Antibiotics for herpes simplex virus

In the United States, valociclovir is more readily available covered by the majority of insurance providers. Valaciclovir is a prodrug of acyclovir and has greater bioavailability and absorption, but it is more expensive. Oral acyclovir is a safe drug with a minimal side effect profile and does not require monitoring. While side effects can occur, they are rare.

For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium or the British National Formulary. Resistance to aciclovir is very rare in immunocompetent people.

If symptoms worsen or do not improve significantly in 5 to 7 days, then an alternative diagnosis should be considered. Patients should be referred for medical review and investigation of systemic causes of ulcers, such as HIV, inflammatory bowel disease, Bechet, complex apthosis, and systemic lupus erythematosus SLE.

Oral antivirals taken early before the lesion appears in a recurrent episode might be more effective than a placebo at reducing symptom duration and healing time.

Treatment is not a cure and will only prevent lesions if administered at the prodromal stage. Once the lesions have appeared, symptoms might be lessened in duration by one day.

In immunocompromised individuals with an episode of primary or recurrent oral herpes simplex infection, use of oral antiviral medications should be based on best clinical judgement. When an oral antiviral drug is indicated, clinicians should advise their patients to take the medication from the time of onset of prodromal symptoms, before vesicles appear, if possible, until lesions have healed, for a minimum of five days.

When a patient reports a cold sore eruption following a low-risk procedure, clinicians should educate patients on management of symptoms and prevention of spread and further reinfection and should continue to monitor and document the eruption until resolved. Patients might present with concurrent or subsequent superimposed bacterial infection with impetigo surrounding crusted lesions. Bacterial infections are often responsible for symptoms worsening rather than failure of antiviral treatment, and following clinical assessment antibiotics should be considered.

In immunocompromised patients or those with poor absorption, mg Aciclovir PO five times a day is recommended. Clinical decision making and risk assessment should consider the patient-specific history and assessment.

While there is no definitive evidence base on the actual risk of reactivation following minimally invasive procedures or in the actual benefit of prophylactic regimes, CMAC advocates anti-HSV prophylaxis for patients who have previously had a herpetic outbreak following an aesthetic procedure,,14 when the procedure breaches the integrity of the skin, such as medical needling, chemical peels, dermabrasion and microdermabrasion, dermal filler injections to the lips or nasal labial folds, and routinely for CO 2 laser resurfacing procedures.

If previous history of failure on aciclovir prophylaxis with good adherence or deemed to be high risk of reactivation including immunosuppression:. There are no randomized controlled trials to indicate optimum time to commence episodic prophylaxis. Based on a review of the literature, a reasonable protocol would not be before two days prior to treatment and no later than the day of treatment and continue for five days, or until skin post procedure has healed.

Oral antivirals do not prevent progression of latent infection. If the patient suffers a recurrence despite prophylaxis, revert to treatment of active infection protocol.

Provide self-help advice on the management of symptoms and the prevention of autoinoculation and transmission to others. All patients presenting with a herpetic eruption postprocedure should be supported to manage their condition, as per patient advice sheet, and carefully monitored.

Photographs should be taken to objectively assess over time. Refer to primary care for further investigation, if symptoms do not improve after seven days or if they worsen. The patient should be offered appropriate prophylactic treatment for subsequent treatments in the future. Identifying and communicating potential risks with the patient as part of the assessment and consent process, good record keeping, and good follow-up and support all play their part in preventing a complication from becoming a complaint.

Members of the organization are part of a collaboration that aims to capture data to help improve patient safety. For more details, please see www. National Center for Biotechnology Information , U.

J Clin Aesthet Dermatol. Author information Copyright and License information Disclaimer. Corresponding author. Matrix Medical Communications. All rights reserved. Abstract The Complications in Medical Aesthetics Collaborative CMAC is a not-for-profit organization established to promote best patient outcomes through educating clinicians who perform nonsurgical cosmetic procedures in the prevention, diagnosis, and management of complications that can arise. Keywords: Herpes dermal fillers, herpes simplex cosmetic treatments, herpes diagnosis and treatment.

