IntraMed – Articles – Treatment with valacyclovir to reduce recurrent genital herpes

It is one of the diseases most common sexually transmitted diseases and is characterized by a latent and recurrent mucocutaneous infection. A major concern regarding maternal infection with HSV during pregnancy is the potential for vertical transmission to the fetus and / or newborn. To reduce vertical transmission, current management guidelines recommend cesarean delivery for women with active HSV lesions perineal or prodromal symptoms at delivery. Several investigations explored the potential use of antiviral acyclovir treatment late in the third trimester of pregnancy to prevent recurrences of HSV at delivery. The results of these investigations suggest that acyclovir, started at 36 weeks gestation, can reduce clinical recurrences and may reduce the need for caesarean sections as a result of active HSV lesions become evident. Valacyclovir is absorbed from the gastrointestinal tract and converted to acyclovir in the hepatic first pass. Bioavailability of this transformation is 3 to 5 times higher than after oral administration of acyclovir, allowing a lower dose interval. Thanks to these favorable attributes, suppressive treatment with valaciclovir in late pregnancy could significantly reduce both the frequency of clinical relapses, as viral lesions at delivery, thereby reducing the need for caesarean sections and the risk of vertical transmission. Currently, however, no published data indicates safety or clinical efficacy of valaciclovir in pregnant women or their babies. Therefore, our objective was to evaluate the efficacy of valaciclovir suppressive therapy initiated 36 weeks of gestation to reduce recurrent genital herpes and to assess preliminarily security in the mother and her child. The medication was suspended after birth, and postpartum mothers received routine care. One of the results was observed that the number of women with clinical recurrences of HSV between the time they started the suppressive treatment and delivery was significantly lower in the group treated with valacyclovir versus placebo. Something important in this study is that there were no significant differences between the valacyclovir and placebo, in mothers and infants, among the variables evaluated to measure the safety of the use of valaciclovir during pregnancy.


Especially, no significant differences between the groups in perinatal outcomes were observed, including birth weight, frequency of hospitalizations in the neonatal intensive care and Apgar score at 5 minutes less than 7. There were also no significant differences regarding the frequency of oligohydramnios, maternal or neonatal renal function. In conclusion we can summarize that the treatment suppressive daily valacyclovir initiated 36 weeks of pregnancy and continuing until delivery in women with documented history of infection recurrent HSV, significantly reduces the number of women with subsequent clinical recurrences of HSV after the start treatment. However, the suppression did not decrease the number of women with viral lesions close to delivery, active HSV lesions at the time of delivery, or the number requiring cesarean active HSV lesions. Although not statistically significant, both the percentage of women with active HSV lesions, as the percentage of women requiring cesarean active lesions was lower in the group treated with valacyclovir group compared to the placebo group. The onset of spontaneous labor is unpredictable, so is also the onset and duration of active genital HSV recurrent. Thus, we believe that an important observation in this study was noted when the entire time between the start of suppressive treatment to 36 weeks to the time of delivery was considered. During this period of approximately 3 weeks, we observed a statistically significant decrease in recurrent HSV lesions active genital among women treated with valaciclovir compared to those treated with placebo. Thus, in the general population of pregnant women with a history of infections recurrent genital HSV, it is reasonable to anticipate that such a reduction in clinical relapses between weeks 36 and childbirth in women receiving suppression with valaciclovir antiviral, could eventually lead a reduction of caesarean sections performed especially for the indication of active HSV lesions at delivery. In future studies, quantitative PCR rather than qualitative detection of the herpes simplex virus, could be useful in determining whether the antiviral suppressive therapy in late pregnancy reduces the viral inoculum that predisposes vertical transmission. Previous studies have investigated the use of suppressive therapy with acyclovir for pregnant women at risk of recurrent HSV infection. The results of our research with valaciclovir are similar to these previous reports where using acyclovir. In addition, physicians who chose to use the antiviral for HSV suppression in late pregnancy, may be encouraged by the improved bioavailability and lower daily dose of valacyclovir compared with acyclovir.

