Skip to main content
PMC home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1997 Mar;166(3):211–215.

Management of herpes simplex and varicella-zoster virus infections.

K S Erlich 1
PMCID: PMC1304126  PMID: 9143202

Abstract

Herpes simplex virus and varicella-zoster virus are common infections and are seen frequently in clinical practice. Infection with these viruses results in cutaneous lesions that may be diagnosed clinically, but widely available laboratory testing is useful for confirmation. Asymptomatic herpes simplex virus shedding, or "subclinical reactivation," likely occurs in all persons infected with herpes simplex virus and results in the transmission of virus despite the absence of signs or symptoms that suggest active infection. Oral and intravenous acyclovir are effective in treating initial and recurrent herpes simplex and varicella-zoster virus infections. The daily administration of oral acyclovir as suppressive therapy is effective in patients with frequently recurring genital infection with herpes simplex virus by reducing the number of symptomatic recurrences and the frequency of asymptomatic virus shedding. Two new antiviral agents, famciclovir and valacyclovir hydrochloride, have been approved for the short-term treatment of recurrent genital herpes simplex virus and recurrent zoster in nonimmunocompromised hosts. Famciclovir and valacyclovir demonstrate superior pharmacokinetics compared with acyclovir and allow for less frequent daily dosing with higher achievable serum drug concentrations. The attenuated live varicella virus vaccine is now available in the United States and prevents primary varicella-zoster virus infection in susceptible children and adults.

