No cure for herpes exists; however, recurrences tend to be milder and of shorter duration than the primary infection. Symptomatic and supportive therapy is essential. Generalized primary infection usually requires an analgesic-antipyretic to reduce fever and relieve pain.
Anesthetic mouthwashes, such as viscous lidocaine, may reduce the pain of gingivostomatitis, enabling the patient to eat and preventing dehydration. (Avoid alcohol-based mouthwashes.) Drying agents, such as calamine lotion, ease the pain of labial or skin lesions. Avoid petroleum-based ointments, which promote viral spread and slow healing.
Refer patients with eye infections to an ophthalmologist. Topical corticosteroids are contraindicated in active infection, but idoxuridine, trifluridine, and vidarabine are effective. Oral acyclovir may bring relief to patients with genital herpes.
Frequent prophylactic use of acyclovir in immunosuppressed transplant patients prevents disseminated disease.Foscarnet can be used to treat HVH that’s resistant to acyclovir. Anti-viral agents similar to acyclovir are valacyclovir and famciclovir. These agents are more active than acyclovir.
Acyclovir has proved to be an effective treatment for genital herpes. I.V. administration may be required for patients who are hospitalized with severe genital herpes or for those who are immunocompromised and have a potentially life-threatening herpes infection. Oral acyclovir may be prescribed for the patient with a first-time infection or recurrent outbreak.
Other agents include famciclovir, valacyclovir, and penciclovir; these drugs suppress symptoms but don’t cure the infection. Daily prophylaxis with acyclovir reduces the frequency of recurrences by at least 50%, but this is only appropriate for a patient with frequent outbreaks and may not decrease transmission rate of the disease.
Foscavir, a powerful antiviral agent, is the treatment of choice for herpes strains that are severe in nature or have become resistant to acyclovir and similar drugs. Administered I.V., foscavir can have several toxic effects, such as reversible impairment of kidney function or induction of sei-zures. As with other antiviral drugs, this drug doesn’t cure herpes.
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