Although valaciclovir is more expensive than acyclovir, a recent cost-effectiveness analysis, it was shown that the suppressive treatment with valaciclovir was economically favorable compared with acyclovir, or no treatment. Another important contribution of this study is to secure information related to the use of valaciclovir in pregnant women. No safety problems in mothers, fetuses or neonates exposed to valacyclovir were identified. Since valacyclovir becomes acyclovir after the first liver passage, the safety profile could also be applied to acyclovir. Some authors might argue that greater experience objectively examined with the use of valaciclovir and / or acyclovir in pregnant before can be established with certainty, the safety of these medications is needed. Despite sharing this position, we are proud of the favorable toxicity profile observed is this study. In addition, no significant adverse effects were reported in previous studies on prophylaxis with acyclovir in late pregnancy. However, in the absence of definitive data regarding safety, universal use of valaciclovir for viral suppression in all women with a history of genital HSV infection, it may not be prudent. Highlights: What question does this work? It shows the experience of the use of valaciclovir to 36 weeks of gestation in women with a history of recurrent genital herpes, reducing the number of subsequent clinical lesions. What adds to what was already known about it? Quantitative PCR rather than qualitative detection of the herpes simplex virus, could be useful in determining whether the antiviral suppressive therapy in late pregnancy reduces the viral inoculum that predisposes vertical transmission.

Further studies to ensure the safety of such treatment are awaited. How does my daily practice? With the introduction of this treatment the number of caesarean sections for active genital herpes lesions, vertical transmission and the number of clinical recurrences of the disease would be reduced.

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Pharmacy Lyhs Jettingen-Scheppach :: STDs

General Sexually transmitted diseases, sexually transmitted diseases, also abbreviated to STD (from the English: Sexually Transmitted Diseases) called, are among the infectious diseases. These include more than 20 diseases caused by bacteria, viruses, fungi or parasites. The Joint at the STD is that they are mainly transmitted during sexual intercourse. Different, however, the infectivity of the pathogen, the disease and the treatment options respectively their prevention. The “classical” venereal disease (For example, syphilis, gonorrhea) have lost their horror, since they are treatable with antibiotics. Against hepatitis B, a serious, also sexually transmitted disease, there has long been a vaccination. Today’s most feared STD is AIDS, because stand against this disease neither a curative drug nor a protective vaccination are available. ill annually worldwide an estimated 330 million people suffer from sexually transmitted diseases. The most widespread are trichomonas with 120 million. , Followed by chlamydia at 50 million. and gonorrhea with 25 million sufferers.

The number of people living with HIV is estimated at 42 million. Infection with an STD occurs primarily during sexual intercourse through direct contact of infected body fluids (such as semen and vaginal fluid) with the mucous membrane. Most venereal diseases, especially herpes infections, can also be transferred (by direct contact with infectious body fluids) during oral sex, kissing or petting. An infection can also take place from an infected mother to the fetus or the newborn. Some STDs (hepatitis B / C, AIDS and syphilis) can be transmitted through infected blood products or blood products, or by needle exchange for drug addicts also have blood. etc. An indirect infection via towels, toiletries is in some pathogens possible, but extremely rare. Transmission through droplets (for example, coughing, sneezing) is not possible. In everyday social contact (household, workplace, travel etc. ) is an infection with an STD in compliance with the usual hygiene rules excluded. Most STD (most important exceptions: hepatitis B and AIDS) first become noticeable at the entry, so the penis in the vagina and the labia; Anus and oral cavity may also be affected. Some STD are simply unpleasant, while others are dangerous: If left untreated, they spread causing all over the body and can then partially serious, irreparable damage such as infertility, brain damage or blindness. The most dangerous STD, HIV infection, leads according to current knowledge on average after 12 years to end-stage AIDS, which can end in death.

The most important venereal syphilis (syphilis, hard chancre) Syphilis is caused by spiral-shaped bacteria (Treponema pallidum). As the illness progresses there are four stages: In stage I, it takes about three weeks after the infection to a hard, non-painful ulcer at the site at which the infection has occurred (generally the penis or the vagina). The nearest lymph nodes swell. Typically the ulcer heals even without treatment. If left untreated, the disease but after about six weeks for stage II fort, in which the bacteria spread throughout the body and cause rashes, fever and swollen lymph nodes. These symptoms disappear temporarily, but occur over the years again and again. Will this stage is not treated, it comes after several years to attack the internal organs, especially the nervous system, as in stage III of the spinal cord (gait disturbance) and in stage IV the brain (dementia). The detection of an infection takes place by microscopic examination or by the syphilis test in blood, which provides about three weeks after infection reliable results. Treatment with antibiotics (e. g. , penicillin) in the early stages leads to a complete cure. The damage in the later stages (III and IV) are not irreversible, even if the bacteria are killed by drugs.

