Sexual transmission of herpes simpl...

Sexual transmission of herpes simplex virus image 2 (HSV-2) has been demonstrated from the two symptomatic and asymptomatic reactivations in the infected partner. Daily anti-viral therapy has been shown to decrease the oftenness and amount of genital HSV shedding. Corey and colleagues exhibitioned daily valacyclovir for efficacy in preventing sexual transmission of HSV-2 from infected individuals to their uninfected partners.

The cogitation enrolled monogamous, immunocompetent, heterosexual links in which only one partner was infected with HSV-2 as demonstrated by dint of Western blot analysis of anti--HSV-2 serum antibodies. Of the initial 4034 links screened, 1,385 asymptomatic partners already had serologic evidence of HSV-2 infection and were ineligible, and 799 of the source partners were symptomatic if it were not that had negative HSV-2 serology. After informed acquiescence 352 couples declined to participate, and 14 bodily forms declined to take the research medicines, leaving 1,484 couples (37 percent) available for randomization.

The infected source partner of each enlisted couple was randomized to receive valacyclovir in a dosage of 500 mg or placebo taken one time daily for eight months. All man and wifes were encouraged at each follow-up visit to use condoms. The medication dose was increased to twice daily for five days during any HSV-2 reactivation episode. A total of 1159 ties (78.1 per-cent) were able to consummated the entire eight-month protocol, with similar dropout rates in the active treatment and placebo clusters (21 percent versus 23 percent)

During the eight-month trial, 71 susceptible partners lay opened genitourinary symptoms suggestive of HSV-2 transmission, nevertheless in 48 of these cases there was no serologic, viral improvement or DNA evidence of HSV-2 infection. The remaining 25 susceptible partners did have evidence of HSV-2 transmission, as did 18 asymptomatic patients. Overall, transmission of HSV-2 infection during the contemplation was about one half as likely in the bonds in which the source partner was taking daily valacyclovir (19 percent) as in married pairs receiving placebo (3.6 percent), which was a statistically significant reduction.

The number of source partners reporting at least united symptomatic genital recur-rence during the reflection also was cut by about united half with use of daily valacyclovir (388 percent versus 773 percent) Four cases of HSV-1 transmission occurr in twos in which placebo was used, with no like cases in couples randomized to active treatment. In a subgroup of 89 pairs who submitted genital swabs daily for brace months, HSV-2 DNA was discovered on 2.9 percent of days in source partners taking valacyclovir, compared with 108 percent of days when placebo was taken.

The authors end that daily valacyclovir halves the transmission rate of HSV-2 to an uninfected partner throughout an eight-month period.

EDITOR'S NOTE: This research confirms the substantial (although incomplete) protective benefits of daily viral suppression that have been reported in other trials of anti-herpes therapy. Whether the absolute risk reduction of 17 percent is worth the capacity of taking daily medication for eight month is in the organ of vision of the beholder. During this thought 66 monogamous couples dissolved their relationships. Perhaps the best use of viral suppression might be early in a relationship, when the long-term viability of the union is les clear, however the risk for transmission is at hand on the many days when viral shedding occurs

Corey L et al. Once-daily valacyclovir to convert into the risk of transmission of genital herpes. N Engl J M January 1 2004;350:11-20

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group