Full text

PDF
215

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ashley R., Cent A., Maggs V., Nahmias A., Corey L. Inability of enzyme immunoassays to discriminate between infections with herpes simplex virus types 1 and 2. Ann Intern Med. 1991 Oct 1;115(7):520–526. doi: 10.7326/0003-4819-115-7-520. [DOI] [PubMed] [Google Scholar]
  2. BRAIN W. R. Mind and matter. Lancet. 1951 Apr 21;1(6660):863–867. [PubMed] [Google Scholar]
  3. Benedetti J., Corey L., Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994 Dec 1;121(11):847–854. doi: 10.7326/0003-4819-121-11-199412010-00004. [DOI] [PubMed] [Google Scholar]
  4. Bennett G. J. Hypotheses on the pathogenesis of herpes zoster-associated pain. Ann Neurol. 1994;35 (Suppl):S38–S41. doi: 10.1002/ana.410350712. [DOI] [PubMed] [Google Scholar]
  5. Beutner K. R., Friedman D. J., Forszpaniak C., Andersen P. L., Wood M. J. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother. 1995 Jul;39(7):1546–1553. doi: 10.1128/aac.39.7.1546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bryson Y. J., Dillon M., Lovett M., Acuna G., Taylor S., Cherry J. D., Johnson B. L., Wiesmeier E., Growdon W., Creagh-Kirk T. Treatment of first episodes of genital herpes simplex virus infection with oral acyclovir. A randomized double-blind controlled trial in normal subjects. N Engl J Med. 1983 Apr 21;308(16):916–921. doi: 10.1056/NEJM198304213081602. [DOI] [PubMed] [Google Scholar]
  7. Corey L., Spear P. G. Infections with herpes simplex viruses (1). N Engl J Med. 1986 Mar 13;314(11):686–691. doi: 10.1056/NEJM198603133141105. [DOI] [PubMed] [Google Scholar]
  8. Corey L., Spear P. G. Infections with herpes simplex viruses (2). N Engl J Med. 1986 Mar 20;314(12):749–757. doi: 10.1056/NEJM198603203141205. [DOI] [PubMed] [Google Scholar]
  9. Dunkle L. M., Arvin A. M., Whitley R. J., Rotbart H. A., Feder H. M., Jr, Feldman S., Gershon A. A., Levy M. L., Hayden G. F., McGuirt P. V. A controlled trial of acyclovir for chickenpox in normal children. N Engl J Med. 1991 Nov 28;325(22):1539–1544. doi: 10.1056/NEJM199111283252203. [DOI] [PubMed] [Google Scholar]
  10. Erlich K. S., Mills J., Chatis P., Mertz G. J., Busch D. F., Follansbee S. E., Grant R. M., Crumpacker C. S. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1989 Feb 2;320(5):293–296. doi: 10.1056/NEJM198902023200506. [DOI] [PubMed] [Google Scholar]
  11. Gershon A. A., Steinberg S. P., LaRussa P., Ferrara A., Hammerschlag M., Gelb L. Immunization of healthy adults with live attenuated varicella vaccine. J Infect Dis. 1988 Jul;158(1):132–137. doi: 10.1093/infdis/158.1.132. [DOI] [PubMed] [Google Scholar]
  12. Gilden D. H. Herpes zoster with postherpetic neuralgia--persisting pain and frustration. N Engl J Med. 1994 Mar 31;330(13):932–934. doi: 10.1056/NEJM199403313301312. [DOI] [PubMed] [Google Scholar]
  13. Goldberg L. H., Kaufman R., Kurtz T. O., Conant M. A., Eron L. J., Batenhorst R. L., Boone G. S. Long-term suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group. Arch Dermatol. 1993 May;129(5):582–587. [PubMed] [Google Scholar]
  14. Huff J. C., Drucker J. L., Clemmer A., Laskin O. L., Connor J. D., Bryson Y. J., Balfour H. H., Jr Effect of oral acyclovir on pain resolution in herpes zoster: a reanalysis. J Med Virol. 1993;Suppl 1:93–96. doi: 10.1002/jmv.1890410518. [DOI] [PubMed] [Google Scholar]
  15. Johnson R. E., Nahmias A. J., Magder L. S., Lee F. K., Brooks C. A., Snowden C. B. A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. N Engl J Med. 1989 Jul 6;321(1):7–12. doi: 10.1056/NEJM198907063210102. [DOI] [PubMed] [Google Scholar]
  16. Kaplowitz L. G., Baker D., Gelb L., Blythe J., Hale R., Frost P., Crumpacker C., Rabinovich S., Peacock J. E., Jr, Herndon J. Prolonged continuous acyclovir treatment of normal adults with frequently recurring genital herpes simplex virus infection. The Acyclovir Study Group. JAMA. 1991 Feb 13;265(6):747–751. [PubMed] [Google Scholar]
  17. Koelle D. M., Benedetti J., Langenberg A., Corey L. Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes. Ann Intern Med. 1992 Mar 15;116(6):433–437. doi: 10.7326/0003-4819-116-6-433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kost R. G., Straus S. E. Postherpetic neuralgia--pathogenesis, treatment, and prevention. N Engl J Med. 1996 Jul 4;335(1):32–42. doi: 10.1056/NEJM199607043350107. [DOI] [PubMed] [Google Scholar]
  19. Lakeman F. D., Whitley R. J. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. 1995 Apr;171(4):857–863. doi: 10.1093/infdis/171.4.857. [DOI] [PubMed] [Google Scholar]
  20. Langenberg A. G., Burke R. L., Adair S. F., Sekulovich R., Tigges M., Dekker C. L., Corey L. A recombinant glycoprotein vaccine for herpes simplex virus type 2: safety and immunogenicity [corrected]. Ann Intern Med. 1995 Jun 15;122(12):889–898. doi: 10.7326/0003-4819-122-12-199506150-00001. [DOI] [PubMed] [Google Scholar]
  21. Mertz G. J., Benedetti J., Ashley R., Selke S. A., Corey L. Risk factors for the sexual transmission of genital herpes. Ann Intern Med. 1992 Feb 1;116(3):197–202. doi: 10.7326/0003-4819-116-3-197. [DOI] [PubMed] [Google Scholar]
  22. Mertz G. J., Coombs R. W., Ashley R., Jourden J., Remington M., Winter C., Fahnlander A., Guinan M., Ducey H., Corey L. Transmission of genital herpes in couples with one symptomatic and one asymptomatic partner: a prospective study. J Infect Dis. 1988 Jun;157(6):1169–1177. doi: 10.1093/infdis/157.6.1169. [DOI] [PubMed] [Google Scholar]
