acyclovir and Ulcer

The rates of herpes simplex virus (HSV) infection are rising, the highest prevalence being in the group infected with the human immunodeficiency virus (HIV). We review the relation between these 2 infections. The presence of genital ulcers increases the transmission of HIV, and the presence of HIV adversely affects the natural history of HSV infection. The detection and treatment of sexually transmitted diseases such as genital herpes actually decrease the rates of HIV infection in groups studied. The treatment of HSV in persons with HIV is challenging because the incidence of immunosuppression increases. Acyclovir resistance is more common in this group, but acyclovir use may prolong survival in some HIV-seropositive patients. Further studies are needed to determine whether persons with HIV disease should routinely be given HSV-specific therapy.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Microbial; Female Urogenital Diseases; Herpes Genitalis; Herpes Simplex; HIV; HIV Infections; Humans; Immune Tolerance; Incidence; Male Urogenital Diseases; Prevalence; Simplexvirus; Survival Rate; Ulcer

Herpes simplex viruses (HSV) 1 and 2 are responsible for genital herpes which is usually recognized as vesicles that ulcerate and eventually heal but recur periodically. Atypical genital herpes is often described in immunocompromised patients and can present as large, chronic, hyperkeratotic ulcers. Acyclovir-resistant HSV is occasionally isolated from such ulcers. Most cases of HSV infection reproduce subtle signs and symptoms, or more commonly, asymptomatic viral shedding. Such subclinical presentations may be responsible for most of the 30% increase in the prevalence of genital herpes in the United States during the past two decades.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Chronic Disease; Drug Resistance, Microbial; Herpes Genitalis; Herpesvirus 2, Human; Humans; Immunocompromised Host; Keratosis; Prevalence; Recurrence; Simplexvirus; Ulcer; Virus Shedding

To date there have been only five reported cases of females with genital ulceration associated with primary Epstein-Barr virus infection. We describe two further patients and review the clinical features of all seven cases, noting the typical features, particularly purple ulcer margins and systemic symptoms, which should alert the physician to consider this diagnosis.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Herpes Genitalis; Herpesvirus 4, Human; Humans; Ulcer; Vulvar Diseases

Neurotoxicity associated with acyclovir use is infrequently encountered. However, the half-life of acyclovir is greatly prolonged in patients with end-stage renal disease, predisposing these patients to neurological side effects that are generally reversible but occasionally severe. In general, renal dialysis effectively decreases the serum level of acyclovir, which correlates with toxicity. We report an unusual case of delirium and coma in a patient undergoing hemodialysis who was receiving what appeared to be an appropriately adjusted dose of acyclovir.

Topics: Acyclovir; Aged; Coma; Delirium; Herpes Simplex; Humans; Kidney Failure, Chronic; Male; Penile Diseases; Renal Dialysis; Ulcer

Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.. A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT04037475. Registered on July 2019.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Herpesvirus 1, Human; Humans; Male; Pain; Photochemotherapy; Prospective Studies; Quality of Life; Recurrence; Ulcer; Visual Analog Scale; Young Adult

Immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected persons beginning antiretroviral therapy (ART) has been incompletely characterized for herpes simplex virus type 2 (HSV-2).. We evaluated genital ulcer disease (GUD) and HSV-2-associated GUD at quarterly visits or when spontaneously reported at monthly visits in 3381 HIV/HSV-2-coinfected individuals in a placebo-controlled trial of suppressive acyclovir therapy to prevent HIV transmission, 349 of whom initiated ART during the study. Incidence was calculated for months before and after ART initiation, and incidence rate ratios (IRRs) were calculated.. GUD incidence increased from 15.0 episodes per 100 person-years before ART to 26.9 episodes per 100 person-years in the first full quarter after ART initiation (IRR, 1.83;P= .03), and the incidence of HSV-2-associated GUD increased from 8.1 to 19.0 episodes per 100 person-years (IRR, 2.20;P= .02). Subsequently, the incidence of GUD was similar to that before ART, although the numbers were small. Persons receiving suppressive acyclovir had fewer GUD episodes, but the IRR after beginning ART was similar in the acyclovir and placebo groups.. Initiation of ART in HIV/HSV-2-coinfected persons is associated with a transient increase in GUD and HSV-2 GUD. Acyclovir reduces the incidence of GUD but does not prevent an increase in GUD incidence during the first quarter following initiation of ART.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Coinfection; Female; Herpes Genitalis; Herpesvirus 2, Human; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Incidence; Male; Middle Aged; Ulcer

In a randomized trial among African women with recurrent genital herpes, episodic acyclovir therapy resulted in modestly greater likelihood of lesion healing (hazard ratio [HR] = 1.48, P = 0.098; mean, 5.1 vs. 6.0 days) and cessation of herpes simplex virus shedding (HR = 1.88, P = 0.008; mean, 3.0 vs. 5.0 days) compared with placebo, similar to results of studies in high-income countries (ClinicalTrials.gov registration NCT00808405).

