Recurrences after first episodes of genital herpes in patients treated with topical acyclovir cream.

The effect of topical acyclovir treatment of first episode genital herpes on the time to first recurrence in a group of 42 patients receiving either acyclovir or placebo was investigated. Topical acyclovir treatment had no effect on time to first recurrence in patients with either first episode HSV-1 or HSV-2 infections. There was no significant difference in the time to first recurrence in patients with either true primary or initial genital infections. However, the time to first recurrence in patients with first episode HSV-2 was significantly shorter than in patients with first episode HSV-1. Acyclovir treatment appeared to have no effect on the development of neutralising antibody in patients with either virus type.

Efficacy of topical acyclovir cream in first and recurrent episodes of genital herpes.

Fifty-three patients with first episodes and 60 patients with prior culture proven recurrent genital herpes were enrolled in a single centre, double-blind, placebo-controlled trial of 5% acyclovir in an aqueous cream base versus matching placebo. For first episodes treated with topical acyclovir the median duration of pain (4 vs. 8 days, P less than 0.05), time to healing of all lesions (8 vs. 14 days, P less than 0.001), duration of viral shedding (4 vs. 11 days, P = 0.001) and duration of new lesion formation (0 vs. 2.5 days, P less than 0.001) were reduced compared with placebo recipients. In patients with recurrent episodes who completed the study topical acyclovir significantly reduced the median duration of all symptoms (3 vs. 6 days, P less than 0.001), the time to healing of all lesions (4 vs. 6 days, P less than 0.01), and the formation of new lesions (5 vs. 29%, P less than 0.01) compared with the controls. Greater clinical benefits were demonstrated in females than in males, particularly for first episodes, but the number of males was small. Topical acyclovir cream is well tolerated and an effective treatment for first and recurrent episodes of genital herpes.

Isolation and characterisation of two strains of Herpesvirus hominis type 1 from fallopian tubes.

Herpesvirus hominis type 1 (HSV-1) was isolated from fallopian-tube biopsies of two women who were using an intra-uterine contraceptive device; the strains were isolated on different dates and at different hospitals. Both the isolates were shown to be HSV-1 by restriction-enzyme analysis, polypeptide profiles and indirect immuno fluorescence; the two isolates could not be distinguished by these tests, but the tests distinguished them from HSV-1 strain 71-15 and HSV-2 strain 333. The viruses were again isolated from samples of fallopian-tube tissue stored in liquid nitrogen, and their polypeptide and restriction-enzyme profiles were the same as those in the initial isolates. Virus was not isolated from fallopian-tube samples obtained from other IUD patients undergoing surgery at the same two hospitals at the same time.

Anaerobic bacteria and herpes simplex virus in genital ulceration.

Of 91 patients with genital ulceration, herpes simplex virus was isolated from 52 (57%) and Haemophilus ducreyi from 12 (13%); none had syphilis. The difference in incidence of other aerobes in patients and controls was not significant. Anaerobes, predominantly Bacteroides spp, were isolated from a large proportion (77%) of men and women patients with ulcers but from few control men. The most common anaerobic species were B asaccharolyticus and B ureolyticus, with fewer isolates of the melaninogenicus/oralis group. The bacterial flora of herpetic and non-herpetic ulcers were similar, but Candida albicans was isolated significantly more often from non-herpetic ulcers. Anaerobic bacteria may contribute to the pathogenesis of genital ulcers.

Acyclovir prophylaxis of recurrent genital herpes: randomised placebo controlled crossover study.

Forty patients were entered into a randomised placebo controlled crossover study to assess the efficacy and safety of oral acyclovir 200 mg four times a day in the prophylaxis of recurrent genital herpes. Each treatment began during a recurrence and continued for a maximum of 84 days or until the onset of the next recurrence, when the alternate medication was started. Of 28 patients who completed both treatment courses, only three developed a recurrence while taking acyclovir compared with 26 while taking placebo. The mean time to first recurrence was more than 84 days in patients receiving acyclovir and 24 days in patients receiving placebo (p less than 0.001). The mean time to first recurrence after treatment with acyclovir ceased was 16 days. Adverse events, though thought unlikely to be related to treatment, necessitated the withdrawal from the study of two patients while taking acyclovir and one patient while taking placebo. No clinically important effects on haematological or biochemical variables occurred during the acyclovir treatment. All viral isolates tested after treatment remained sensitive to acyclovir. Acyclovir prophylaxis of recurrent genital herpes is effective and safe but does not appear to influence the natural history of the disease after cessation of 84 days' continuous treatment.

Susceptibility of HSV strains from patients with genital herpes treated with various formulations of acyclovir.

Virus isolates from 55 patients with recurrent or first-episode genital herpes, treated with various formulation of acyclovir, were tested for their susceptibility to the drug. In all but one of these patients pre-treatment isolates were available for comparison with later isolates. In none of patients, even those receiving long-term prophylaxis, was the susceptibility of the post-treatment isolates significantly reduced.

Incidence of herpes simplex virus types 1 and 2 isolated in patients with herpes genitalis in Sheffield.

Thirty-one strains of herpesvirus (HSV), isolated from patients presenting with the clinical features of herpes genitalis, were typed by polypeptide analysis of virus proteins in sodium dodecyl sulphate polyacrylamide gels. Nineteen (61.3%) of the isolates were shown to be HSV type 1 and 12 (38.7%) HSV type 2. There was no obvious difference in the incidence of HSV-1 in primary or recurrent infections and no apparent correlation between the genital site of isolation and virus type. The high incidence of genital HSV-1 infection in this group of patients is probably due to the increased practice of oro-genital contact and has possible implications for the future development of drugs and vaccines in the control of genital herpes.