Key Questions for Acyclovir Refill Requests in HSV-2 Patients
When a patient requests a refill for acyclovir for HSV-2, healthcare providers should assess treatment effectiveness, adherence, and potential complications through a structured set of targeted questions about symptoms, medication use patterns, and risk factors.
Assessment of Current Treatment Regimen
Frequency of outbreaks/recurrences:
- How often are you experiencing outbreaks since starting acyclovir?
- Has there been a change in frequency compared to before treatment?
- When was your last outbreak?
Current dosing regimen:
- What dose of acyclovir are you currently taking?
- Are you taking it for suppressive therapy (daily) or episodic treatment (only during outbreaks)?
- If suppressive: Have you been taking it continuously for more than 1 year? 1
- If episodic: Are you able to start medication at the first sign of prodrome or outbreak?
Medication effectiveness:
- How well is the medication controlling your symptoms?
- Has there been any change in the duration or severity of outbreaks?
- Do you experience prodromal symptoms (tingling, burning, itching) before outbreaks?
Medication Adherence and Safety
Adherence assessment:
- How often do you miss doses?
- Do you have any difficulties taking the medication as prescribed?
- Are you experiencing any side effects from the medication?
Renal function:
- Do you have any known kidney problems?
- Are you taking other medications that might affect kidney function? 2
- When was your last kidney function test?
Hydration status:
- Are you maintaining adequate fluid intake while on acyclovir? 2
Risk Assessment and Transmission Prevention
Sexual activity and protection:
- Are you sexually active?
- Do you abstain from sexual activity when lesions or prodromal symptoms are present?
- Do you use condoms during sexual encounters?
- Are you aware that HSV-2 can be transmitted even when no symptoms are present? 1
Partner notification:
- Have you informed your sexual partner(s) about your HSV-2 status?
- Has your partner(s) been tested for HSV-2?
For women of childbearing age:
- Are you pregnant or planning to become pregnant?
- Are you aware of the importance of informing healthcare providers about HSV-2 during pregnancy? 1
Complications and Special Considerations
Immunocompromised status:
- Do you have HIV or any other condition affecting your immune system?
- Have you noticed any changes in your outbreaks that seem unusual or severe? 1
Treatment failure indicators:
- Are lesions persisting despite acyclovir treatment?
- Has there been an increase in outbreak frequency despite adherence to medication?
- For HIV-positive patients: Has your HIV treatment regimen changed recently? 1
Counseling and Education Needs
Understanding of condition:
- Do you understand that acyclovir is not a cure for genital herpes? 2
- Are you aware of the natural history of HSV-2 infection?
- Do you need additional information about managing your condition?
Psychological impact:
- How are you coping with having HSV-2?
- Would you benefit from counseling or support resources?
Treatment Plan Reassessment
- After 1 year of continuous suppressive therapy, consider discontinuing acyclovir temporarily to reassess the patient's rate of recurrent episodes, as the frequency of recurrences may decrease over time 1
- For patients with frequent recurrences (≥6 per year), discuss continuing suppressive therapy versus switching to episodic treatment 1
- For patients on suppressive therapy with very frequent recurrences (≥10 per year), ensure adequate dosing (valacyclovir 500mg once daily may be less effective than other regimens) 1
Remember that appropriate management of HSV-2 requires both effective treatment of symptoms and comprehensive counseling about preventing transmission to partners.