just on the horizon, it may be years before any are available to consumers.

The process of introducing a new treatment to the public can be a long one. Before the FDA approves a drug, it must go through rigorous clinical trials, which are divided into three phases. In phase I, researchers try to find out if the drug is safe for people to take. If the drug is deemed safe, it may go on to phase II, when researchers aim to determine if the drug works as it should. They also collect more safety data. In phase III trials, they expand their research to include more patients in more places.

To conduct a clinical trial, scientists need people to participate voluntarily. Clinical trials often involve thousands of patients who volunteer to take the experimental drug. The FDA and an independent review board carefully monitor every aspect of the trial. There are rules the researchers must follow to ensure that their work is scientifically correct and ethically sound. Study volunteers have clearly defined rights, such as the right to drop out of the trial at any time.

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Symptoms Of Genital Herpes

Many people who have genital herpes may not be aware they have the infection, because they may not have any symptoms.

The first episode of herpes can cause considerable pain and distress. Symptoms of the first episode may include:

• flu-like symptoms such as feeling unwell, headaches and pains in the back and legs, with or without enlarged glands in the groin
• small blisters around the genitals these break open to form shallow, painful ulcers, which scab over and heal after one to two weeks
• small cracks in the skin with or without an itch or tingling
• redness or a distinct rash
• some people also have considerable pain and swelling in the genital area, and hence may have additional pain and difficulty passing urine.

Do Natural Remedies Help

There are several options that can be tried to ease the pain. A73612 and Donnor52059 suggest dabbing cornstarch directly on the sores. I cant find any scientific studies that have researched this, but I cant see that it would do any harm.

A73612 also recommends squirting water from a bottle over the sores when you pee. This is a time-honoured method that will help to ease the pain.

Yolandayw mentioned taking a simple painkiller such as paracetamol during an outbreak. Feelbroken advised putting Vaseline on the sores. Lidocaine 5%, a local anaesthetic gel that numbs the area, is another option. Some people find it helpful to put on five minutes before passing urine. You need to get it on prescription and it doesnt suit everyone. Some people develop sensitivity to it which makes the symptoms worse.

Yolandayw also advised using ice as a home remedy. Simply wrap the ice in a tea towel and apply for 5-10 minutes. Never put ice directly on the skin as this can cause ice burn. Drinking plenty of water can also be helpful as it reduces the concentration of urine, making it less painful when you have to pee.

D91907 mentioned putting aloe vera gel on the sores. There is some scientific evidence that aloe vera is useful for both genital and oral herpes.

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