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Double-Blind Method; Female; Herpes Genitalis; Herpesvirus 2, Human; HIV Seronegativity; HIV-1; Humans; Kaplan-Meier Estimate; Middle Aged; Recurrence; Seroepidemiologic Studies; South Africa; Ulcer; Virus Shedding; Zambia

This study aimed to determine the prevalence of genital ulcer and urethral pathogens, as well as their association with clinical features, in men with genital ulcer disease (GUD) enrolled in a clinical trial.. Clinical data were collected by questionnaire. Ulcer swabs were tested for herpes simplex viruses (HSV-1/2), Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis L1-L3. First-pass urine was tested for urethral pathogens, namely Neisseria gonorrhoeae, C. trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Pathogens were detected by real-time molecular assays. Blood was tested for HIV, HSV-2, and syphilis-associated antibodies. Pathogens and clinical associations were investigated using the χ test.. A total of 615 men with GUD were recruited. Herpes simplex virus (HSV-1, 4.2%; HSV-2, 98.2%) and bacterial pathogens were detected in 451 (73.6%) and 48 (7.8%) of genital ulcers, respectively. Human immunodeficiency virus, HSV-2, and treponemal antibodies were detected in 387 (62.9%), 434 (70.6%), and 141 (23.0%) men, respectively, whereas 54 men (8.8%) were rapid plasmin reagin (RPR) seropositive. A total of 223 urethral infections were diagnosed in 188 men (30.6%), including 69 (11.2%) M. genitalium, 64 (10.4%) T. vaginalis, 60 (9.8%) C. trachomatis, and 30 (4.9%) N. gonorrhoeae infections. Dysuria was reported by 170 men (27.6%), and 69 men (11.5%) had urethral discharge on examination. Urethral pathogens were detected in 102/409 (24.9%) men without these clinical features.. Herpes accounted for most GUD cases and urethral pathogen coinfections were common. Erythromycin, dispensed to treat infrequent chancroid and lymphogranuloma venereum cases, provided additional treatment of some asymptomatic urethral pathogens. Additional antibiotics would be required to treat asymptomatic trichomoniasis and gonorrhea.

Topics: Acyclovir; Adult; Chancre; Chlamydia Infections; Chlamydia trachomatis; Gonorrhea; Haemophilus ducreyi; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Seropositivity; HIV-1; Humans; Male; Neisseria gonorrhoeae; Prevalence; Primary Health Care; Real-Time Polymerase Chain Reaction; Sentinel Surveillance; South Africa; Surveys and Questionnaires; Syphilis; Treponema pallidum; Ulcer; Urethral Diseases; Urine

A randomized controlled trial in South Africa found a beneficial effect of acyclovir on genital ulcer healing, but no effect was seen in trials in Ghana, Central African Republic and Malawi. The aim of this paper is to assess whether the variation in impact of acyclovir on ulcer healing in these trials can be explained by differences in the characteristics of the study populations.. Pooled data were analysed to estimate the impact of acyclovir on the proportion of ulcers healed seven days after randomisation by HIV/CD4 status, ulcer aetiology, size and duration before presentation; and impact on lesional HIV-1. Risk ratios (RR) were estimated using Poisson regression with robust standard errors. Of 1478 patients with genital ulcer, most (63%) had herpetic ulcers (16% first episode HSV-2 ulcers), and a further 3% chancroid, 2% syphilis, 0.7% lymphogranuloma venereum and 31% undetermined aetiology. Over half (58%) of patients were HIV-1 seropositive. The median duration of symptoms before presentation was 6 days. Patients on acyclovir were more likely to have a healed ulcer on day 7 (63% vs 57%, RR = 1.08, 95% CI 0.98-1.18), shorter time to healing (p = 0.04) and less lesional HIV-1 RNA (p = 0.03). Small ulcers (<50 mm(2)), HSV-2 ulcers, first episode HSV-2 ulcers, and ulcers in HIV-1 seropositive individuals responded best but the better effectiveness in South Africa was not explained by differences in these factors.. There may be slight benefit in adding acyclovir to syndromic management in settings where most ulcers are genital herpes. The stronger effect among HIV-1 infected individuals suggests that acyclovir may be beneficial for GUD/HIV-1 co-infected patients. The high prevalence in this population highlights that genital ulceration in patients with unknown HIV status provides a potential entry point for provider-initiated HIV testing.

