From the FDA Drug Label
Patients should be informed that VALTREX is not a cure for genital herpes Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes is frequently transmitted in the absence of symptoms through asymptomatic viral shedding Therefore, patients should be counseled to use safer sex practices in combination with suppressive therapy with VALTREX. Sex partners of infected persons should be advised that they might be infected even if they have no symptoms. Type‑specific serologic testing of asymptomatic partners of persons with genital herpes can determine whether risk for HSV‑2 acquisition exists If medical management of a genital herpes recurrence is indicated, patients should be advised to initiate therapy at the first sign or symptom of an episode
The causes of Genital Herpes are related to the Herpes Simplex Virus (HSV). The risk factors for transmission include:
- Contact with lesions or intercourse when lesions and/or symptoms are present
- Asymptomatic viral shedding The preventive measures include:
- Avoiding contact with lesions or intercourse when lesions and/or symptoms are present
- Using safer sex practices in combination with suppressive therapy with VALTREX
- Type‑specific serologic testing of asymptomatic partners to determine risk for HSV‑2 acquisition The signs and symptoms of Genital Herpes are not explicitly listed, but patients should initiate therapy at the first sign or symptom of an episode. The treatment options include:
- Initiating therapy at the first sign or symptom of an episode
- Using VALTREX for suppressive therapy, but it has not been shown to reduce transmission of sexually transmitted infections other than HSV‑2 1
From the Research
Introduction to Genital Herpes
Genital herpes, caused by the herpes simplex virus (HSV) type 1 or 2, is a sexually transmitted infection that affects a significant portion of the global population, with at least 500 million people infected worldwide 2. This condition is characterized by its lifelong impact, involving initial infection and periodic reactivation with variable viral shedding.
Causes and Risk Factors
The primary cause of genital herpes is the herpes simplex virus, which can be transmitted through sexual contact with an infected individual. Risk factors include engaging in sexual activities without the use of protective measures such as condoms, having multiple sexual partners, and being in a serodiscordant relationship where one partner has the infection and the other does not 2, 3.
Preventive Measures
Prevention of genital herpes involves practices that reduce or prevent transmission. These include:
- The use of suppressive antiviral therapy in serodiscordant partners to reduce the risk of transmission
- Avoiding sexual contact during outbreaks
- Consistent use of condoms during sexual activity
- Screening for other sexually transmitted infections as part of comprehensive sexual health care 2, 3
Signs and Symptoms
A clinically apparent herpes outbreak is characterized by:
- Painful vesicles on the genitals, rectum, or perineum
- A flulike syndrome of fever, malaise, and lymphadenopathy may accompany the outbreak
- Primary infections tend to be more severe than recurrent episodes, which are generally milder but can still cause significant discomfort and distress 2, 4, 5
Diagnosis
Diagnosis of genital herpes can be achieved through:
- Type-specific polymerase chain reaction (PCR)
- Viral culture of active lesions
- Type-specific serologic testing to identify the presence of HSV antibodies in the blood 2, 4, 5
Treatment Options
Treatment for genital herpes focuses on reducing viral shedding and alleviating symptoms. Nucleoside analogue medications, such as aciclovir, valaciclovir, and famciclovir, are effective in treating active outbreaks and preventing recurrences. The dosing and duration of treatment can vary depending on whether it is for an initial outbreak, recurrent episodes, or suppressive therapy:
- For initial outbreaks, treatment may involve higher doses and longer durations to manage symptoms and promote healing.
- For recurrent episodes, treatment is typically shorter, aiming to reduce the severity and duration of symptoms.
- Suppressive therapy involves daily medication to prevent recurrences and is particularly recommended for individuals with frequent outbreaks or in serodiscordant relationships 2, 3, 4
Complications and Special Considerations
Complications of genital herpes include:
- Encephalitis
- Meningitis
- Urinary retention During pregnancy, antiviral suppression is recommended starting at 36 weeks of gestation for patients with a known history of genital herpes to reduce the risk of neonatal transmission. Elective cesarean delivery should be offered to patients with active lesions at the time of labor to minimize neonatal exposure to HSV 2.
Conclusion
Genital herpes, caused by the herpes simplex virus, is a significant sexually transmitted infection with lifelong implications. Understanding its causes, risk factors, preventive measures, signs, symptoms, and treatment options is crucial for healthcare providers to manage the condition effectively and provide appropriate care and counseling to affected individuals.