TABLE 1. Types of virus and associated clinical features. Open in a separate window. TABLE 2. Differential diagnosis and associated key clinical features. Chicken pox Disseminated vesicles throughout the body, general malaise, systemically unwell.

Variations in sensitivity may occur in cultured cell lines for various reasons. Positive and negative control slides should be included daily in each run to ensure that the antibody reagents are performing correctly. Typical immunofluorescence should be observed in the positive controls but not the negative controls.

Positive and negative controls must be included with each batch of sera tested. When commercial kits are used, these controls are usually provided in the kit. Results obtained in serology assays should be discarded and not be reported if control samples are out of the expected range. In addition, the use of in-house positive and negative controls should be considered.

Run-to-run variability in readings on the control samples should be tracked. Testing of new lots of kits should be performed before their use in the laboratory. Most laboratories undertake regular tests to determine analytical sensitivity and specificity of any in-house procedures. Weak positive controls should be included in every PCR run to ensure consistent sensitivity of the assay along with negative extraction and amplification controls to assess any potential problems with contamination that could lead to false-positive results.

Internal controls may be used to detect the presence of any amplification inhibitors that could lead to false-negative results, although this is rarely a problem. The authors are indebted to Dr Bonita Lee and Barbara LeBlanc for their invaluable comments and review of the manuscript.

The authors would like to dedicate this article to the memory of Dr Stephen Sacks, whose work contributed to significant advances in HSV infections. National Center for Biotechnology Information , U. Author information Copyright and License information Disclaimer.

Telephone , fax , e-mail ac. All rights reserved. This article has been cited by other articles in PMC. Abstract Herpes simplex virus HSV types 1 and 2 cause genital herpes infections and are the most common cause of genital ulcer disease in industrialized nations. Specimen Choice, Collection And Transport Direct methods Specimens obtained from vesicular lesions within the first three days after their appearance are the specimens of choice, but other lesion material from older lesions or swabs of genital secretions should be obtained if suspicion of HSV infection is high 10 , Indirect serological methods Approximately 8 mL to 10 mL of blood is usually collected in tubes without anticoagulant or preservatives.

Diagnostic Tests Direct methods Direct tests endeavour to demonstrate the presence of HSV in a suspicious lesion or in genital secretions. Viral isolation Standard viral culture: Tube culture isolation is the traditional gold standard for HSV detection and the reference method against which all other tests are measured 16 , Shell vial or centrifugation-enhanced culture: Many laboratories now use centrifugation-enhanced shell vial culture methods to reduce viral isolation times Antigen detection Viral antigen detection may be a suitable alternative to culture for smaller laboratories in which the expense of maintaining cell lines is unwarranted.

Tzanck smears HSV infection causes typical cytopathic changes in genital epithelial cells 3. Electron microscopy Direct examination of vesicle fluid or other clinical material by electron microscopy for the diagnosis of HSV is limited by the fact that viral morphology cannot be used to distinguish HSV from other herpes viruses eg, varicella zoster virus Indirect Serological Tests The detection of antibodies to HSV allows for diagnosis when other virological methods cannot be performed or yield negative results Seroepidemiological studies Seroprevalence studies Seroincidence studies Sexual transmission studies Current and potential clinical uses Patients with apparent first episode and recurrent genital herpes, especially pregnant women Clinically discordant couples, particularly where the man is positive and the woman is negative and of child-bearing potential Women of child-bearing potential with a history of lesions suspicious for genital herpes where repeated direct testing for HSV has been negative Sexually transmitted infection screening, especially those at risk of acquiring HIV infection Diagnosis of genital herpes when lesions tested using direct tests are negative on at least two occasions Screening of all HIV-infected individuals at the time of initial diagnosis with HIV, with a view to providing suppressive HSV antiviral therapy in those found to be HSV-2 antibody-positive.

Open in a separate window. Reproduced with permission from reference 2. Commercial gG-based type-specific tests Although most of the available literature evaluating the performance of type-specific tests was based on kits developed by Gull Laboratories USA , these tests have now been withdrawn from the market.