Topics: Acyclovir; Adolescent; Adult; Africa South of the Sahara; Female; Herpes Genitalis; HIV Seropositivity; HIV-1; Humans; Male; RNA, Viral; Ulcer; Young Adult

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

It is uncertain whether episodic acyclovir will enhance ulcer healing if delivered at primary health care settings, because there is often a delay in treatment initiation.. A double-blind, randomized, placebo-controlled trial of 5-day acyclovir (400 mg 3 times daily) was conducted among men with genital ulcers in South Africa. Participants received syndromic management; were tested for ulcer etiology, human immunodeficiency virus (HIV), syphilis, and herpes simplex virus type 2 (HSV-2); and were seen over the course of a month to evaluate ulcer healing and HIV-1 RNA shedding. Outcomes were ulcer duration and HIV-1 RNA shedding, assessed on day 7 among HIV-1-seropositive participants with a herpetic ulcer.. A total of 309 men received acyclovir, and 306 received placebo; 63% were HIV-1 positive. There were 295 HIV-1-positive participants with a herpetic ulcer. Acyclovir improved ulcer healing--61% of those receiving acyclovir healed by day 7, compared with 42% of those receiving placebo (adjusted relative risk, 1.4 [95% confidence interval, 1.1-1.8]; P= .003). Acyclovir also improved healing by a median of 3 days (P= .002) and reduced HIV-1 ulcer shedding on day 7 (24% for acyclovir vs 37% for placebo; P= .05).. Addition of acyclovir to syndromic management will improve healing of genital ulcers and may potentially reduce HIV transmission in combination with other interventions.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Double-Blind Method; Herpes Genitalis; Herpesvirus 2, Human; HIV Infections; HIV-1; Humans; Male; Middle Aged; South Africa; Ulcer; Virus Shedding; Young Adult

To demonstrate a causal relationship between herpes simplex virus 2 (HSV-2) and increased genital HIV-1-RNA shedding in women on HAART.. A randomized, double-blind, placebo-controlled trial of herpes-suppressive therapy (valacyclovir 500 mg twice a day) in HIV-1/HSV-2-infected women taking HAART in Burkina Faso.. Participants were followed for a total of 12 biweekly visits before and after randomization. The presence and frequency of genital and plasma HIV-1 RNA, and of genital HSV-2 were assessed using summary measures, adjusting for baseline values. Random effect linear regression models were used to assess the impact of treatment on genital and plasma viral loads among visits with detectable virus.. Sixty women were enrolled into the trial. Their median CD4 lymphocyte count was 228 cells/mul, and 83% had undetectable plasma HIV-1 RNA at baseline. Valacyclovir reduced the proportion of visits with detectable genital HSV-2 DNA [odds ratio (OR) 0.37, 95% confidence interval (CI) 0.13, 1.05], but had no significant impact on the frequency (OR 0.90, 95% CI 0.31, 2.62) or quantity (reduction of 0.33 log copies/ml, 95% CI -0.81, 0.16) of genital HIV-1 RNA. However, according to pre-defined secondary analyses restricted to women who shed HIV-1 at least once in the baseline phase, valacyclovir reduced both the proportion of visits with detectable HIV-1 shedding (OR 0.27, 95% CI 0.07, 0.99) and the quantity of genital HIV-1 RNA during these visits (-0.71 log10 copies/ml, 95% CI -1.27, -0.14).. HSV-2 facilitates residual genital HIV-1 replication among dually infected women taking HAART despite HIV-1 suppression at the systemic level.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; DNA, Viral; Double-Blind Method; Female; Genitalia, Female; Herpes Genitalis; HIV Infections; HIV-1; Humans; Middle Aged; RNA, Viral; Ulcer; Valacyclovir; Valine; Viral Load

