Understanding STIs and Genital Herpes Education

All sexually-active individuals should be educated on the risks associated with sexually transmitted infections (STIs), including herpes simplex virus (HSV).
Approximately half of individuals with asymptomatic HSV-2 have mild, unrecognized symptoms and should be taught to identify them.

Most HSV transmission occurs in asymptomatic phases; individuals without visible lesions can still spread the virus.
Patients advised to avoid sexual intercourse during outbreaks and for 1 to 2 days post-outbreak.
Use of condoms is recommended between outbreaks to reduce transmission risk.

Suppressive antiviral therapy is an option for individuals concerned about spreading the infection to partners.
Education on safer sex practices is crucial in managing risks.

The risk of transmitting genital herpes to a newborn during childbirth is low for women with known genital herpes.
Clinical evaluation at delivery is important; if signs of active infection are present, cesarean delivery may be necessary.
Long ruptured membranes (≥24 hours) may still risk neonatal HSV infection despite cesarean delivery.

Pregnant women with primary HSV infection are recommended antiviral therapy.
For women at or beyond 36 weeks of gestation with a history of recurrent HSV infections, suppressive antiviral therapy is suggested to minimize viral shedding.

Close follow-up of infants born to seropositive mothers is essential, including sequential PCR or cultures for HSV.
Prophylactic intravenous acyclovir is recommended for infants born to mothers with primary HSV infection.
If HSV is detected in infants from seropositive mothers, treatment with intravenous acyclovir is advised.

Women without genital herpes, confirmed by history and serologic tests, should receive counseling on HSV symptoms and prevention strategies during pregnancy.
Serologic testing can aid in counseling couples where the male partner has recurrent genital herpes and the pregnant partner is susceptible.

Many HSV infections require no treatment; lesions often heal on their own.
Treatment is necessary for prolonged, symptomatic, or complicated cases.
Acyclovir is favored due to its selective activation in infected cells and inhibition of viral DNA polymerase.
Acyclovir requires phosphorylation via viral thymidine kinase to become active.
Inhibitory concentrations of acyclovir for HSV-1 and HSV-2 are 0.1 and 0.3 μg/mL respectively; toxic at over 30 μg/mL.
Strains needing over 3 μg/mL of acyclovir are considered relatively drug-resistant.
Valacyclovir is an oral prodrug of acyclovir offering enhanced bioavailability and easier dosing.
Famciclovir is an oral form of penciclovir, requiring phosphorylation for activation; efficacy similar to acyclovir.
Penciclovir 1% cream is FDA-approved for herpes simplex labialis; has local antiviral effects.
Docosanol 10% cream is FDA-approved for nonprescription use, inhibiting viral entry and reducing healing time by 18 hours compared to placebo.

Treatment options depend on the type of HSV disease, host immune status, primary vs recurrent episodes, and whether suppressive therapy is needed.
Severe herpes infections should be treated with intravenous acyclovir at 10-15 mg/kg every 8 hours; neonatal herpes requires 20 mg/kg every 8 hours.
Oral treatments for first episodes of genital HSV-2 (acyclovir, famciclovir, valacyclovir) improve symptom resolution and healing times.
Acyclovir reduces healing time from 16 to 12 days and pain duration from 7 to 5 days.
Antiviral treatment does not stop subsequent recurrences since HSV establishes latency quickly.

For recurrent genital herpes, famciclovir, acyclovir, and valacyclovir shorten healing time from approximately 7 to 5 days.
Valacyclovir and acyclovir show equivalent effectiveness; valacyclovir may be more effective than famciclovir in some studies.
Long-term suppressive therapy with acyclovir or its analogs is the best strategy for frequent/genital recurrences.
Annual “holidays” from suppressive treatment may help reassess needs, as HSV is not progressive and recurrence rates may decrease.

Antiviral suppressive therapy in late pregnancy may prevent neonatal herpes but requires large-scale studies.
Antiviral treatment during late pregnancy can prevent recurrences and reduce the need for cesarean births.
Oral acyclovir for primary HSV gingivostomatitis in children involves a dosage of 15 mg/kg 5 times daily for 7 days.
Humorously infected patients need hydration and may require IV acyclovir.
Modest benefits from antiviral treatment of recurrent herpes labialis in immunocompetent hosts.

Penciclovir 1% cream should be applied every 2 hours while awake for 4 days, starting early in recurrence.
Docosanol 10% cream is applied 5 times daily at first sign of herpes labialis recurrence; no direct comparison with penciclovir available.
Oral acyclovir (400 mg 5 times daily) shows limited efficacy for herpes labialis if initiated early.
Famciclovir may reduce healing time after UV exposure; however, it’s not suitable for general herpes labialis.
Single doses of valacyclovir (2 g twice daily) or famciclovir (1500 mg) can decrease healing time compared to placebo.

Suppressive acyclovir for herpes labialis is controversial; some studies indicate it may reduce recurrences.
Famciclovir and valacyclovir show effectiveness in preventing recurrences, particularly with patients exposed to sunlight.
Pre- and post-procedure prophylaxis with famciclovir or valacyclovir may reduce orofacial HSV recurrence during facial procedures.
Ocular HSV should always involve an ophthalmologist; topical antivirals like vidarabine and trifluridine are commonly used.
Oral acyclovir is effective for ocular HSV and is crucial for history of HSV stromal keratitis to prevent vision loss.