AbstractsAcyclovir (“Zovirax,” Wellcome) is an antiviral drug with considerable specific activity against certain herpes strains, particularly herpes simplex virus (HSV), types 1 and 2. It is effective when given intravenously, but an oral form of treatment is needed for patients who do not require hospitalization. The present authors have assessed the effectiveness and tolerance of orally administered acyclovir in the treatment of patients with initial and recurrent genital herpes. This paper describes the results of the completed study.A total of 31 patients with initial and 85 patients with recurrent genital herpes were studied. Seventeen patients with initial disease were treated with acyclovir (200 mg five times daily for 5 days) and 14 with placebo. Of the patients with recurrent disease, 42 received acyclovir and 43 received placebo. For both initial and recurrent disease, the treated and control groups were closely similar in sex ratio, age, duration of lesions before presentation, severity of pain, presence of lymphadenopathy, frequency of infection in the sexual partner, and recovery of virus from lesions. For those with recurrent disease, treated and control groups were also similar in the average duration of attacks (8 days). In comparison with those with recurrent infections, patients with initial infections were younger (mean age, 25.7 vs. 29.9 years) and had a longer duration of lesions before presentation (mean, 2.7 vs. 1.0 days) and a higher frequency of lymphadenopathy (89 vs. 42 per cent). The clinical diagnosis of genital herpes was confirmed by isolation of HSV from about 80 per cent of initial and recurrent lesions at presentation.In cases of initial disease, the duration of virus shedding was much shorter in acyclovir-treated patients than in controls, and the difference was highly significant whether analyzed separately (by sex) in those from whom HSV had been recovered, or for the total group of patients. New lesion formation was completely prevented after the start of treatment in all patients receiving acyclovir. By comparison, 29 per cent of the female and 57 per cent of the male patients (43 per cent overall) who received placebo developed new lesions. The differences for male patients and for all patients were significant, whereas the difference for female patients was not significant. Of 17 female patients with initial genital herpes, seven received placebo. HSV was not recovered from two of the seven patients at any time in the trial, and their lesions healed completely in 3 to 6 days, respectively.Lesion progression, as measured by time to development of first crust, and time to complete healing, was clearly curtailed by acyclovir treatment. The time to development of crust was shorter in those treated with acyclovir and reached significance in the female subgroup and in those from whom HSV had been cultured. The duration of pain, itching, and of all symptoms combined was significantly shorter in treated than in control groups.The duration of viral shedding was significantly shorter in patients with recurrent disease who received acyclovir than in controls. New lesion formation after the start of treatment was present in only one patient (2 per cent) treated with acyclovir, as compared with eight (19 per cent) controls (P 0.05). The effects of acyclovir on lesion progression were less pronounced in this group than in patients with initial disease, but healing times were still significantly shorter in acyclovir-treated patients than in controls.There was no evidence of any adverse effect from the acyclovir treatment.
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