In pregnancy can syphilis cause serious damage to the unborn child. Gonorrhoea (gonorrhea) Gonorrhoea is also caused by bacteria (Neisseria gonorrhea). Two to seven days after infection occurs gelbgrünlichem, purulent discharge from the penis and vagina and painful urination. In women, these symptoms may be absent. If the disease is not treated, it can in men to infect prostate, vas deferens and epididymis come. In women, the uterus, fallopian tubes and ovaries can be so damaged that it can lead to infertility. In the late stage of gonorrhea may spread the bacteria to the whole body, especially the joints and liver region (Perihepatitis acuta) from. Proof of Gonorrhöeinfektion done by microscopic and cultural examination of the effluent. Gonorrhoea can be cured with antibiotics. A major problem in this context of sex tourism in the Far East are: The local prostitutes often use antibiotics for the prevention of sexually transmitted diseases. In this way arise increasingly antibiotic-resistant bacterial strains. Chancroid (chancroid)

The chancroid caused by bacteria (Haemophilus ducreyi), and is a rare disease in central Europe, but common in tropical developing countries. Two to six days after infection occur soft, painful and irregular limited ulcers at the site of infection. The lymph nodes of the groin can swell strongly. Diagnosis is made by microscopic detection of the pathogen in the ulcers. The disease is cured with antibiotics. Venereal lymph node inflammation (Lymphogranuloma inguinale) Lymphogranuloma inguinale is caused by particular strains of Chlamydia trachomatis and is very rare in central Europe. At least 14 days after the infection occur in sexual area demarcated small nodules that can embark on an ulcer. This little painful nodules heal after 10? 14 days from spontaneously and are therefore often overlooked. Only the swelling of lymph nodes in the groin area (up to fist size) that the patient leads to the doctor. Problems arise especially when lymph nodes inside the body outwards break (fistulas), or lymph nodes. Diagnosis is made by the direct detection of pathogens in infection or by a blood test. The disease can be cured in the early stages with antibiotics.

chlamydia infections Chlamydial infections are very common in Europe and are caused by bacteria (Chlamydia trachomatis). They produce annoying urethra infections that lead to severe itching and burning during urination. In men, the prostate and the epididymis, be concerned with the woman also vagina, uterus, fallopian tubes and ovaries, which can lead to infertility and ectopic pregnancies. The infection is often without symptoms and can be easily cured with antibiotics. A transmission to the newborn is common and leads to conjunctivitis and pneumonia. AIDS AIDS (Acquired Immune Deficiency Syndrome = acquired immunodeficiency disease) is the final stage of infection with HIV (Human Immunodeficiency Virus). To date, two virus types (HIV 1 + 2) were detected with numerous subgroups. Between the infection and the onset of the disease takes on average about twelve years. In this time, the infected can? without something to remember from the infection? transmit the virus to other people.


Simultaneously existing “classical” venereal diseases (especially syphilis and chancroid) increase the susceptibility to infection with the AIDS virus. Evidence of HIV infection is carried out by a blood test (HIV test). The disease is still incurable and may cause death. Through early detection of infection and appropriate medical care it is possible to delay the onset of the disease and improve the quality of life of those affected. A vaccination is not available in the foreseeable future. Hepatitis (infectious jaundice) There are various hepatitis viruses, of which especially the hepatitis B virus (HBV) and to a lesser extent, the hepatitis C virus (HCV) are sexually transmitted. The disease is very different: The infection can pass without symptoms or an acute severe liver inflammation (hepatitis) lead which can prove fatal in some cases. To a considerable extent the infection proceeds to a chronic inflammation of the liver that can lead to cirrhosis and liver cancer. The problem with hepatitis B / C, that some people remain lifelong carriers of the virus (also without being ill) can and infect other people. The hepatitis B / C viruses can except for sexual intercourse and through blood transfusions, needle exchange for drug addicts and are sometimes transmitted even through direct and indirect contact with body fluids under unsanitary living conditions. In third world countries hepatitis B is widespread among the general population in Europe are mainly intravenous drug addicts (Fixer) and the medical staff concerned. For Hepatitis B is the only STD there is a safe vaccination today.

genital herpes Genital herpes is a common viral infection that is related to herpes labialis ( “cold sores” on the lips) close. Three to seven days after infection occur in the crotch region of small, intensely itchy or painful blisters, which contain an infectious fluid. In addition lymph node swelling and general febrile symptoms can occur. The virus can be detected directly in the blister fluid or indirectly with blood tests. Despite treatment with an antiviral drug (e. g. acyclovir), the virus can survive in the nerve cells and after years lead to another disease, but runs mostly mild. Infected pregnant women may during childbirth, the herpes virus can be transmitted to the newborn and cause serious diseases (for example inflammation of the brain). Genital warts (condylomata acuminata) Approximately four weeks after an infection the genital warts grow often cauliflower-like in the genital area. They are caused by viruses (human papilloma viruses = HPV) and can surgically (laser, liquid nitrogen, electrocoagulation or with the scalpel) be removed. Papilloma viruses can be transmitted to the newborn during birth.

Some papilloma viruses are discussed as a cause of cervical cancer in women. trichomoniasis Trichomonas infested widespread unicellular parasite, the urethra and vagina. The infection manifests itself by watery discharge and itching. The diagnosis is done by microscopic detection of pathogens. This worldwide most common but harmless infectious disease is cured with special drugs (for example, metronidazole). fungal infections The yeast (Candida albicans) is very widespread and the most frequent cause of sexually transmitted fungal infections. This, in itself harmless infection (inflammation of the vagina or glans) can, however, lead to unpleasant symptoms such as intense itching and burning. In women also occurs a vaginal discharge. With special medication (antimycotics) and appropriate hygiene are to treat fungal infections well. Pubic lice Pubic lice are small insects that attach themselves in the pubic hair.

They are visible to the naked eye, as their eggs (nits) that attach themselves to the hair. Severe itching is the main symptom. Treating these harmless venereal disease is done with a special emulsion. What to do if you are affected by a sexually transmitted disease? If you are concerned that you have been infected with a sexually transmitted disease, consult a physician immediately you trust. In addition to the practitioner may be a dermatologist, a gynecologist, a urologist or an internist. Trying to “treat” a venereal disease themselves, is problematic, even dangerous, because it allows the doctor later diagnosis difficult and the infection may go undetected. Most STDs can be cured with proper medical treatment. Exceptions are the viral STD such as herpes infections, hepatitis B / C and AIDS. But also in HIV infection can improve life time and especially the quality of life of the patient modern drugs. but of which only one benefit, the white of his HIV infection early. Therefore, it pays to be always perform an HIV test in the presence of other sexually transmitted diseases. Talk to your doctor about it.

If you suffer from a sexually transmitted disease, you need to? to protect your partner? so long without sexual contacts until the disease is cured and you can no longer infect your partner. Your doctor will tell you when no more risk of infection. Your previous and / or your current partner should inform about your venereal disease. At least one of them is suffering from the same disease (otherwise you can not have yes), and you may already have passed the infection to others. These partners should also consult a doctor and be treated if necessary. Many people have inhibitions to talk about STDs. But it is important the confidence and openness to the doctor over who will treat you with account any confidentiality competently and without bias. How can you protect yourself against sexually transmitted diseases? Since the infection occurs almost exclusively with STDs during intercourse, protective measures have to start there. Some STDs are visible externally, but most of you do not see it the partner whether an STD is present. loyalty

In a faithful love relationship between two healthy partners an infection is practically impossible with a sexually transmitted disease. Careful choice of partner A new sexual relationship in general entails the risk of becoming infected with a sexually transmitted disease in itself. Only if the partner is not infected, an infection is excluded. For this reason, it is particularly important to select the partner very carefully. By talking openly with your partner should make sure risks. How was the former life of the future partner? How do we protect ourselves? Verheimlichen ultimately benefits only the pathogens. HIV test Since AIDS is not curable, it is advisable today to make an HIV test in order to exclude an undetected infection in the past. No volatile sexual contacts Since not all venereal diseases are treatable and u. U.

may lead to death (AIDS, hepatitis B / C) or result in infertility, it is recommended to volatile sexual contacts to renounce (especially when traveling). A single sexual contact may suffice for infection with a sexually transmitted disease. Frequent change of partners increases the risk to encounter an infected partner. condoms In contacts outside a committed relationship can be reduced by the proper use of condoms, the risk of sexually transmitted disease, but can not be excluded. Given the deadly disease AIDS remains a non-negligible residual risk on the order of a few percent even in certified condoms. natural Young people have little or no experience with condoms, so the risk of operating errors is large. drug abstinence Drugs and alcohol cloud sense of reality, obfuscate the sense of responsibility, weakening the judgment and self-control and tempt thereby thoughtless and often unprotected sexual contacts. Especially with the AIDS drug abstinence is of great importance. Vaccination against hepatitis B Those of a risk group for hepatitis B at (for example, medical personnel, dialysis patients, intravenous drug addicts [also called. Fixer], longer stay in a developing country), vaccination against hepatitis B is recommended in any case.

Today vaccination is generally recommended for all.

own horse – Monthly service charges realistic so? (Ride horses)

Take the iron down, otherwise relatively quickly can a few hundred euros per year calculate for leg injuries and take the 50 Euro not every 6 weeks, but all 4, it can namely easy pay a good Huforthopäden, then the hooves also edited so, that they do not run excessively, not be wrong, the long toe from the fitting is back to normal before the tendons are overloaded . . . Vaccinations are very different, depending on which grade Päparat is available. Herpes has recently cost me 45 euros, until a few years ago there was a combined preparation Herpes / influenza, which cost 33 euros. Herpes must semiannually be vaccinated, influenza annually, unless you startes at FN tournaments, all other organizations leave it namely as it stands on the package insert of the vaccine. Tetanus would I grundimmunisieren, if it has not then be determined titers by about 3 to 4 years time. Most horses need there still long not return a tetanus shot. reckon for teeth times annually a hundred. Good malnourished horses that primarily eat roughage and when concentrate, then only oats in whole grain often need only every 3 to 4 years time dental treatment. Let but necessarily make the dentist and not the general-horse doctor. Makes a big difference whether someone is specialized on it. Mineral feed need in Germany necessarily, not the cheapest, which you can find, but a decent with organic additives and a good Ca-P ratio .

. . since then will land at a daily rate of 50 cents to 1 euro, it will save in well 100 euros for products sold by the veterinarian because of deficiency symptoms you. Deworming also come. Often the outdated method of Strategic deworming is not yet, that is not allowed actually to medicines regulation, namely a drug causing breaking oaks without Previously disadvantaged diagnostics. Since then there’s 3 to 4 times a year a tube into your horse, whether necessary or not. Actual is the process of selective deworming where taken to plan for all horses samples and be examined in the laboratory and is then wormed specifically for horses that exceed a certain threshold of worm eggs in feces with the preparation that is useful for exactly the worm species that can be found. In so-called Hochausscheidern, so the horses, which always have a lot of worm eggs, which sees only times more expensive, because the owners have to pay the sample AND the worm treatment, on the other hand you can go downhill on track repeatedly enter with about one year a worming the horse from high shedders down bring, so it only rarely in the future, if ever, needs to be addressed and it’s much cheaper, because at some point, only three times a year does the sampling by McMaster and McMaster at the university laboratory grade times 15 Euro cost. For the money you get only the cheapest wormers. Overall, I calculate (do not forget what a good adjustable saddle – horses are constantly changing – new costs and the saddler for umpolstern also gets money and make it from time to time needs) with equipment procurement and maintenance pi of a Horse life of thumb stall full board plus 200 euros WITHOUT diseases and injuries and thus come out well. 340 euros is cheap for a stall. Ah, NRW . .

. because there are a lot of space, a lot of horses. Ok, here in Upper Bavaria will not get away with 400, in the Munich district it falls not difficult to find a stable for 600th