Genital Herpes Prevention

The key to stopping the spread of HSV 2 is understanding genital herpes prevention. The herpes simplex virus is spread only through skin-to-skin contact or Mucous membrane contact. Common occurrences of skin-to-skin contact that result in the spread of the virus include penile-vaginal intercourse, anal intercourse, oral-genital sex, and other sexual body-to-body contact.

To reduce the risk of transmitting genital herpes, people who have the virus should avoid sexual contact from the time they first feel any symptoms until their lesions are completely healed. During periods when there are no signs of an outbreak, genital herpes prevention is still advisable. Latex condoms offer significant protection against the spread of HSV 2 to women. However, because the effected area of a woman can be so wide, using a condom does not necessarily protect a man as well as a woman. It's important to note that lambskin or other natural membrane condoms should not be used for genital herpes prevention because naturally occurring pores in the material are large enough to allow some viruses to pass through. The FDA recommends latex condoms or polyurethane condoms for those sensitive to latex.

Despite common misconceptions, Genital herpes is not transmitted through the air. Also, there are no documented cases of a person getting genital herpes from an inanimate object such as a toilet seat, body towel, or hot tub. In fact, the herpes virus does not do well in chlorinated water. Though it may be present in a hot tub, it won't be active. It is advised, though, that individuals should avoid sharing razors, especially with someone who has an active cold sore or outbreak to insure genital herpes prevention. Also, other viruses, such as hepatitis C, can be transmitted by sharing razors. Spreading herpes from one part of the body to another (auto-inoculation) is possible, but unusual. To be safe, individuals should wash their hands with soap if they touch a herpes sore.

Treatment is also key to genital herpes prevention. The first drug developed to treat genital herpes was Zovirax (acyclovir) and was approved in 1985. This drug is now available in generic form and is an inexpensive option for individuals who do not have insurance. More recently, Famvir and Valtrex have been approved to treat genital herpes. All three of these drugs can be taken episodically (during an outbreak or at the first sign of a potential outbreak) or suppressively (daily to help prevent recurrence of outbreaks). Individuals with genital herpes should discuss these options with their physician to determine what treatment is best.

The Therapeutic Use Of Lysine For Cold Sores And Herpes Viruses

Cold sores are caused by the Herpes simplex virus (HSV), also known as Human herpes virus (HHV).

When The herpes simplex virus causes outbreaks on the lips and around the mouth it is known as Cold sores, when the outbreaks occur mainly on the genitals, it is more commonly known as Genital herpes.

HHV-1 Herpes simplex virus-1 (HSV-1) Oral and/or genital herpes (predominantly orofacial)

HHV-2 Herpes simplex virus-2 (HSV-2) Genital herpes and/or oral (predominantly genital)

Both viruses cause periods of active disease presenting as painful blisters containing infectious virus particles which typically last for 2-21 days and is followed by remission when the sores disappear. Most cases of genital herpes are asymptomatic, although viral shedding may still occur. HSV-1 and HSV-2 are transmitted by direct contact with a sore or body fluid of an infected individual. After initial infection, these viruses move to sensory nerves, where they reside as lifelong, latent viruses. The viruses lie dormant in the trigeminal ganglia nerve that provide sensation to the lips, lower mouth and neck, or in lumbrosacral nerve that supply sensation to the genitals, perineum and upper legs. There will be occasions when either or both these viruses reactivate and return to the area of skin originally infected during the primary infection. Triggers for recurrences are uncertain but may include sunburn, ultraviolet light, wind, trauma, surgery, and stress.

Cold Sores

Cold sores are very painful outbreaks on the lips. In some people the virus reactivates to cause recurrent infection this is more common with an HSV-1 than an HSV-2 oral infection. Prodromal (an early non-specific symptom) symptoms often precede a recurrence, which typically begins with reddening of the skin around the infected site, with eventual ulceration to form fluid-filled blisters that affect the lip (labial) tissue and the area between the lip and skin (vermilion border) .A lot of people are aware an outbreak is going to occur before the reddening of the skin is by a tingling feeling at the site where the out break is going to occur. It is at this time people start to use treatments to try and prevent the outbreak.

Genital Sores

Clusters of inflamed papules and vesicles on the outer surface of the genitals represent the typical symptoms of a primary HSV-1 or HSV-2 genital infection. These usually appear 4 to 7 days after sexual exposure to HSV for the first time, and may resemble cold sores. In males the lesions occur on the shaft of the penis or other parts of the genital region like the inner thigh, buttocks or anus. In females lesions appear on or near the pubis, labia, clitoris, vulva, buttocks or anus. Other common symptoms include pain, itching and burning. Less frequent yet still common symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise. Women often experience additional symptoms that include painful urination (dysuria) and cervicitis (inflammation of the tissues of the cervix). After 2-3 weeks, existing lesions progress into ulcers and then crust and heal although lesions on the mucosal surfaces may never form crusts.

