Efficacy of combined treatment with oral and topical acyclovir in first episode genital herpes

Anxiety and Sun Exposure as Triggers for Herpes Labialis: A Case Report and Review of Literature

Introduction

Herpes labialis (HL) is a prevalent viral infection caused by herpes simplex virus type 1 (HSV-1), affecting a significant portion of the global population. The reactivation of HSV-1 leading to HL can be triggered by various factors, including psychosocial factors (depression, stress, and anxiety), exposure to ultraviolet light, a febrile environment, and specific dietary inadequacy.

Purpose

This case report explores the association between HL, psychological conditions, and sun exposure.

Case Report

A 20-year-old male patient came with a chief complaint of swollen lips with tiny pimples for two days, accompanied by malaise. The patient was working as a florist in a sun-exposed area and experiencing stress due to financial difficulties. Extraorally, multiple vesicles were found on the left side of the upper lip, surrounded by erythema, and painless. Laboratory examinations showed a reactive HSV-1 IgG. The depression, anxiety, and stress scale-21 (DASS-21) questionnaire showed an extremely severe level of anxiety.

Case Management

The patient was given systemic and topical acyclovir, multivitamins, hyaluronic acid mouthwash, and petroleum jelly. In addition, the patient was advised to reduce the frequency of sun exposure, apply sunscreen, and seek professional help to manage the anxiety. A review of eight case reports related to HL from 1994-2024 has been reported in this literature and emphasizes the connection of HL with psychological factors and sun exposure.

Conclusion

This case underscores the potential link between anxiety, sun exposure, and the onset of HL. Understanding these associations is crucial for effective management and prevention strategies.

Contemporary antiviral drug regimens for the prevention and treatment of orolabial and anogenital herpes simplex virus infection in the normal host: Four approved indications and 13 off-label uses

Herpes simplex virus (HSV) orolabial and anogenital infection causes substantial and recurring disease in healthy individuals due directly to infection of these sites and, indirectly, due to its complications. These complications include eczema herpeticum plus erythema multiforme and neonatal HSV infection, respectively. Four drugs: acyclovir, famciclovir, valacyclovir and penciclovir, are currently licensed by the Therapeutics Products Directorate of Health Canada for the management of HSV infections. Although these drugs are only approved for four orolabial and anogenital infections in healthy persons, their efficacy and safety for 13 other related uses in this population have been demonstrated in controlled clinical trials, so called off-label uses. In this review, the evidence supporting these 17 uses, the drugs and regimens evaluated, and their current costs, are described.

Management of genital herpes by genitourinary physicians: does experience or doctor's gender influence clinical management?

OBJECTIVE

To determine the variation in management of genital herpes by genitourinary physicians, and whether their duration of experience or gender influence their clinical management.

METHODS

A postal questionnaire was sent to UK consultant genitourinary physicians with detailed questions about management of primary and recurrent herpes. The gender and duration of genitourinary medicine experience of the physicians were also recorded.

RESULTS

One hundred and eighty two questionnaires were sent, 112 (62%) returned. Eighty-one (72%) physicians treat all patients with primary genital herpes, but physicians with more than 20 years experience were significantly (p < 0.05) more likely to treat only "severe" primary attacks. Most experienced physicians were also most likely (p < 0.05) to prescribe topical acyclovir. Prescription of suppressive acyclovir was also influenced by the experience of the physician, the least experienced physicians being more likely to prescribe to patients who were HIV antibody positive or to those entering new relationships, whereas the more experienced prescribed to those patients who were particularly anxious (p < 0.05 for each of these). Male physicians were significantly more likely to agree with the proposition that men cope better with genital herpes (54%) than female physicians (24%, p < 0.01).

CONCLUSION

The response to the questionnaire illustrates that management of genital herpes is influenced by the duration of the physicians clinical experience. Gender of the physician may have an indirect role to play as we have shown that physicians differ in their perception of how the sexes cope with genital herpes.

Acyclovir. An updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy

Acyclovir (aciclovir) is a nucleoside antiviral drug with antiviral activity in vitro against members of the herpes group of DNA viruses. As an established treatment of herpes simplex infection, intravenous, oral and to a lesser extent topical formulations of acyclovir provide significant therapeutic benefit in genital herpes simplex and recurrent orofacial herpes simplex. The effect of acyclovir therapy is maximised by early initiation of treatment, especially in non-primary infection which tends to have a less protracted course than the primary episode. Long term prophylactic oral acyclovir, in patients with frequent episodes of genital herpes simplex, totally suppresses recurrences in the majority of subjects; as with other infections responding to acyclovir, viral latency is not eradicated and pretreatment frequencies of recurrence return after discontinuation of treatment. Caution should accompany the prophylactic use of acyclovir in the general population, due to the theoretical risk of the emergence of viral strains resistant to acyclovir and other agents whose mechanism of action is dependent on viral thymidine kinase. Intravenous acyclovir is the treatment of choice in biopsy-proven herpes simplex encephalitis in adults, and has also been successful in the treatment of disseminated herpes simplex in pregnancy and herpes neonatorium. Intravenous and oral acyclovir protect against dissemination and progression of varicella zoster virus infection, but do not protect against post-herpetic neuralgia. In immunocompromised patients, intravenous, oral and topical acyclovir shorten the clinical course of herpes simplex infections while prophylaxis with oral or intravenous dosage forms suppresses reactivation of infection during the period of drug administration. Ophthalmic application of 3% acyclovir ointment rapidly heals herpetic dendritic corneal ulcers and superficial herpetic keratitis. Thus, despite an inability to eradicate latent virus, acyclovir administered in therapeutic or prophylactic fashion is now the standard antiviral therapy in several manifestations of herpes simplex virus infection, and indeed represents a major advance in this regard. With the exception of varicella zoster virus infections, early optimism concerning the use of the drug in diseases due to other herpes viruses has generally not been supported in clinical investigations.