To evaluate (a) the prophylactic effect of the antiherpetic drug acyclovir on oral ulcers in patients with acute myeloid leukaemia receiving remission induction chemotherapy and thus (b), indirectly, the role of herpes simplex virus in the aetiology of these ulcers.. Randomised, double blind, placebo controlled trial.. 74 herpes simplex virus seropositive patients aged 18-84. Thirty seven patients received acyclovir (800 mg by mouth daily) and 37 placebo. The patients were examined daily for 28 days.. Occurrence of herpes labialis, intraoral ulcers, and acute necrotising ulcerative gingivitis.. The two populations were comparable in age, sex, type of antineoplastic treatment, and history of herpes labialis. Acute oral infections occurred in 25 of the acyclovir treated patients and 36 of the placebo treated patients (relative risk 0.69 (95% confidence interval 0.55 to 0.87)). This difference was due to a reduction in the incidence of herpes labialis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)), intraoral ulcers excluding the soft palate (one case versus 13 cases; relative risk 0.08 (0.01 to 0.56)), and acute necrotising ulcerative gingivitis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)). However, ulcers on the soft palate were diagnosed with similar frequency in the two groups. Isolation of herpes simplex virus type 1 in saliva was reduced from 15 cases in the placebo group to one case in the acyclovir group (relative risk 0.07 (0.01 to 0.48)).. Intraoral ulcers excluding the soft palate are most often due to infection with herpes simplex virus, whereas ulcers on the soft palate have a non-herpetic aetiology. The findings suggest that acute necrotising ulcerative gingivitis may also be due to herpes simplex virus. Prophylaxis with acyclovir should be considered for patients with acute myeloid leukaemia during remission induction therapy.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Gingivitis, Necrotizing Ulcerative; Herpes Labialis; Herpes Simplex; Humans; Leukemia, Myeloid; Male; Middle Aged; Mouth Diseases; Opportunistic Infections; Stomatitis, Herpetic; Ulcer

For treatment of herpetic keratitis, 5-iodo-2'-deoxyuridine (IUdR) has been the only drug available in Japan. However, IUdR is not completely satisfactory, and alternative antivirals are required. The Association for Research in Infectious Diseases of the Eye, Japan, carried out a clinical trial in 92 cases of ulcerative herpetic keratitis using 3 percent acyclovir ophthalmic ointment to determine its efficacy and safety. In 63 eyes, it had an excellent effect and ulcers healed within seven days. In 26 eyes, it had a good effect and ulcers healed within 14 days or became half-size within seven days. Therefore, the response to acyclovir in 96.8 percent of cases was excellent or good. The average healing time in 81 eyes in which ulcers disappeared within 14 days was 5.8 +/- 3.4 days. Including the five eyes in which ulcers took more than 14 days to heal, the average healing time of ulcers was 6.6 +/- 4.8 days. Of the 92 patients treated with acyclovir ointment, one had contact blepharoconjunctivitis and another complained of mild irritation. Mild punctate keratitis, as another side effect of acyclovir ointment, was observed in 22 eyes (23.9 percent) by photo-slit lamp examination, but in these patients it was possible to continue treatment without complaint.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Clinical Trials as Topic; Guanine; Humans; Infant; Keratitis, Dendritic; Middle Aged; Ulcer

The results of a double-blind clinical trials of acyclovir and adenosine arabinoside (ara-A) in 93 patients with herpetic keratitis demonstrated a significantly faster healing rate for acyclovir (p less than 0.01). Ulcers in 45 (94 percent) of acyclovir-treated patients and 37 (82 percent) of ara-A-treated patients healed within 14 days. No serious side effects were observed.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Humans; Keratitis, Dendritic; Male; Ulcer; Vidarabine

Topics: Acyclovir; Amino Acids; Antiviral Agents; Drug Resistance, Viral; Female; Genitalia; Herpes Genitalis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Male; South Africa; Thymidine Kinase; Ulcer