Antivirals

There are over the counter antiviral medications available for controlling hsv outbreaks, including aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir. Aciclovir was the original and prototypical member of this drug class and is now available in generic brands at a greatly reduced cost. Valaciclovir and famciclovir are prodrugs of aciclovir and penciclovir respectively, which have improved solubility in water and better bioavailability when taken orally.

Lysine, Arginine and dietary sources explained.

There are natural supplements which may also help to prevent outbreaks of HSV. One supplement which is widely reported to prevent outbreaks of cold sores is the amino acid lysine usually in the form of L-lysine. Lysine prevents the herpes virus using the amino acid Arginine which it requires in order to replicate and break out in the sores.

Lysine is an essential amino acid, which means that it is essential to human health but cannot be manufactured by the body, for this reason it must be obtained from food or by taking a lysine supplement.

Dietary sources include cheese, eggs, milk, meat and pulses.

It is important to avoid foods which contain the amino acid Arginine as herpes virus require this. Dietary sources which have high levels of Arginine are nuts. Whilst Arginine is found in other foods like dairy products and meats, as is Lysine the amount of Lysine in these foods is far greater then the amount of Arginine.

Lysine is available in capsule form, powder form and in various topical creams.

Genital Herpes Medicine

I am a pharmacist and am often asked questions about genital herpes. So, I have some info for you and info for you to discuss with your physician.

But first...

Did you know that right now in the United States, for any school to get federal funding for sex ed. -they need to teach an ABSTINENCE ONLY program.

What?? Our society -from school, home, social and church life -has always supported education. Have we ever said, as a people -What we really need is LESS education?? No, that is completely against our beliefs as a community.

But instead the government says -Keep these kids in the dark, don't put ideas in their head, don't educate them too much and that'll keep'em safe. Yeah, that's great -wonderful idea! So, I guess the government believes less is more (except when taxes are concerned, of course !).

So, you are probably thinking -is this chic going to talk about genital herpes or not?! Well, I say no, because if you know more about herpes, you may get into some trouble....okay, I'm bluffing- here goes...

Herpes simplex virus -there are two different strains. The first one is HSV-1 which typically causes cold sores and then HSV-2 which causes genital herpes. It is possible to transfer a cold sore to the genital area and transfer genital herpes to the lip area.

Genital herpes is a sexually transmitted disease. Over 22% of Americans have HSV-2. It is one of those STDs that can be spread through sexual touching (even without penetration). Condoms can help but do not protect 100%. Very important to know is that a person with HSV-2 can be contagious even without any obvious breakout.

Just a short point here...I was on a Q&A site on the internet and found a ton of questions about STDs. They would talk about HSV2 as though it is the plague but HSV1 as "just a cold sore." The truth is HSV1 and 2 are not that different -except one is "caught" during sex. As a society, we do not talk about sex and STDs openly (see rant above about governmentt and sex ed.). Maybe if we spoke openly (instead of ignoring them) about these taboo subjects we could make a real difference in STD transmission. Alright, I am off my soap box, let's go on...

After becoming infected, symptoms usually start in 2-14 days. The first infection is usually the worse and can last for 2 to 3 weeks. There are usually pimple-like bumps that turn into blister-like vesicles that 90% of people say are painful. Flu-like symptoms may also occur (like fever, headache, body aches). Viral shedding (which is when it is contagious) goes on for about 12 days. Like most STDs, symptoms are often worse for women!

Once infected with the virus -it is there for life. The first year is usually the worse -averaging about 10 outbreaks. After that, the average person has 4 outbreaks in a year. However, some people get very few outbreaks throughout their lifetime. Some people have a "natural immunity" that can keep the virus under control. Stress, other sickness and some drugs can increase risk of recurrence.

The following outbreaks are usually less painful, less serious and shorter. They last an average of 7 to 10 days and viral shedding (when it is most contagious) is about 2 to 5 days.

Treatment for an outbreak:

* All treatments are antiviral prescription medications.
* It is best to start treatment with 72 hours of start of symptoms.
* Treatment within 72 hours has been proven to lessen length and severity of symptoms.
* All of the following drugs work equally as well...decision on which one to use is based on price and frequency of dosing.

First outbreak:

* Valtrex (valacyclovir) 1000mg twice daily for 7-10 days
o Available only in brand (generic is suppose to be released soon)
o This is exactly the same as acyclovir except it has easier dosing (twice a day versus three to five times)
* Famvir (famciclovir) 250mg three times daily for 7 -10 days
o Available in a generic
* Zovirax (acyclovir) 400mg three times a day or 200mg five times a day for 7 -10 days
o Comes in a generic and the 200 mg is currently on discount lists at a few retail pharmacies

Following outbreaks:

* Zovirax (acyclovir) 800mg three times a day for 2 days or 400mg three times a day for 3 to 5 days
* Famvir (famciclovir) 125mg twice daily for 3 to 5 days
* Valtrex (valacyclovir) 500mg twice daily for 3 days

Prevention of outbreaks:

* If a patient has regular outbreaks and they want to avoid them, antiviral medication can be taken on a daily basis.
* Zovirax (acyclovir) 400mg twice daily
* Famvir (famciclovir) 250mg twice daily
* Valtrex (valacyclovir) 500 mg or 1000mg once daily

Some studies have shown that OTC lysine daily (500-1000mg) can be helpful.

