All patients with genital, anal or perianal ulcers should be evaluated with a serologic test for syphilis in addition to a diagnostic evaluation for genital herpes. In settings where chancroid is prevalent, a test for Haemophilus ducreyi should also be performed. Specific tests for evaluation of genital, anal, or perianal ulcers Includes syphilis serology and darkfield examination HSV culture and PCR are preferred serologic testing for type-specific HSV antibody. No FDA-cleared PCR test for syphilis or chancroid is available in the U.S.; however, such testing can be performed by clinical laboratories that have developed their own tests and conducted a Clinical Laboratory Improvement Amendment (CLIA) verification study. Healthcare providers frequently must patients before test results are available, because early treatment decreases the possibility of ongoing transmission and because successful treatment of genital herpes depends on prompt initiation of therapy. 40] Lesson V: Patient Management 41] Principles of Management of Genital Herpes Counseling about the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission is integral to clinical management. Antiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management. Partially controls symptoms and signs of herpes episodes when used to treat first clinical and recurrent episodes, or when used as daily suppressive therapy Does not eradicate latent virus and does not affect risk, frequency, or severity of recurrences after drug is discontinued 42] Antiviral Therapy for HSV HSV systemic antiviral chemotherapy includes three oral medications: Acyclovir (ACV) Valacyclovir (Valine of acyclovir) high oral bioavailability — Famciclovir (Penciclovir prodrug) high oral bioavailability — Topical antiviral treatment is of minimal clinical benefit and is not recommended. 43] Management of Clinical Episode of Genital Herpes Many patients with first episode of herpes present with mild clinical manifestations, but later develop severe or prolonged symptoms. Therefore, patients with initial genital herpes should receive antiviral therapy.
All patients with genital, anal or perianal ulcers should be evaluated with a serologic test for syphilis in addition to a diagnostic evaluation for genital herpes. In settings where chancroid is prevalent, a test for Haemophilus ducreyi should also be performed. Specific tests for evaluation of genital, anal, or perianal ulcers Includes syphilis serology and darkfield examination HSV culture and PCR are preferred serologic testing for type-specific HSV antibody. No FDA-cleared PCR test for syphilis or chancroid is available in the U.S.; however, such testing can be performed by clinical laboratories that have developed their own tests and conducted a Clinical Laboratory Improvement Amendment (CLIA) verification study. Healthcare providers frequently must patients before test results are available, because early treatment decreases the possibility of ongoing transmission and because successful treatment of genital herpes depends on prompt initiation of therapy. 40] Lesson V: Patient Management 41] Principles of Management of Genital Herpes Counseling about the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission is integral to clinical management. Antiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management. Partially controls symptoms and signs of herpes episodes when used to treat first clinical and recurrent episodes, or when used as daily suppressive therapy Does not eradicate latent virus and does not affect risk, frequency, or severity of recurrences after drug is discontinued 42] Antiviral Therapy for HSV HSV systemic antiviral chemotherapy includes three oral medications: Acyclovir (ACV) Valacyclovir (Valine of acyclovir) — high oral bioavailability Famciclovir (Penciclovir prodrug) — high oral bioavailability Topical antiviral treatment is of minimal clinical benefit and is not recommended. 43] Management of Clinical Episode of Genital Herpes Many patients with first episode of herpes present with mild clinical manifestations, but later develop severe or prolonged symptoms. Therefore, patients with initial genital herpes should receive antiviral therapy.
hsv-notes-2014.docx