[Recurrent herpes simplex. The situation in the United States]

At present, there is no drug marketed in the United States for the treatment of herpes simplex, except for idoxuridine for the treatment of herpetic keratitis. The recent enthusiasm for the use of heterocyclice fluorescent dyes in conjunction with exposure to light (photodynamic inactivation) has diminished, and the efficacy of all available topical measures is being questioned. Of the numerous antiviral drugs being investigated, the following seem to show promise: idoxuridine, adenin arabinoside, trifluorothymidine, phosphonoacetic acid, and ribavirin. There are no vaccines available. Measures to stimulate immune response concern the use of levamisole hydrochloride, Interferon, Inosiplex and Transfer factor. Only adenine arabinoside will be available in the near future, and then only to serious life threatening infections. The marketing of other medications is several years in the future.

Chemotherapy of genital herpes simplex virus type 2 infections of female hamsters

The antiviral activity of 1-beta-d-arabinofuranosylcytosine (ara-C, cytarabine, Cytosar), 5-iodo-2'-deoxyuridine (IdUrd), 9-beta-d-arabinofuranosyladenine (ara-A), and disodium phosphonoacetate (PAA) have been compared in herpes simplex virus type 2 (HSV-2)-infected primary rabbit kidney cells and in female hamsters with genital HSV-2 infection. In vitro, ara-C and IdUrd were more active than ara-A, and PAA was least active. In female hamsters with genital HSV-2 infection, intravaginal treatment with PAA or ara-A was more effective than either ara-C or IdUrd. PAA was more active than ara-A when treatment was initiated early (1 h) after infection. The activity of PAA was greatly reduced if initiation of treatment was delayed for 24 h. Both PAA and ara-A reduced the virus titers of the vagina and protected hamsters from death when the drugs were given by either the intravaginal or subcutaneous route, with intravaginal treatment being more effective.

Viral chemotherapy

New antiviral compounds are being tested constantly and may be of considerable value with increasing availability. More than 200 analogues of purines and pyrimidines have been found to inhibit DNA and RNA viruses. Adenine arabinoside is most effective against disseminated herpes simplex virus and disseminated herpes zoster. Idoxuridine is useful in treatment of herpetic keratitis. Interferon still is in the experimental stage, and, because of its short half-life and high cost, it probably will not be released in the near future. Amantadine appears to be useful in prevention of A2 influenza, but its value against swine flu has not been established. Methisazone is effective in prevention of smallpox and in the treatment of complications of vaccinia.

Herpes simplex keratitis

This article reviews the current concepts for the diagnosis and treatment of Herpes simplex keratitis and its complications, discussing characteristics of the virus, the prevalence of the disease, chemical and clinical differentiation between Types I and II Herpesvirus hominis, and the many clinical presentations of Type I disease. The antiviral agents commonly in use are reviewed, covering the historical development of the drugs, indications for their use and the associated toxic and untoward reactions. An outline for the medical treatment of the different forms of Herpes simplex keratitis is given, as well as the indications for surgical intervention in the treatment of the disease. The surgical complications and results following keratoplasty are discussed.

Double controlled comparison of IDU and trifluorothymidine in thirty-three patients with superficial herpetic keratitis

Thirty-three patients were followed in a double controlled study to test the efficacy of IDU and TFT on superficial epithelial herpes simplex virus infection. Sixteen received TFT and 17, IDU. There were four failures in patients on IDU therapy and no failures in the 16 patients using TFT. These results indicate a trend for greater efficacy of TFT than IDU. In those patients who healed with IDU and with TFT, there was no difference in the number of days to heal in each group.

Anorectal Herpesvirus hominis infection in men

Thirteen cases of anorectal Herpesivirus hominis infection in male homosexuals are described. Symptoms included pruitus ani in 11 cases, while 7 noticed intense and pain. Change of bowel habits and anal discharge were not presenting symptoms in the majority. None had generalized complications. Inguinal lymphadenopathy, a vesicular eruption, and superficial ulceration around the anal margin were commonly found. Some developed vesicular spread to the natal cleft. Treatment with cotrimoxazole to prevent masking of possible coexistent syphilis, though satisfactory in preventing secondary infection seemed to have little effect on early resolution of the lesions. Relapse occurred in over one third of the patients. Infection with Herpesvirus hominis seems an uncommon but increasingly recognized hazard for the passive homosexual and should be included in the differential diagnosis of lesions presenting at the anus.

Treatment of Vaccinial keratitis with trifluorothymidine

The efficacy of trifluorothymidine was compared with idoxuridine on a blind basis by noting the effect of topical administration of the drugs on the severity of vaccinial keratitis induced in rabbits. Trifluorothymidine was found to be substantially more effective, and was well tolerated. In addition, positive viral cultures after the treatment period were substantially reduced in the trifluorothymidine groups when compared with the idoxuridine or control groups.

Herpes simplex eye infections: clinical manifestations, pathogenesis and management

Herpes infection of the eye may be acquired as the patient's first exposure to the virus (primary infection) or as involvement of a new anatomical site (the eye) in a patient with previous HSV infection. In either case, patients with herpetic eye infection risk recurrent eye disease throughout their lives. The infective lesions of the corneal epithelium (dendritic and geographic ulcers) occasionally develop into noninfective indolent or trophic ulcers, particularly under the influence of cauterizing chemicals or corticosteroids. Inflammation of the corneal stroma may accompany herpetic epithelial lesions or occur independently. Stromal keratitis probably represents the host's immune response to viral antigens filtering down from epithelial lesions or from viral replication in stromal cells. The clinical manifestations of ocular HSV infection are reviewed, pathogenesis and possible pathways of the infection are analyzed, and some practical guidelines for management and prevention are presented.