From the Guidelines
Women exposed to diethylstilbestrol (DES) in utero do not have a specifically increased risk of herpes infections compared to the general population. DES was a synthetic estrogen prescribed to pregnant women between the 1940s and 1970s to prevent miscarriage, and while it has been linked to various reproductive health issues in female offspring (such as clear cell adenocarcinoma of the vagina and cervix, structural abnormalities of the reproductive tract, and fertility problems), there is no established connection to herpes susceptibility, as noted in studies such as 1. Women with DES exposure should follow standard herpes prevention measures, including practicing safe sex and avoiding contact with active herpes lesions, as recommended by guidelines such as those from the Centers for Disease Control and Prevention 1.
If diagnosed with herpes, they would receive the same treatment as anyone else: antiviral medications such as acyclovir (400mg three times daily for 7-10 days for initial outbreaks; 400mg twice daily for recurrent episodes), valacyclovir (1g twice daily for initial outbreaks; 500mg daily for suppression), or famciclovir. While DES-exposed women should receive regular gynecological care due to their increased risk of reproductive tract abnormalities and certain cancers, their herpes management would not differ from standard protocols. It's also important for these women to be aware of the recommendations for cervical cancer screening, as they are at a higher risk and should follow guidelines specific to their risk group, as outlined in studies like 1 and 1.
Key points to consider include:
- Practicing safe sex to prevent the transmission of herpes
- Avoiding contact with active herpes lesions
- Receiving regular gynecological care to monitor for reproductive tract abnormalities and cancers
- Following standard protocols for herpes treatment if diagnosed
- Being aware of and following specific guidelines for cervical cancer screening due to increased risk.
From the Research
Herpes in DES Exposure Women
There is no direct evidence in the provided studies to suggest a link between DES exposure and herpes. However, the following information is available on herpes treatment:
- The treatment of herpes simplex virus infections has been transformed by guanosine nucleoside antivirals such as valacyclovir, acyclovir, and famciclovir 2, 3, 4.
- Current therapies for genital herpes include episodic treatment and chronic suppressive therapy, which are generally well tolerated and effective 5.
- Suppressive antiviral therapy with acyclovir, valacyclovir, or famciclovir can decrease the number of patients with at least one recurrence of genital herpes per year compared to placebo 6.
- The efficacy of valacyclovir, acyclovir, and famciclovir in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials 3, 4, 6.
Treatment Options
- Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, and it is also approved for a 3-day course in the episodic treatment of recurrent genital herpes 4.
- Acyclovir, valacyclovir, and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes, and are useful as suppressive therapy for individuals with frequent genital herpes recurrences 2, 6.
- High doses of oral acyclovir, valacyclovir, and famciclovir have been shown to speed the healing of herpes zoster, and data suggests that these agents also decrease associated acute and chronic pain in people of 50 years of age or older 2.