Herpes simplex virus (HSV) has been the leading cause of genital ulcer syndrome (GUS) in South Africa for more than a decade, and acyclovir therapy is incorporated into syndromic management guidelines. We conducted surveillance at 3 sentinel sites to define the common sexually transmitted etiologies of GUS and to determine whether current syndromic management is appropriate. Secondary objectives of surveillance were to determine the seroprevalence of coinfections (HIV, syphilis, HSV-2) in persons presenting with GUS.. Consecutive, consenting adult men and women presenting with visible genital ulceration were enrolled between January 1, 2019, and December 31, 2020. Genital ulcer swab and blood specimens were collected and transported to a central sexually transmitted infection reference laboratory in Johannesburg.. Among 190 participants with GUS, HSV-2 was the most frequently detected ulcer pathogen (49.0%; 95% confidence interval [CI], 41.9%-56.1%). The relative prevalence of the second most common ulcer-derived pathogen, Treponema pallidum, was 26.3% (95% CI, 20.5%-33.1%), with 90% of primary syphilis cases having a positive rapid plasma reagin (RPR) titer. Male sex was independently associated with primary syphilis compared with herpetic ulcers, after adjusting for the effect of casual sex partners and other exposures (adjusted odds ratio, 3.53; 95% CI, 1.35-9.21; P = 0.010). The overall HIV prevalence among participants was 41.3% (78 of 189; 95% CI, 34.2%-48.6%).. Herpes simplex virus 2 remains the predominant cause of GUS, justifying the continued use of acyclovir in syndromic guidelines. Adequate supplies of benzathine penicillin G for syphilis treatment are essential at primary health care level, in addition to the provision of syphilis and HIV risk reduction services.

Topics: Acyclovir; Adult; Female; Genitalia; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; HIV Infections; Humans; Male; Seroepidemiologic Studies; Sexually Transmitted Diseases; South Africa; Syphilis; Ulcer

Topics: Acyclovir; Aged; Antiviral Agents; Coinfection; Cytomegalovirus Infections; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Ganciclovir; Herpes Simplex; Humans; Hypoalbuminemia; Immunocompetence; Pain; Parenteral Nutrition; Ulcer

A 24-year-old transgender woman consulted our outpatient clinic with a painful, itchy and red left labia. She underwent a penile inversion vaginoplasty 18 months before presentation. At physical examination of the left labia, erythema, edema and herpetic vesicles with ulceration were observed. A vesicle fluid swab was obtained and the presence of herpes simplex virus type 1 (HSV-1) was detected by PCR assay. Treatment consisted of oral valaciclovir (500 mg twice daily) for a total of five days.Topically-applied lidocaine cream (3%) was used for pain management. Treatment gave symptom relief in five days. At physical examination 14 days after symptom onset, there were no signs of active infection. To our knowledge, this is the first case report of HSV-1 infection of the neolabia in a transgender woman.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Female; Herpes Genitalis; Herpesvirus 1, Human; Humans; Lidocaine; Male; Transgender Persons; Treatment Outcome; Ulcer; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Aged; Antiviral Agents; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Ulcer; Valacyclovir; Valine

Although atypical presentations of herpetic infection in immunocompetent individuals are common, they very rarely have the extensive, chronic and verrucous appearances seen in the immunocompromised host. We report a case of genital herpes manifesting as painless chronic non-healing genital ulcers with exuberant granulation tissue in an immunocompetent man. Owing to this morphology, the ulcers were initially mistaken for donovanosis. To the best of our knowledge, such a presentation of genital herpes in an immunocompetent individual has not been described previously.

Topics: Acyclovir; Antiviral Agents; Calymmatobacterium; Diagnosis, Differential; Granuloma Inguinale; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV-1; Humans; Immunocompetence; Male; Polymerase Chain Reaction; Simplexvirus; Treatment Outcome; Ulcer

Topics: Acyclovir; Adrenal Cortex Hormones; Aged, 80 and over; Antiviral Agents; Herpes Simplex; Humans; Male; Respiratory Sounds; Simplexvirus; Ulcer; Vagus Nerve Diseases; Virus Activation; Vocal Cord Paralysis

Topics: Acyclovir; Antiviral Agents; Esophageal Diseases; Fetal Blood; Herpes Simplex; Humans; Male; Middle Aged; Ulcer

Atypical presentations of genital herpes simplex virus have been described in HIV. We report two cases with hypertrophic presentations which were effectively treated with imiquimod, one of which is the first reported case occurring in a patient with HIV-2.

