Mindel, Adrian; (1992) The treatment of herpes simplex genital infection. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The introduction reviews the virology, epidemiology, clinical features and previous treatments for genital herpes. The studies described here involve 6 randomised controlled trials for the treatment of genital herpes. The first was a double blind placebo controlled study of intravenous acyclovir in 30 patients with first attack genital herpes. Patients treated with acyclovir had a statistically significant reduction in the duration of viral shedding, symptoms and the time to healing, but the drug had no effect on the development of recurrences. The second study was designed to determine whether prolonged treatment of primary herpes could prevent recurrences. Sixty patients were treated with either 42 days of acyclovir or 5 days of acyclovir followed by 37 days of placebo. Prolonged treatment delayed the onset of recurrences but did not decrease their subsequent frequency. Two studies were conducted to assess the efficacy of suppressive oral acyclovir in patients with frequent recurrences. The first was a 12 week double blind placebo controlled trial in 56 patients which showed a statistically significant decrease in the frequency of recurrences in acyclovir recipients. The second assessed the safety and dosage of suppressive oral acyclovir in 134 patients over a year and showed that the likelihood of recurrences was related to dosage and the frequency of tablet taking. No important side effects were noted. The final 2 trials compared the efficacy of acyclovir and inosine pranobex. Eighty-eight patients with primary and 32 with recurrent herpes were treated. Patients with primary herpes treated with acyclovir healed more quickly and had a shorter duration of symptoms and viral shedding than those treated with inosine pranobex. Suppression with oral acyclovir was shown to be vastly superior to inosine pranobex. These studies have established that acyclovir is the drug of choice for the treatment of primary and the suppression of recurrent genital herpes.

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