Recently the CDC updated its guidelines for treating sexually transmitted diseases (STDs).1 In last month’s issue (CONSULTANT, June 2002, page 849), the recommendations for managing sexually transmitted bacterial diseases were discussed. Here the focus is on genital herpes simplex virus (HSV) infection and human papillomavirus (HPV) infection. In a future issue, sexually transmitted fungal and protozoan infections, as well as pediculosis pubis and scabies, will be addressed.
Highlights of the new guidelines for treating viral STDs, which are provided below, include:
* Renewed emphasis on counseling for patients with genital herpes and those with HPV infection.
* Improved type-specific serologic tests for HSV.
* Updated dosing recommendations and alternative regimens.
* Tips for follow-up.
Acyclovir is used for herpes, not HPV–but there are two different types of herpes (oral and genital). Management of the first clinical episode of genital herpes includes systemic antiviral medication (acyclovir, famciclovir, or valacyclovir) and counseling.
Although, more recent developments in adjuvant therapy have been shown to provide some benefit in controlling RRP although no therapies have been able to eradicate the HPV genome from mucosal tissues. The adjuvant therapies include alfa-interferon, acyclovir, indole-3-carbinol, Retinoic acid, methotrexate, photodynamic therapy and cidofovir.
Acyclovir has recently been shown to reduce the recurrence of papilloma following surgical excision. The mechanism by which it slows the recurrence is unknown. Acyclovir is a purine nucleoside analog that inhibits DNA replication of the human herpes simplex virus. Coinfection with HSV is found in 50% of adult patients with RRP and in 38.5% of pediatric patients. It is postulated that herpes simplex virus augments HPV replication and that inhibition of HSV with acyclovir may indirectly slow the growth of HPV. The clinical efficacy of acyclovir in slowing the growth of papillomas seems to correlate well with the presence of HSV co-infection. The usual dose of acyclovir is 800 mg daily for patients greater than 5 years of age and 400 mg for those under the age of 5 years.
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