Topics: Acyclovir; Adult; Aminoquinolines; Antiviral Agents; Herpes Genitalis; Herpes Simplex; HIV Infections; HIV-1; HIV-2; Humans; Imiquimod; Male; Polymerase Chain Reaction; Simplexvirus; Treatment Outcome; Ulcer

Patients with vulval aphthae, also termed Lipschütz ulcers, often present to genitourinary medicine clinics. Typically, these ulcers present as acute, painful, vulval ulcers in young women and adolescents. The aetiology is unknown, and often these ulcers are accompanied by flu-like symptoms. Previous case reports have linked such lesions to acute viral infections such as Epstein-Barr virus, cytomegalovirus and influenza A. We report the first case of influenza B virus and adenovirus infections associated with this presentation.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Humans; Influenza B virus; Influenza, Human; Polymerase Chain Reaction; Skin Ulcer; Treatment Outcome; Ulcer; Vulvar Diseases

Atypical presentations of herpes simplex genitalis are becoming more frequent. The aim of this study was to investigate the atypical clinical manifestations and treatment of this infection.. The charts of patients with herpes simplex genitalis who attended our clinics between January 2009 and December 2013 were reviewed retrospectively.. Of 294 patients, 147 (50%) were male with a mean (standard deviation, SD) age of 48.3 (16.8) years. An ulcerative lesion was the most common symptom (48.3%), followed by vesicle clusters (36.4%). The mean duration of symptoms at first visit was 6 days. Oral acyclovir was administered to 87.6% of patients. Hypertrophic manifestations were observed in 4.8% (14/294) of patients; 50% (7/294) were male, with a mean age of 44.5 (SD 9) years. All patients with hypertrophic manifestations were infected with HIV. Hypertrophic manifestations had a mean duration of onset of 53.3 days. Acyclovir was prescribed to 11 (78.6%) patients. The mean duration to cure was 40.9 days. Topical imiquimod was given in six resistant cases (42.9%) as adjunctive therapy.. Atypical manifestations of herpes simplex genitalis require careful consideration because their frequency is rising, particularly in patients with HIV infection. Although acyclovir is important in their treatment, imiquimod provides an additional benefit in resistant cases.

Topics: Acyclovir; Adjuvants, Immunologic; Adult; Aged; Aminoquinolines; Antiviral Agents; Coinfection; Drug Therapy, Combination; Female; Herpes Genitalis; HIV Infections; Humans; Hypertrophy; Imiquimod; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Ulcer

Herpes simplex virus (HSV) ocular infection causes significant visual burden worldwide. Despite the fact that dendritic or geographic corneal ulcers are typical findings in HSV epithelial keratitis, conjunctival ulcer as a sign of HSV infection has rarely been reported. Although easily overlooked, this important sign could be enhanced by fluorescein staining. We report two cases of conjunctival geographic ulcers proven to be HSV infection by viral isolation and polymerase chain reaction (PCR). One patient had bilateral disease and blepharitis, and the other had unilateral involvement without skin lesions. With timely diagnosis and proper management, excellent visual outcome can be expected.

Topics: Acyclovir; Adult; Antigens, Viral; Antiviral Agents; Blepharitis; Conjunctival Diseases; DNA, Viral; Female; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Polymerase Chain Reaction; Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Alpinia; Antiviral Agents; Erythema Multiforme; Herpes Simplex; Humans; Lip; Male; Medicine, Ayurvedic; Plant Preparations; Ulcer

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Coloring Agents; Conjunctival Diseases; Eye Infections, Viral; Female; Herpes Simplex; Humans; Immunoglobulin G; Lissamine Green Dyes; Simplexvirus; Ulcer; Valacyclovir; Valine

Herpes simplex virus (HSV)-induced sepsis affects immunocompromised patients. We report here the case of an immunocompetent adult with sepsis, hepatitis, renal failure and esophagitis. The possibility of HSV should be considered in cases of sepsis without any evident cause, even in immunocompetent patients. The characteristic endoscopic and histological findings of the associated esophagitis may assist the etiology of sepsis.

Topics: Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompetence; Male; Middle Aged; Sepsis; Ulcer

The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection.

Topics: Acyclovir; Adult; Antiviral Agents; Dermatologic Agents; Female; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Methotrexate; Pemphigus; Perineum; Plasma Cells; Prednisolone; Skin; Skin Diseases; Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Ulcer

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Topics: Acyclovir; Adult; Antiviral Agents; Eyelid Diseases; Female; Herpes Simplex; HIV Infections; Humans; Opportunistic Infections; Ulcer; Young Adult

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; DNA, Viral; Duodenal Ulcer; Esophageal Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Stomach Ulcer; Ulcer

Topics: Acyclovir; Antiviral Agents; Child; Drug Therapy, Combination; Exanthema; Facial Paralysis; Glucocorticoids; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Male; Prednisone; Tongue; Tongue Diseases; Ulcer

