acyclovir and Genital-Diseases--Male

In the past 12 months, the FDA has approved important new pharmaceutical drugs and devices of particular interest to primary health care providers. The drugs include: Oxytrol (for urinary incontinence), Valtrex (for reducing the risk of heterosexual transmission of genital herpes), Femring (for vaginal delivery of hormone therapy), Uroxatral (for benign prostatic hypertrophy), Levitra (for erectile dysfunction), Flumist (for preventing influenza), Xolair (for asthma), Raptiva (for psoriasis), Cubicin (for skin infections), Crestor (for hypercholesterolemia), and Coreg (for severe heart failure).

Topics: Acyclovir; Cardiovascular Agents; Cardiovascular Diseases; Dermatologic Agents; Drug Approval; Estrogen Replacement Therapy; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Immunologic Factors; Male; Mandelic Acids; Skin Diseases; Valacyclovir; Valine; Women's Health

Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes.. Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit).. Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV.. Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed.

Topics: Acyclovir; Adolescent; Adult; Age Factors; Antiviral Agents; CD4 Lymphocyte Count; Delayed Diagnosis; Genital Diseases, Male; Herpes Genitalis; Herpesvirus 2, Human; HIV Infections; HIV-1; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Sex Factors; Sexual Behavior; Sexually Transmitted Diseases; South Africa; Treatment Outcome; Ulcer; Viral Load; Virus Shedding; Young Adult

By a randomised, double-blind, placebo-controlled trial of aciclovir 800 mg twice daily for 5 days added to the syndromic management of genital ulcer disease (GUD) to determine the impact on ulcer healing and HIV outcomes.. Patients presenting with GUD in Malawi were evaluated for HIV and herpes simplex virus type-2 (HSV-2) serologies, ulcer aetiology, lesional, genital and plasma HIV-1 RNA and CD4+ count. Patients were followed up at days 2, 4, 7, 14 and 28. The primary study outcome was ulcer healing at day 14, with secondary outcomes being lesional and genital HIV-1 shedding at day 14 and HIV-1 plasma viral load at day 28 among HIV-1/HSV-2 co-infected individuals.. Four hundred and twenty-two patients (74% male) were randomised (208 to aciclovir, 214 to placebo), of whom 61% were HIV-1 seropositive and 72% HSV-2 seropositive; 67% (267/398) had HSV-2 ulcers. 85% of ulcers were healed at day 14 with no difference between treatment arms (risk ratio (RR)=1.02, 95% CI 0.93 to 1.11). Among 244 HIV-1/HSV-2 co-infected individuals, aciclovir reduced lesional HIV-1 RNA (adjusted RR=0.64, 95% CI 0.41 to 0.99) and seminal HIV-1 RNA (adjusted RR=0.59, 95% CI 0.40 to 0.88), but not cervical HIV-1 RNA or plasma HIV-1 RNA.. Episodic HSV treatment with aciclovir added to syndromic management did not produce a significant clinical benefit in this African population.

Topics: Acyclovir; Adult; Antiviral Agents; Double-Blind Method; Female; Genital Diseases, Female; Genital Diseases, Male; Herpes Genitalis; Herpesvirus 2, Human; HIV Seropositivity; HIV-1; Humans; Malawi; Male; Medication Adherence; Recurrence; RNA, Viral; Ulcer; Viral Load; Young Adult

Topics: Acyclovir; Africa South of the Sahara; Antiviral Agents; Female; Genital Diseases, Female; Genital Diseases, Male; Health Policy; Herpes Genitalis; Herpesvirus 2, Human; Humans; Male

Herpes simplex virus-2, the most common cause of genital ulcer disease (GUD) globally, is a cofactor in human immunodeficiency virus type-1 (HIV-1) acquisition and transmission. Current World Health Organization guidelines for sexually transmitted infections recommend acyclovir as first-line syndromic treatment of GUD in countries with high herpes simplex virus-2 prevalence (> or =30%).. To assess the extent of adoption of acyclovir as syndromic treatment for GUD, and describe procurement, distribution, and cost of acyclovir in the public and private sectors of 8 sub-Saharan African countries.. We conducted standardized interviews with Ministry of Health (MoH) officials, pharmacists, and other pharmacy workers based in the public and private sectors. Interviews were conducted in Botswana, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Price comparisons were conducted using the 2007 median international reference price (IRP) for acyclovir.. Of the 8 African countries, 4 surveyed had adopted acyclovir as first-line syndromic GUD treatment in both their essential medical lists and sexually transmitted infection guidelines. Country-specific acquisition prices for acyclovir 200 mg were comparable to the median IRP and ranged from 0.74 to 1.95 times the median IRP. The median retail cost of acyclovir in the private sector ranged from 5.85 to 9.76 times the median IRP. Public health facilities faced cost and regulatory barriers that impeded the requisitioning of acyclovir from the central medical stores.. Systems for drug procurement, distribution, and access in sub-Saharan African countries need strengthening for a GUD treatment policy using acyclovir to be effective.

Topics: Acyclovir; Africa South of the Sahara; Antiviral Agents; Female; Genital Diseases, Female; Genital Diseases, Male; Health Policy; Health Services Accessibility; Herpes Genitalis; Herpesvirus 2, Human; Humans; Interviews as Topic; Male; Practice Guidelines as Topic; Private Sector; Public Sector; Ulcer

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Fetal Diseases; Genital Diseases, Male; Gestational Age; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Infectious; Virus Cultivation

Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Chancroid; Chlamydia Infections; Epididymitis; Escherichia coli Infections; Female; Genital Diseases, Male; Herpes Simplex; Humans; Infertility, Male; Male; Mumps; Orchitis; Prostatitis; Syphilis; Urethritis

Dermatologic diseases of the genitalia are of several types: congenital diseases, acquired diseases (those caused by viruses, bacteria, fungi, or physical or chemical toxins), tumors, and atrophic dermatoses. The methods available to diagnose these diseases vary. Some conditions may be recognized by appearance alone, whereas others require histopathologic examination of involved skin for correct diagnosis. Some do not need treatment, while others call for an aggressive approach. Some types of genital dermatologic diseases, such as herpes infections and condylomata acuminata, appear to be associated with genital carcinogenesis. Patients with these diseases should be carefully examined.

Topics: Acyclovir; Condylomata Acuminata; Dermatitis, Contact; Female; Genital Diseases, Female; Genital Diseases, Male; Herpes Genitalis; Humans; Male; Skin Diseases; Skin Diseases, Infectious