acyclovir and Proctitis

Topics: Acyclovir; Adult; Antiviral Agents; Fecal Incontinence; Female; Herpes Genitalis; Humans; Manometry; Proctitis; Rectum; Remission Induction; Sexual Behavior; Time Factors

There has been a dramatic increase in patient visits to physicians for evaluation and treatment of genital herpes infections. This has resulted in part from an increase in genital herpes infections, particularly severe, first-episode genital herpes infections in adults without prior HSV-1 infection. Virus culture remains the most sensitive and specific method for diagnosis, and use of viral cultures is encouraged. Type-specific antibody tests have been employed in studies documenting the role of asymptomatic shedding of HSV in transmission of genital infections, the role of genital HSV in transmission of HIV, the predominance of asymptomatic and unrecognized infections in those infected with HSV-2, and the presence of past asymptomatic or unrecognized acquisition of HSV-2 in 25% of persons presenting with first-episode genital herpes. Unfortunately, commercially available serologic tests do not reliably differentiate between antibody to HSV-1 and HSV-2. Recent studies suggest that the annual risk of transmission from a sexual partner with genital herpes is about 10% in heterosexual couples. Currently, promotion of "safe sex" is the only available approach for prevention of transmission. However, ongoing research is focused on the development of an effective vaccine. Acyclovir should be used routinely in persons with first-episode genital herpes, but careful evaluation is needed in persons with recurrent genital herpes to determine whether episodic or suppressive treatment is indicated. Acyclovir should also be used routinely for episodic or suppressive treatment of HSV infections in persons with AIDS. Additional antiviral agents are needed for more effective suppressive therapy and for treatment of ACV-resistant HSV infections in the immunocompromised host.

Topics: Acyclovir; Herpes Genitalis; HIV Infections; Humans; Immune Tolerance; Proctitis; Recurrence

With the decline in prevalence of childhood-acquired oral-labial herpes simplex type 1 infections in some populations and the increasing incidence of genital herpes infections in adults, clinicians are more likely to see patients with severe primary, first-episode genital herpes infections. Complications of these primary infections may include aseptic meningitis and urine retention secondary to sacral radiculopathy or autonomic dysfunction. Presented are the clinical course of first-episode and recurrent infections, complications, diagnostic laboratory methods, and results of controlled clinical trials evaluating the efficacy of topical, intravenous, and oral preparations of acyclovir.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antibodies, Viral; DNA, Viral; Drug Resistance, Microbial; Female; Herpes Genitalis; Humans; Immunologic Deficiency Syndromes; Injections, Intravenous; Male; Nervous System Diseases; Proctitis; Prostatitis; Recurrence; Sex Factors; Sexually Transmitted Diseases; Urethral Diseases

Twenty-nine patients with first-episode rectal herpes simplex virus infection were enrolled in a double-blind trial of oral acyclovir, 400 mg five times daily, vs placebo treatment. Eighty percent of those receiving acyclovir compared with 25% of placebo recipients no longer had herpes simplex virus isolated from their rectal lesions three days after onset of therapy. The median duration of rectal lesions and viral excretion from rectal lesions (median, five and zero days, respectively) was significantly shorter in patients treated with acyclovir than in placebo-treated patients (14 and 11 days, respectively). Durations of local signs and symptoms of proctitis, such as rectal pain, discharge, and friability, were shorter in acyclovir recipients than in placebo recipients, but these differences were not statistically significant. Daily administration of 2 g of oral acyclovir for ten days alleviates some of the clinical signs of herpes simplex virus rectal infection.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Double-Blind Method; Drug Evaluation; Herpes Simplex; Homosexuality; Humans; Male; Proctitis; Random Allocation

Human herpes simplex virus infections are very common and represent significant morbidity in the immunocompromised host. Patients with acyclovir resistant strains of HSV based on viral thymidine kinase gene mutations need alternative therapeutic approaches. Leflunomide has been shown to possess antiviral activity against several viruses. Herein we describe a case of acyclovir resistant HSV-2 proctitis in an HIV patient successfully treated with leflunomide without significant side effects.

Topics: Acyclovir; Adult; Antiviral Agents; Drug Resistance, Viral; Herpes Genitalis; Herpesvirus 2, Human; HIV Infections; Humans; Isoxazoles; Leflunomide; Male; Proctitis; Treatment Outcome

In an AIDS patient who had repeated successful treatment with acyclovir in his history, erosive herpes perianalis with herpes proctitis appeared, which persisted over several weeks. High-dose intravenous administration on of acyclovir (500-750 mg, 3 x daily, over 7 weeks) did not reveal any beneficial effects: However, almost complete clearing of the lesions occurred within 3 weeks of intravenous administration of Foscarnet (50 mg/kg body wt., 3 x daily). No relapse was seen in a follow-up period of 4 months. HSV type II was isolated by culture from the erosive lesions before treatment, but no virus was found 1 week after application of Foscarnet. The unusual chronic refractory course of a severe HSV type II infection in AIDS suggests the presence of an acyclovir-resistant HSV strain in this case. This is the first observation indicating acyclovir-resistance in the Federal Republic of Germany and a warning against the unlimited use of acyclovir in AIDS patients. Foscarnet may be beneficial in some of these cases.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Foscarnet; Herpes Genitalis; Humans; Infusions, Intravenous; Male; Opportunistic Infections; Phosphonoacetic Acid; Proctitis