Antiviral Resistance Testing A number of antiviral agents have been developed for the management of HSV infections; of these, acyclovir is the most commonly used. Drug sensitivity assays The complexity of drug sensitivity assays for antiviral resistance limits their availability.

Proficiency And Quality Assurance All laboratories providing diagnostic services for the detection of HSV in clinical samples or performing HSV serological assays must participate in the testing of proficiency panels provided by external agencies whenever possible for all tests performed.

Culture Subpassages of HSV clinical isolates should be inoculated with each batch of HSV roller tube or shell vial cultures to serve as positive controls. Direct smears Positive and negative control slides should be included daily in each run to ensure that the antibody reagents are performing correctly. Indirect serological methods Positive and negative controls must be included with each batch of sera tested.

Acknowledgments The authors are indebted to Dr Bonita Lee and Barbara LeBlanc for their invaluable comments and review of the manuscript. References 1. Herpes simplex virus type 2 in the United States, to N Engl J Med ; Corey L. The current trend in genital herpes. Progress in prevention. Sex Transm Dis ; 21 Suppl 2 :S The Tzanck smear in the diagnosis of cutaneous herpes simplex. JAMA ; Corey L, Spear PG. Infections with herpes simplex viruses 1.

Ashley RL. Genital herpes. Type-specific antibodies for diagnosis and management. Dermatol Clin ; 16 Risk factors for the sexual transmission of genital herpes. Ann Intern Med ; The management of pregnancies complicated by genital infections with herpes simplex virus.

Clin Infect Dis ; 15 From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect ; 75 Frequent genital herpes simplex virus 2 shedding in immunocompetent women. Effect of acyclovir treatment. J Clin Invest ; 99 Koneman EW. Diagnosis of infections caused by viruses, Chlamydia, Rickettsia, and related organisms.

Color Atlas and Textbook of Diagnostic Microbiology, 4th edn. Pennsylvania: JB Lippincott Company , Herpes simplex viruses. Manual of Clinical Microbiology, 7th edn. Washington: ASM Press , Incubation of swab materials with herpes simplex virus. J Infect Dis ; Petric M, Szymanski M.

Electron microscopy and immunoelectron microscopy. Clinical Virology Manual, 3rd edn. Genital herpes during pregnancy: Inability to distinguish primary and recurrent infections clinically. Obstet Gynecol ; 89 Diagnosis of herpes simplex virus by direct immunofluorescence and viral isolation from samples of external genital lesions in a high-prevalence population.

J Clin Microbiol ; 25 Laboratory techniques in the diagnosis of herpes simplex infection. Genitourin Med ; 69 Manual of Clinical Virology. New York: Raven Press , Recurrences after oral and genital herpes simplex virus infection.

Influence of site of infection and viral type. Comparison of viral isolation, direct immunofluorescence, and indirect immunoperoxidase techniques for detection of genital herpes simplex virus infection. J Clin Microbiol ; 13 Rapid isolation of herpes simplex virus by using mink lung and rhabdomyosarcoma cell cultures. J Clin Microbiol ; 28 Comparison of primary rabbit kidney and MRC-5 cells and two stain procedures for herpes simplex virus detection by a shell vial centrifugation method.

J Clin Microbiol ; 26 Comparison of enzyme immunoassay, shell vial culture, and conventional cell culture for the rapid detection of herpes simplex virus.

Diagn Microbiol Infect Dis ; 13 Evaluation of three immunofluorescence assays for culture confirmation and typing of herpes simplex virus. Obstet Gynecol ; 73 Comparison of two enzyme-linked immunosorbent assays for detection of herpes simplex virus antigen. J Clin Microbiol ; 29 Verano L, Michalski FJ. Genital Herpes Treatment and Care. Minus Related Pages. Medicine can reduce symptoms and the chance of spreading it to others. Is there a cure or treatment for genital herpes?

October 5, Related Content. STDs Home Page. See Also Pregnancy Reproductive Health.