This is quite detailed info on the drugs but I thought it important -I have patients taking Valtrex and paying a lot of money when they could take acyclovir and pay 1/10 of the price. So, talk with your physician about it!

Antiviral Drugs For Herpes Treatment

The major drugs developed to work against herpes simplex virus (HSV) are antiviral agents called nucleosides and nucleotide analogues, which block viral reproduction. They include acyclovir (Zovirax), valacyclovir (Valtrex), famciclovir (Famvir).

The antiviral medications available in pill form have been specifically developed for the treatment of genital herpes. Antiviral medications may significantly lessen the severity of a primary outbreak and reduce the time it takes genital herpes outbreaks to heal. The medication also decreases the number of days of painful symptoms and for some people, the number of days you can spread the virus. Antiviral medication is most effective if it is taken when you first notice the prodromal symptoms (tingling and pain) of a recurrent genital herpes outbreak and if they are taken for the next 5 to 7 days or until symptoms go away. Some people with frequent recurrent outbreaks (more than 6 recurrences a year) take antiviral medication every day (suppressive therapy) to help reduce the frequency and duration of recurrent outbreaks.

Brief History

Acyclovir (brand name Zovirax) is the oldest of the antiviral medications. It has been available since 1982 in a topical form (as an ointment) and sold since 1985 in pill form. Now acyclovir is available in a generic form.

Valtrex (valacyclovir) was the second Antiviral medication to come to market in the United States, and it was approved by the FDA in December 15, 1995. Valtrex is manufactured by GlaxoSmithKline. Valtrex is a prodrug of acyclovir, meaning that the body converts it to acyclovir after it has been absorbed. This medication delivers acyclovir more efficiently so that the body absorbs much of the drug, which has the advantage of taking the medication fewer times during the day.

Famvir (famciclovir) is a prodrug manufactured by Novartis. When taken, the body converts it to the long-acting antiviral drug penciclovir. Like valacyclovir, it is well absorbed, persists for a longer time in the body, and can be taken less frequently than acyclovir.

Mechanism of action

Antiviral agents reduce viral replication by inhibiting viral DNA synthesis, needed to reproduce itself. This helps to keep the virus inactive.

Approved indications and uses

Acyclovir is indicated for:

• treatment of initial episodes and the management of recurrent episodes of genital herpes
• treatment of acute herpes zoster (shingles)
• treatment of chickenpox (varicella)

Valacyclovir is indicated for:

• treatment or suppression of genital herpes and for the suppression of recurrent genital herpes
• reduction of transmission of genital herpes
• treatment of herpes zoster
• treatment of cold sores (herpes labialis)

Famciclovir is indicated for:

• treatment or suppression of recurrent genital herpes
• treatment of acute herpes zoster

Efficacy

Clinical studies have not found any significant differences in effectiveness among the three medications. All are quite safe, very rarely producing any side effects at all. For the treatment of first genital herpes infections, oral acyclovir or valacyclovir is preferable to famciclovir. The efficacy of famciclovir for initial episode genital herpes infection has not been established.

Intravenous acyclovir is used to treat serious flare-ups or outbreaks that effect internal organs.

Adverse reactions and side effects

All these agents are well tolerated and have excellent safety records. Possible side effects from oral agents include nausea, vomiting, headache, fatigue, tremor, and very rarely, seizures. They can effect the kidney, however, and people with kidney problems should use them with caution and at lower doses. Intravenous administration increases the risk for kidney problems and can cause blood clots at the injection site. In rare cases, it can cause central nervous system complications.

Pharmacokinetics

Acyclovir has poor bioavailability of about 20% and a short half-life, which necessitates frequent dosing. Acyclovir speeds healing of lesions and suppress viral shedding if taken within 24 hours of the first indication of a recurrent episode. Early treatment may even prevent the development of lesions in some patients.

Valacyclovir provides a unique mechanism of enhancing the oral bioavailability of the parent compound, acyclovir. Valacyclovir is a prodrug converted to acyclovir in the intestine and liver. It has better bioavailability (about 55%) and has a longer duration of action than acyclovir. Thus, valacyclovir requires less frequent dosing than acyclovir. Valacyclovir is most effective if taken within 24 hours of the first signs of an outbreak.

Famciclovir is a prodrug for the active metabolite penciclovir. Famciclovir is converted into its active compound within the infected cell by contact with an enzyme from the virus. It has high bioavailability of 77%. It remains active in the body longer than acyclovir (half the dose is still active after 10 to 20 hours) and, like valacyclovir, requires less frequent dosing (usually two or three times a day). It is most effective if taken within six hours of onset of symptoms.

Both Famciclovir and valacyclovir have greater oral bioavailability that acyclovir. Famciclovir and valacyclovir, which are better absorbed by the body, can be taken less often than acyclovir. The simpler dosing schedule of famciclovir and valacyclovir, allows patients more convenient dosing regimens with less interruption of their activities of daily living.