What patient education is necessary when starting acyclovir (antiviral medication) for genital herpes?

Patient Education for Starting Acyclovir for Genital Herpes

Patients starting acyclovir for genital herpes should be clearly informed that while the medication can control symptoms and reduce recurrences, it does not cure the infection, and transmission can still occur even during asymptomatic periods. 1, 2

Key Information to Provide

About the Condition

• Explain that genital herpes is a recurrent, incurable viral disease that may have periods of active symptoms followed by dormancy 3, 1
• Clarify whether the infection is HSV-1 or HSV-2, as HSV-1 typically causes less frequent recurrences, which is important prognostic information for counseling purposes 3
• Emphasize that many people with genital herpes experience recurrences, particularly with HSV-2 infection 1

Medication Information

• Explain the prescribed dosing regimen (depending on whether it's for first episode, recurrent episode, or suppressive therapy) 3, 1
  • First episode: 400 mg three times daily or 200 mg five times daily for 7-10 days 3
  • Recurrent episodes: 400 mg three times daily, 800 mg twice daily, or 200 mg five times daily for 5 days 1
  • Suppressive therapy: 400 mg twice daily 1, 4
• Advise that treatment may be extended if healing is incomplete after the initial course 3
• Instruct patients to maintain adequate hydration while taking acyclovir 2

Common Side Effects

• Inform patients about potential side effects, with the most common being:
  • Nausea/vomiting (2.7% for short-term treatment) 2
  • Diarrhea (2.4% for long-term treatment) 2
  • Malaise 2
• Advise patients to report any severe or troublesome adverse reactions 2

Preventing Transmission

• Instruct patients to abstain from sexual activity when lesions or prodromal symptoms are present 3, 1
• Encourage the use of condoms during all sexual exposures with new or uninfected partners 3, 1
• Inform patients that asymptomatic viral shedding can occur, potentially leading to transmission even without visible symptoms 3, 2
• Advise patients to inform their sex partners about having genital herpes 1

Timing and Effectiveness of Treatment

For Episodic Therapy

• Emphasize that episodic treatment is most effective when started during the prodrome or within 1 day after onset of lesions 3, 1
• Provide patients with a prescription so they can initiate treatment at the first sign of prodrome or genital lesions 3
• Explain that while treatment can shorten the duration of symptoms, it does not prevent all future recurrences 1, 2

For Suppressive Therapy

• Inform patients that daily suppressive therapy can reduce recurrence frequency by ≥75% among those with frequent recurrences (six or more per year) 1, 4
• Explain that after 1 year of continuous suppressive therapy, discontinuation should be considered to reassess recurrence frequency 4
• Clarify that suppressive treatment reduces but does not eliminate asymptomatic viral shedding 4

Special Considerations

For Women of Childbearing Age

• Advise women to inform healthcare providers who care for them during pregnancy about their HSV infection 3
• Instruct patients to consult with their physician if they become pregnant or intend to become pregnant while taking acyclovir 2

For Patients with Renal Impairment

• Explain that dosage adjustment is recommended for patients with renal impairment 2

Follow-up Recommendations

• Advise patients to seek medical attention if symptoms persist beyond 5 days of treatment 1
• Inform patients that if recurrences remain frequent or severe after discontinuing suppressive therapy, treatment can be restarted 4

By providing comprehensive education about acyclovir treatment for genital herpes, healthcare providers can help patients manage their condition effectively and reduce the risk of transmission to others.