Topics: Acyclovir; Antiviral Agents; Drug Administration Schedule; Female; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Male; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Time Factors; Ulcer; World Health Organization

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; Anti-Bacterial Agents; Antiviral Agents; Child; Female; Herpes Zoster Ophthalmicus; Humans; Ophthalmoplegia; Prednisolone; Treatment Outcome; Ulcer

Topics: Acyclovir; AIDS Serodiagnosis; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Ophthalmoplegia; Prednisolone; Ulcer

Mostly, herpes zoster affects adults and therefore childhood presentation can represent a diagnostic challenge. Childhood herpes zoster, when it occurs, can also be associated with peripheral nerve complications, as illustrated by this case. A 3-year-old child who had herpes zoster developed a nasolabial scar resulting in a shallow non-healing ulcer from being repeatedly picked. Healing was only achieved after nocturnal sedation, with chloral hydrate.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Chloral Hydrate; Face; Facial Pain; Female; Herpes Zoster; Humans; Hypnotics and Sedatives; Ulcer

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Herpes Genitalis; Humans; Male; Penile Diseases; Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Groin; Herpes Genitalis; Herpesvirus 2, Human; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphadenitis; Male; Middle Aged; Necrosis; Recurrence; Scrotum; Ulcer

A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Humans; Immunocompetence; Simplexvirus; Thymidine Kinase; Ulcer; Valacyclovir; Valine; Vulvar Diseases

Persistent mucocutaneous ulcers in AIDS represent a variety of disease entities. The purpose of this study was to characterize clinicopathologic features of persistent oral ulcers associated with cytomegalovirus and herpes simplex virus in AIDS. Forty-seven persons infected with HIV with persistent ulcers (mean, 2.4 ulcers/person) were included in this study. A biopsy specimen from a representative ulcer was taken from each patient. Hematoxylin-eosin, periodic acid-Schiff, cytomegalovirus, and herpes simplex virus immunocytochemical stains were performed on tissue sections. The most common sites of involvement were the buccal/labial mucosa (27%), tongue (25%), and gingiva (18%). Mean ulcer size was 1.8 cm with a mean duration of 5.6 weeks. The ulcerogenic viral agents were cytomegalovirus alone in 53% of cases, cytomegalovirus and herpes simplex virus coinfection in 28% of cases, and herpes simplex virus alone in 19% of cases. Treatment response to ganciclovir with or without topical steroids resulted in lesion resolution in the cytomegalovirus and cytomegalovirus/herpes simplex virus groups; however, recurrence/resistance was relatively high (23%). Herpes simplex virus/cytomegalovirus ulcers responded to oral acyclovir in combination with systemic ganciclovir. Increasing the oral acyclovir dosage resulted in resolution of herpes simplex virus-only ulcers in all but one case. Cytomegalovirus and herpes simplex virus are associated with persistent mucocutaneous ulcers in AIDS. These lesions responded to systemic antiviral therapy but are difficult to differentiate from other ulcerogenic diseases such as aphthous major, necrotizing stomatitis, and ulcerations not otherwise specified without biopsy and histopathologic examination.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytopathogenic Effect, Viral; Diagnosis, Differential; Female; Ganciclovir; Humans; Male; Middle Aged; Mouth Diseases; Recurrence; Stomatitis, Herpetic; Ulcer

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cell Nucleus; Cytomegalovirus; Cytomegalovirus Infections; Cytoplasm; Endothelium, Vascular; Follow-Up Studies; Ganciclovir; Gingival Diseases; HIV Seropositivity; Humans; Immunohistochemistry; Keratinocytes; Lip Diseases; Male; Mesoderm; Middle Aged; Mouth Diseases; Palate; Simplexvirus; Stomatitis, Herpetic; Tongue Diseases; Ulcer

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Anus Diseases; Herpes Simplex; Humans; Injections, Intramuscular; Interferon alpha-2; Interferon-alpha; Male; Recombinant Proteins; Ulcer

Topics: Acyclovir; Child; Female; Humans; Infectious Mononucleosis; Ulcer; Vulvar Diseases

