From the Guidelines
A positive HSV culture indicates an active herpes simplex virus infection, and antiviral treatment should be initiated immediately with oral acyclovir 400mg twice daily, valacyclovir 500mg daily, or famcyclovir 250mg twice daily as prophylaxis. When considering treatment, it's essential to note that herpes simplex virus can cause severe disease in immunocompetent individuals, including keratitis, encephalitis, and retinitis 1. Some key points to consider in management include:
- Patients with a history of HSV infection should be asked about it before commencing immunosuppressive therapy
- Routine prophylaxis to suppress virus replication should be considered for patients with frequent recurrent attacks
- Reactivation may cause severe localized systemic infections with significant morbidity and mortality, including encephalitis, meningitis, pneumonia, oesophagitis, and colitis 1
- There is no vaccine available for HSV, making antiviral prophylaxis crucial for patients at risk While taking antivirals, it's crucial to maintain good hygiene, avoid touching lesions, and abstain from sexual contact until lesions completely heal to prevent transmission. Pain can be managed with acetaminophen or ibuprofen. The virus remains dormant in nerve cells after symptoms resolve and may reactivate periodically, so patients with frequent recurrences may need suppressive therapy with daily antivirals at lower doses 1.
From the Research
HSV Culture: Isolated
- The isolation of HSV is crucial in understanding the virus's behavior and developing effective treatment strategies 2.
- Studies have shown that HSV can be isolated from clinical specimens and characterized based on its cytopathological features and antiviral sensitivity 2.
- The emergence of drug-resistant HSV strains is a significant concern, particularly in immunocompromised individuals 3, 4, 5.
- Research has focused on developing new antiherpes agents to address issues such as drug resistance and safety concerns 6, 5.
- Antiviral sensitivity assays have been performed to determine the effectiveness of commercially available antiherpesvirus drugs, such as acyclovir, phosphonophormic acid, and trifluridine, against HSV isolates 2.
- The results of these assays have shown that all isolated HSV strains were sensitive to these drugs, with varying degrees of virus inhibition 2.
Treatment Options
- Acyclovir is a commonly used antiviral drug for treating HSV infections, but its limitations include the development of resistant isolates and poor oral bioavailability 6.
- Foscarnet has been shown to be effective in treating acyclovir-resistant HSV infections, particularly in immunocompromised patients 3, 4.
- Other treatment options, such as penciclovir, valacyclovir, and famciclovir, have also been developed and shown to be effective in treating HSV infections 6, 5.
- Topical trifluorothymidine and cidofovir have also been used to treat resistant mucocutaneous HSV disease, with encouraging results 4.