VOL. 31, 1987
LETTER TO THE EDITOR
1865
9. Swamy, K. H. S., M. Sirsi, and G. R. Rao. 1974. Studies on the mechanism of action of miconazole: effect of miconazole on respiration and cell permeability of Candida albicans. Antimicrob. Agents Chemother. 5:420-425. 10. Van den Bossche, H., G. Willemsens, W. Cools, W. F. J. Lauwers, and L. LeJeune. 1978. Biochemical effects of miconazole on fungi. II. Inhibition of ergosterol biosynthesis in Candida albicans. Chem. Biol. Interact. 21:59-78. 11. Van den Bosshe, H., G. Willemsens, W. Cools, P. Marichal, and W. Lauwers. 1983. Hypothesis on the molecular basis of the
antifungal activity of N-substituted imidazoles and triazoles. Biochem. Soc. Trans. 11:665-667.
William H. Beggs Irene R. LaSota Carolyn E. Hughes
General Medical Research and Medicine Services Veterans Administration Medical Center Minneapolis, Minnesota 55417
Acyclovir Prophylaxis for Herpes Simplex Virus Infection
We wish to congratulate Drs. Gold and Corey on an excellent review of the literature regarding acyclovir (ACV) prophylaxis for herpes simplex virus (HSV) infection (D. Gold and L. Corey, Antimicrob. Agents Chemother. 31:361-367, 1987). We take exception to one sentence which states, "Oral ACV does not produce significant reduction in symptoms of recurrent genital HSV episodes but does decrease the duration of viral shedding and slightly reduces the time to healing." If this were true, there would be no sense in using intermittent dosage of ACV for recurrent genital HSV episodes. In our experiences, this is the commonest use of ACV. In fact, in an article published in 1986, Goldberg et al. (1) showed that oral ACV was effective in reducing time to healing and new lesion formation. If oral ACV is used early enough in an outbreak, the outbreak could occasionally be aborted altogether.
LITERATURE CITED 1. Goldberg, L. H., R. Kaufman, M. A. Conant, J. Sperber, M. L. Allen, M. Illeman, and S. Chapman. 1986. Oral acyclovir for episodic treatment of recurrent genital herpes. J. Am. Acad. Dermatol. 15:256-264.
Leonard H. Goldberg Jay Sperber Department of Dermatology Baylor College of Medicine Houston, Texas 77030
1.5 day in males and 0.5 day in females. Similar figures were a 1.5-day reduction in lesion duration with patient-initiated therapy. No data concerning the effect of this higher dose of acyclovir on symptoms were reported. The effect of acyclovir on aborting episodes remains controversial. Dr. Goldberg's study suggested that early therapy was associated with a higher frequency of aborted episodes, although the differences between acyclovir and placebo recipients were not statistically significant. This effect has been shown in an additional study (5), while others have not demonstrated this (4). Selective use of oral acyclovir for the early treatment of recurrent genital herpes is appropriate. Whether use of larger doses of acyclovir will enhance these therapeutic
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benefits requires further study.
LITERATURE CITED 1. Goldberg, L. H., R. Kaufman, M. A. Conant, J. Sperber, M. L. Allen, M. Illeman, and S. Chapman. 1986. Oral acyclovir for episodic treatment of recurrent genital herpes. J. Am. Acad. Dermatol. 15:256-264. 2. Guinan, M. E. 1986. Oral acyclovir for treatment and suppression of genital herpes simplex virus infection. J. Am. Med. Assoc. 255:1747-1756. 3. Nilsen, A. E., T. Aasen, A. M. Halsos, B. R. Kinge, E. A. L. Tjotta, K. Wikstrom, and A. P. Fiddian. 1982. Efficacy of oral acyclovir in the treatment of initial and recurrent genital herpes. Lancet ii:571-573. 4. Reichman, R. C., G. J. Badger, G. J. Mertz, L. Corey, D. D. Richman, J. D. Connor, D. Redfield, M. C. Savoia, M. N. Oxman, Y. Bryson, D. L. Tyrrell, J. Portnoy, T. Creigh-Kirk, R. E. Keeney, T. Ashikaga, and R. Dolin. 1984. Treatment of recurrent genital herpes simplex infections with oral acyclovir. J. Am. Med. Assoc. 251:2103-2107. 5. Ruhnek-Forsbeck, M., E. Sandstrom, B. Andersson, G. Ericksson, K. Hersle, G. B. Lovhagen, H. Mobacken, L. Hillstrom, and L. Svensson. 1985. Treatment of recurrent genital herpes simplex infections with oral acyclovir. J. Antimicrob. Chemother.
Author's Reply In reply to the letter from Dr. Goldberg and J. Sperber, we offer the following. The majority of studies evaluating oral acyclovir for the treatment of recurrent genital herpes have demonstrated a shortening of the duration of viral excretion from lesions and hastened healing of lesions. The effect of therapy on the symptoms of genital herpes have been more variable, some studies showing no effect and others showing some shortening of the duration of pain and itching (2-5). In the study of Goldberg et al. (1) in which they compared 800 mg of acyclovir twice daily versus the standard dosage of 200 mg five times a day, in physician-initiated therapy, acyclovir reduced the healing times of genital lesions by an average of
16:621-628.
Lawrence Corey Deborah Gold Virology Division Department of Laboratory Medicine School of Medicine
University of Washington Seattle, Washington 98195