Check dosing regimens to treat genital herpes
March 1, 2009 4 minutes read
Check dosing regimens to treat genital herpes
Think about the last five women who have entered your examination room. How many of them have had genital herpes simplex virus Type 2 (HSV-2) infection? While the percentage of Americans with genital herpes infection has decreased over the past decade — from about 21% to 17% — genital HSV-2 infection is more common in women.1,2 According to the Centers for Disease Control and Prevention (CDC), about one out of four women have been infected, compared to almost one out of eight men.3
While there is no treatment that can cure herpes, the antiviral medications acyclovir, famciclovir, and valacyclovir can shorten and prevent outbreaks during the period of time the medication is taken. A number of management approaches with antiviral medications are commonly used, including episodic and suppressive treatments.4 Episodic treatment is taken only at the outbreak of a recurrent infection. Suppressive therapy relies on daily dosing to reduce the frequency of genital herpes recurrences in patients who have frequent outbreaks.
The traditional course of antiviral therapy for herpes recurrences has consisted of five-day regimens.5 However, researchers in the past decade have looked at short-course episodic treatment for recurrent HSV-2. Short-course episodic treatment listed by the CDC include:
- acyclovir 800 mg orally three times a day for two days;
- famciclovir 1,000 mg orally twice daily for one day;
- valacyclovir 500 mg orally twice a day for three days.6
Famciclovir (Famvir, Novartis Pharmaceuticals Corp.; East Hanover, NJ) gained supplemental Food and Drug Administration approval in 2007 for use of the drug as a single-day treatment for immunocompetent patients with recurrent genital herpes. Data indicate that when patients were treated with the drug within six hours of prodromal symptoms, it shortened the duration of outbreaks and improved the time to resolution of symptoms.7
Single-day dosage of Famvir is 1,000 mg twice daily for one day. Therapy should be initiated within six hours of the first sign of such prodromal symptoms as tingling, itching, burning, or lesion appearance.8
Results of a 2008 multinational, randomized, double-blind, comparative trial indicate that single-day famciclovir was as effective as three-day valacyclovir for treating genital herpes.9 To perform the study, 1,179 adults with recurrent genital herpes were randomly assigned to begin treatment with famciclovir or valacyclovir within six hours after a recurrence. About one-third of patients in each treatment group had aborted genital herpes episodes, which suggested that both treatments have similar efficacy in preventing outbreaks or progression of lesions. There was no significant difference in time to resolution of symptoms associated with recurrence, researchers note.9 The overall incidence of adverse events was similar (23.2% for the famciclovir group vs. 22.3% for the valacyclovir group); headache, nausea, diarrhea, vomiting, and abdominal pain were the most often reported.9
Since the single-day regimen of famciclovir was similar in efficacy and safety to the three-day valacyclovir regimen, it represents a more convenient treatment, researchers conclude.9
Scientists have looked at a one-day regimen of valacyclovir for recurrent HSV-2 episodes.10 In an open-label pilot study, patients with recurrent HSV-2 infection were given a one-day course of valacyclovir (2,000 mg given by mouth twice daily) to be taken at the first sign of recurrence or prodrome. Ninety patients (78%) had a recurrence or the signs of initial symptoms, and four patients (5%) developed a second recurrence during the 14 days after treatment. The average duration of genital sores was five days, and the average duration of pain was three days.
Viral shedding was detected in 60 patients and lasted an average of two to three days. Of those with viral shedding, 14 (23%) had an additional shedding episode after the initial sore healed, with the second recurrence lasting approximately two days.
"A one-day course of valacyclovir may be a convenient treatment for recurrent genital herpes and comparative trials are warranted," researchers note.
References
- Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997; 337:1,105-1,111.
- Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006; 296:964-973.
- Centers for Disease Control and Prevention. Genital Herpes. Fact sheet. Accessed at www.cdc.gov/std.
- Corey L, Bodsworth N, Mindel A, et al. An update on short-course episodic and prevention therapies for herpes genitalis. Herpes 2007; 14 Suppl 1:5A-11A.
- Wald A. Recurrent genital HSV infections: How brief can treatment be? Accessed at www.ihmf.org/Library/down_k10_6.asp#.
- Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55(RR-11):1-94.
- Aoki FY, Tyring S, Diaz-Mitoma F, et al. Single-day, patient-initiated famciclovir therapy for recurrent genital herpes: A randomized, double-blind, placebo-controlled trial. Clin Infect Dis 2006; 42:8-13.
- Novartis Pharmaceuticals Corp. FDA Approves Supplemental New Drug Application for Antiviral Treatment Famvir. Press release. Accessed at www.pharma.us.novartis.com/newsroom.
- Abudalu M, Tyring S, Koltun W, et al. Single-day, patient-initiated famciclovir therapy versus 3-day valacyclovir regimen for recurrent genital herpes: A randomized, double-blind, comparative trial. Clin Infect Dis 2008; 47:651-658.
- Bavaro JB, Drolette L, Koelle DM, et al. One-day regimen of valacyclovir for treatment of recurrent genital herpes simplex virus 2 infection. Sex Transm Dis 2008; 35:383-386.
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