Chemotherapy for herpes simplex virus infections

Abstract

Infections due to herpes simplex virus type 1 and type 2 result in a wide spectrum of clinical illness ranging from a state of asymptomatic viral shedding to widespread dissemination or encephalitis. The propensity of the virus to achieve a latent state in nerve root ganglia permits spontaneous recurrences of clinically symptomatic lesions. Herpes simplex infection is usually suspected in a patient with typical external lesions and should be confirmed by identifying the virus in culture, by immunofluorescence or identifying by other sensitive and specific methods. Diagnosis of encephalitis due to herpes simplex virus still requires confirmatory brain biopsy for histopathology, detection of viral antigens and viral culture. Therapy with acyclovir has been shown to be beneficial in patients with both localized HSV eruptions and disseminated illness. Persons with a first episode of genital herpes have a dramatic reduction in local symptomatology, viral shedding and systemic symptoms when treated with either oral or intravenous administration of acyclovir; topical application of acyclovir results in a more modest local response. Recurrent genital herpetic eruptions can be treated effectively with acyclovir given orally or intravenously in both immunocompetent and immunosuppressed patients. No beneficial effect with the use of topical acyclovir in these patients has been shown. Acyclovir is superior to vidarabine in the treatment of HSV encephalitis and also may be the agent of choice in the therapy for disseminated neonatal disease.