  23. Nahmias A. J., Whitley R. J., Visintine A. N., Takei Y., Alford C. A., Jr Herpes simplex virus encephalitis: laboratory evaluations and their diagnostic significance. J Infect Dis. 1982 Jun;145(6):829–836. doi: 10.1093/infdis/145.6.829. [DOI] [PubMed] [Google Scholar]
  24. Peikert A., Hentrich M., Ochs G. Topical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy, predictors of response and long-term course. J Neurol. 1991 Dec;238(8):452–456. doi: 10.1007/BF00314653. [DOI] [PubMed] [Google Scholar]
  25. Reichman R. C., Badger G. J., Mertz G. J., Corey L., Richman D. D., Connor J. D., Redfield D., Savoia M. C., Oxman M. N., Bryson Y. Treatment of recurrent genital herpes simplex infections with oral acyclovir. A controlled trial. JAMA. 1984 Apr 27;251(16):2103–2107. [PubMed] [Google Scholar]
  26. Rooney J. F., Straus S. E., Mannix M. L., Wohlenberg C. R., Alling D. W., Dumois J. A., Notkins A. L. Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. Ann Intern Med. 1993 Feb 15;118(4):268–272. doi: 10.7326/0003-4819-118-4-199302150-00004. [DOI] [PubMed] [Google Scholar]
  27. Sacks S. L., Aoki F. Y., Diaz-Mitoma F., Sellors J., Shafran S. D. Patient-initiated, twice-daily oral famciclovir for early recurrent genital herpes. A randomized, double-blind multicenter trial. Canadian Famciclovir Study Group. JAMA. 1996 Jul 3;276(1):44–49. [PubMed] [Google Scholar]
  28. Safrin S., Arvin A., Mills J., Ashley R. Comparison of the Western immunoblot assay and a glycoprotein G enzyme immunoassay for detection of serum antibodies to herpes simplex virus type 2 in patients with AIDS. J Clin Microbiol. 1992 May;30(5):1312–1314. doi: 10.1128/jcm.30.5.1312-1314.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Safrin S., Crumpacker C., Chatis P., Davis R., Hafner R., Rush J., Kessler H. A., Landry B., Mills J. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. N Engl J Med. 1991 Aug 22;325(8):551–555. doi: 10.1056/NEJM199108223250805. [DOI] [PubMed] [Google Scholar]
  30. Safrin S., Kemmerly S., Plotkin B., Smith T., Weissbach N., De Veranez D., Phan L. D., Cohn D. Foscarnet-resistant herpes simplex virus infection in patients with AIDS. J Infect Dis. 1994 Jan;169(1):193–196. doi: 10.1093/infdis/169.1.193. [DOI] [PubMed] [Google Scholar]
  31. Schlossberg D., Littman M. Varicella pneumonia. Arch Intern Med. 1988 Jul;148(7):1630–1632. [PubMed] [Google Scholar]
  32. Sköldenberg B., Forsgren M., Alestig K., Bergström T., Burman L., Dahlqvist E., Forkman A., Frydén A., Lövgren K., Norlin K. Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet. 1984 Sep 29;2(8405):707–711. doi: 10.1016/s0140-6736(84)92623-0. [DOI] [PubMed] [Google Scholar]
  33. Spruance S. L., Hamill M. L., Hoge W. S., Davis L. G., Mills J. Acyclovir prevents reactivation of herpes simplex labialis in skiers. JAMA. 1988 Sep 16;260(11):1597–1599. [PubMed] [Google Scholar]
  34. Straus S. E., Ostrove J. M., Inchauspé G., Felser J. M., Freifeld A., Croen K. D., Sawyer M. H. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med. 1988 Feb;108(2):221–237. doi: 10.7326/0003-4819-108-2-221. [DOI] [PubMed] [Google Scholar]
  35. Tyring S., Barbarash R. A., Nahlik J. E., Cunningham A., Marley J., Heng M., Jones T., Rea T., Boon R., Saltzman R. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Ann Intern Med. 1995 Jul 15;123(2):89–96. doi: 10.7326/0003-4819-123-2-199507150-00002. [DOI] [PubMed] [Google Scholar]
  36. Wald A., Zeh J., Barnum G., Davis L. G., Corey L. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):8–15. doi: 10.7326/0003-4819-124-1_part_1-199601010-00002. [DOI] [PubMed] [Google Scholar]
  37. Wallace M. R., Bowler W. A., Murray N. B., Brodine S. K., Oldfield E. C., 3rd Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial. Ann Intern Med. 1992 Sep 1;117(5):358–363. doi: 10.7326/0003-4819-117-5-358. [DOI] [PubMed] [Google Scholar]
  38. White C. J., Kuter B. J., Hildebrand C. S., Isganitis K. L., Matthews H., Miller W. J., Provost P. J., Ellis R. W., Gerety R. J., Calandra G. B. Varicella vaccine (VARIVAX) in healthy children and adolescents: results from clinical trials, 1987 to 1989. Pediatrics. 1991 May;87(5):604–610. [PubMed] [Google Scholar]
  39. Whitley R. J., Alford C. A., Hirsch M. S., Schooley R. T., Luby J. P., Aoki F. Y., Hanley D., Nahmias A. J., Soong S. J. Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med. 1986 Jan 16;314(3):144–149. doi: 10.1056/NEJM198601163140303. [DOI] [PubMed] [Google Scholar]
  40. Whitley R. J., Cobbs C. G., Alford C. A., Jr, Soong S. J., Hirsch M. S., Connor J. D., Corey L., Hanley D. F., Levin M., Powell D. A. Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group. JAMA. 1989 Jul 14;262(2):234–239. [PubMed] [Google Scholar]
  41. Whitley R. J., Gnann J. W., Jr Acyclovir: a decade later. N Engl J Med. 1992 Sep 10;327(11):782–789. doi: 10.1056/NEJM199209103271108. [DOI] [PubMed] [Google Scholar]
  42. Whitley R. J., Weiss H., Gnann J. W., Jr, Tyring S., Mertz G. J., Pappas P. G., Schleupner C. J., Hayden F., Wolf J., Soong S. J. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. 1996 Sep 1;125(5):376–383. doi: 10.7326/0003-4819-125-5-199609010-00004. [DOI] [PubMed] [Google Scholar]
  43. Wood M. J., Johnson R. W., McKendrick M. W., Taylor J., Mandal B. K., Crooks J. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. 1994 Mar 31;330(13):896–900. doi: 10.1056/NEJM199403313301304. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES