In the February 2008 edition of the "Journal of Oral Pathology and Oral Medicine," researchers Paolo G. Arduino, D.D.S., M.M.Sc., and Stephen R. Porter, D.D.S., Ph.D., report that 70 to 80 percent of adults test positive for exposure to the herpes simplex type 1 virus. Many, say Arduino and Porter, experience symptoms that are so mild that they go unrecognized. Others experience the unsightly blistering skin lesions commonly referred to as cold sores or fever blisters. Herpes simplex type 1 treatment centers on antiviral drugs.
Types
The Food and Drug Administration has approved five antiviral drugs for the treatment of herpes simplex 1. According to University of California-San Francisco Professor Sharon Safrin, M.D. in the 2008 edition of "Basic and Clinical Pharmacology," these include acyclovir, valacyclovir, famciclovir, penciclovir and docosanol. Doctors prescribe the first three for oral use while the last two come as creams for topical use. Docosanol is the only treatment that's available over-the-counter.
Function
Safrin says that acyclovir, valacyclovir, famciclovir and penciclovir share a common mechanism--each works by replacing the nucleic acid, guanosine, in viral DNA replication. Unlike guanosine, the drugs have no attachment site for another nucleic acid, so DNA replication stalls, leaving the virus unable to reproduce and infect new cells. Docosanol, a 22-carbon fatty alcohol derived from plants, dissolves into the outer covering of cells, called a membrane, and prevents the herpes simplex virus from binding and infecting the cell. None of the drugs eradicates the virus completely, so patients are still susceptible to recurrences when treatment is discontinued.
Uses
Herpes simplex 1 infections resolve in 10 to 14 days with no treatment at all, according to National Institutes of Health researcher Adriana Marques, M.D. in the 2008 edition of "Fitzpatrick's Dermatology in General Medicine." Treatment is generally reserved for people with particularly severe symptoms, including those who develop symptoms inside the mouth where they can interfere with eating and drinking. People who suffer from recurrent outbreaks sometimes benefit from ongoing treatment to suppress new outbreaks.
Safety
Safrin says that treatment for herpes simplex 1 is generally considered safe and well tolerated. About 10 percent of people experience side effects, such as headaches, nausea, vomiting or diarrhea. Among those who use topical treatments, Safrin says that about 2 percent report skin reactions, such as acne, redness, swelling, dryness, flaking, itching or burning. Patients who experience severe side effects or those that become progressively worse should stop treatment and check with their doctors, because these can be signs of an allergic reaction.
Effectiveness
According to dermatologist Christina Cernik, M.D. in the June 9, 2008 edition of "Archives of Internal Medicine," herpes simplex type 1 treatments are generally most effective during the first outbreak, when they can shave up to five days off of the typical recovery time when started within the first 48 hours of symptom onset. Recurrent outbreaks affect only about 20 percent of the population and tend to become shorter over time, making it difficult to obtain a uniform sample. In general, however, Cernik says, studies suggest they reduce the duration of symptoms by about one day.
References
- "Journal of Oral Pathology and Oral Medicine"; Herpes Simplex Virus Type 1 Infection; Paolo G. Arduino, D.D.S., M.Sc. and Stephen R. Porter, D.D.S, Ph.D.; Feb. 2008
- "Basic and Clinical Pharmacology, 11th Edition"; Bertram G. Katzung, M.D., Ph.D. et al.; 2008
- "Archives of Internal Medicine"; "The Treatment of Herpes Simplex Infections; Christina Cernik, M.D., et al.; June 9, 2008
- "Fitzpatrick's Dermatology in General Medicine, 7th Edition"; Klaus Wolff, M.D. et al.; 2008