Few longitudinal studies have investigated the onset, duration, and resolution of ulcerative mucositis in bone marrow transplant recipients. This study prospectively followed a group of such patients on a daily basis to obtain data on the incidence of ulcerative mucositis, location and duration of lesions, severity with different conditioning regimens, and the relationship of such mucositis to the absolute neutrophil count.. Fifty-nine bone marrow transplant recipients on prophylactic acyclovir were examined daily for 26 days after marrow infusion, and all oral ulcerative lesions were recorded.. Oral ulcers occurred in 76.3% of patients, began at a mean of 5 days after marrow infusion (day + 5), and lasted for a median of 6 days. More than 90% of patients showed complete resolution of ulcers on or before day + 15, and all showed resolution when the absolute neutrophil count was > 500 cells/ml. Persistence of ulcers was noticed in patients who had oral graft-versus-host disease and in some patients who initially developed more severe ulcerations. Ninety-six percent of ulcers were located on nonkeratinized mucosa.. Ulcerative mucositis occurs in about 75% of bone marrow transplant recipients in the absence of herpes simplex virus infection. Most lesions occur on nonkeratinized mucosae which are vulnerable to trauma, especially if such mucosae are rendered atrophic by conditioning regimens. Oral ulcers may persist beyond day + 15 and after recovery of the neutrophil count in patients who initially develop more severe ulcerations or in patients who develop graft-versus-host disease.

Topics: Acyclovir; Adolescent; Adult; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Candidiasis, Oral; Child; Cohort Studies; Diagnosis, Differential; Female; Graft vs Host Disease; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Mouth Diseases; Prospective Studies; Stomatitis; Time Factors; Ulcer

The aim of this study was to determine the prevalence and type of symptomatic anal and perianal diseases in patients belonging to group IV of the Centers for Disease Control classification of infections with human immuno-deficiency virus. Among the 190 prospectively included patients, 31 (16.3 percent) (30 men, 29 homosexuals or bisexuals; 1 woman) had anal symptoms and were referred for proctological examination. Thirty-five "specific" diagnoses were reached in 25 (13.2 percent) patients: 21 ulcerations, 7 condyloma acuminata, 6 perianal sepsis and 1 non-Hodgkin malignant lymphoma. The causes of ulcerations were 16 herpes, one syphilitic chancre and one fissure-in-ano. Three ulcerations remained unexplained despite bacteriological, viral, and histological investigations. Eight patients underwent 10 surgical procedures without significantly delayed wound healing.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Anus Diseases; Anus Neoplasms; Condylomata Acuminata; Female; Herpes Simplex; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Opportunistic Infections; Prevalence; Prospective Studies; Ulcer

We present a patient with chronic lymphocytic leukemia who developed a painful penile ulcer that was initially diagnosed as leukemia cutis, as evidenced by an atypical leukemic infiltrate on biopsy. A Tzanck preparation was positive for multinucleated giant cells, and the diagnosis of herpes genitalis was confirmed by viral culture. In patients with hematologic malignancies, herpes simplex virus must be included in the differential diagnosis of ulcerative lesions. The histopathologic findings of inflammatory dermatoses in these patients may include an atypical infiltrate, because of the predominance of atypical inflammatory cells in the peripheral circulation.

Topics: Acyclovir; Biopsy; Cells, Cultured; Diagnosis, Differential; Herpes Genitalis; Humans; Immunoenzyme Techniques; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Penile Diseases; Ulcer

9-(1,3-dihydroxy-2-propoxymethyl) guanine (ganciclovir) was used to treat 41 patients (median age, 37 years) with the acquired immunodeficiency syndrome and cytomegalovirus gastrointestinal infection. Sites of infection were the colon in 31, the esophagus in 5, the rectum in 4, and the small bowel in 1. Patients received ganciclovir, 5 mg/kg body weight, intravenously every 12 hours for 14 days. Clinical improvement was seen in 30 patients and virologic response in 32. Mainly hematologic toxicity occurred: moderate leukopenia (1000 to 1900/mm3) was seen in 7 patients and severe (less than 1000/mm3) in 1, and moderate neutropenia (500 to 1000/mm3) in 5 and severe (less than 500/mm3) in 1. A cutaneous rash developed in 2 patients. Median overall survival was 16 weeks (range, 2 to 56). Cytomegalovirus recurred in 13 patients; median time to recurrence was 9 weeks from the start of treatment. Ganciclovir may be effective in treating cytomegalovirus gastrointestinal disease in patients with the acquired immunodeficiency syndrome.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Colitis; Cytomegalovirus Infections; Digestive System Diseases; Esophagitis; Ganciclovir; Hematologic Diseases; Hormones; Humans; Intestine, Small; Male; Middle Aged; Prospective Studies; Rectal Diseases; Recurrence; Ulcer