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Adverse effects, usually mild, include nausea, vomiting, rash and headache. Valacyclovir, a new antiviral agent, is the -valine ester prodrug of acyclovir; it is easily absorbed and converted to acyclovir.Lethargy, tremulousness, seizures and delirium have been reported rarely in studies of renally impaired patients.23The Acyclovir in Pregnancy Registry has documented prenatal exposures in more than 850 women (with 578 first-trimester exposures) without any adverse outcomes.7 However, the total number of pregnancies monitored to-date may not be enough to detect defects that occur only infrequently.6 Therefore, the drug is labeled pregnancy category C by the U. It has an oral bioavailability three to five times greater than that of acyclovir,8 and several large trials have shown that it is safe and well tolerated.8-10Famciclovir, another new antiviral medication, is the oral form of penciclovir, a purine analog similar to acyclovir.In immunocompetent patients, the initial ulceration crusts and heals by 14 to 21 days.Systemic symptoms are common in primary disease and include fever, headache, malaise, abdominal pain and myalgia.2Shedding of viable viral particles happens frequently.The diagnosis of genital HSV infection may be made clinically, but laboratory confirmation is recommended in patients presenting with primary or suspected recurrent infection.The gold standard of diagnosis is viral isolation by tissue culture,1 although this process can take as long as four to five days, and the sensitivity rate is only 70 to 80 percent.Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients.There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.
HSV exists as two separate types, labeled 1 and 2, which have affinities for different body sites.2 Ninety percent of infections caused by HSV-2 are genital, and 90 percent of those caused by HSV-1 are oral; the reason for this division is unknown.5 In addition, oral HSV-1 infection recurs more frequently than oral HSV-2, and genital HSV-2 recurs more often than genital HSV-1.Despite these limitations, viral culture is still the diagnostic test of choice for HSV skin infections.Tzanck preparations and antigen detection tests have lower sensitivity rates (50 to 70 percent) than viral culture.3 Serologic testing is extremely sensitive but is not helpful during primary infection because of the delay in antibody development.2 Polymerase chain reaction enzyme-linked immunosorbent assay (PCR-ELISA) is extremely sensitive (96 percent) and specific (99 percent) but expensive.1 For this reason, it is not used for the diagnosis of skin lesions but is the laboratory test of choice for diagnosing HSV encephalitis.Acyclovir, an acyclic guanosine analog, binds viral DNA polymerase, acting as a chain terminator and ending replication.