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Obstetrics & Gynecology

Answer 3
  1. Valacyclovir 500 mg twice daily for 3 days and valacyclovir suppression therapy 1000 mg once daily, beginning at 36 weeks’ gestation. Treatment of primary HSV outbreak involves 10 days of valacyclovir 1000 mg twice daily by mouth, acyclovir 200 mg 5 times daily, or famciclovir 250 mg 3 times daily. Treatment of recurrent HSV infection includes valacyclovir 500 mg twice daily for 3 days, acyclovir 200 mg 5 times daily for 5 days, or famciclovir 125 mg twice daily for 5 days. Suppression therapy for HSV infections involve valacyclovir 1000 mg once daily, acyclovir 400 mg twice daily, or famciclovir 250 mg twice daily. The case patient had a recurrent HSV infection outbreak during pregnancy; thus, a course of recurrent treatment along with suppressive therapy starting at 36 weeks’ gestation is recommended in order to prevent a recurrence at the time of delivery. This treatment course will likely help the patient avoid cesarean delivery and the complications associated with surgery. In addition, clinicians should keep in mind that the fewer pills any patient must take, the higher the compliance rate will be, leading to successful outcomes in HSV infection management.

     Langenberg AG, Corey L, Ashley RL, et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. New Engl J Med 1999;341:1432-8.
    2. Scott LL, Sanchez PJ, Jackson GL, et al. Acyclovir suppression to prevent cesarean delivery after first-episode genital herpes. Obstet Gynecol 1996;87:69-73.

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