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Australian Journal of Pharmacy : October 2006
FAQ FREQUENTLY ASKED QUESTIONS Valtrex® H and genital herpes National Herpes Day, 13 October, brings focus to this common sexually transmitted infection and offers pharmacists an opportunity to deal with an expected increase in inquiries.The following may be useful to help pharmacy customers with their questions and identify those at risk ow common is genital herpes (HSV-2) in Australia? Genital herpes is the second most common sexually transmitted infection (STI) in Australia with an estimated one in eight adults, and one in six women, carrying the virus. Seroprevalence of HSV-2 in Australian adults was found to be 12 per cent in a random sample of 4,000 adults conducted between 1999 and 2000. Seroprevalence of HSV-2 in women was at 16 per cent—twice the 8 per cent prevalence in men. The highest prevalence was found among indigenous adults with 18 per cent infected. In metropolitan areas 13 per cent were infected versus 9 per cent in rural areas. Genital herpes is most common in the 35-to-44 age group. W hat are the symptoms of genital herpes? For the vast majority of those infected—80 per cent—there are no symptoms and these people are usually unaware they have genital herpes. Initial episodes can pass unnoticed and the first indication may only become evident years after the first infection.1,2 In this time the virus can be carried and transmitted unknowingly with the patient never experiencing any symptoms. Symptoms vary from mild, thrush-like, indications of redness and itchiness to genital blisters. Initial outbreaks may also include flu symptoms of fever and pain in the back, legs and joints. The first infection is usually followed by another four-to-six outbreaks within 12 months. Many women may mistake signs of genital herpes as thrush, due to the close similarity of the symptoms.3 when urinating or notice vaginal discharge.2 H ow is genital herpes diagnosed? Genital herpes is often misdiagnosed because it is easily connected with a wide range of signs and symptoms associated with other diseases, particularly sexual diseases. A standard STI test does not detect HSV-2. The most important action for those who think they may 46 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 OCTOBER 2006 have genital herpes is to be examined by a doctor. Accurate diagnosis requires a swab from an active lesion for laboratory investigation and sometimes a blood test, although these may not produce a definite diagnosis. s there any difference in the efficacy of episodic therapy compared with suppressive therapy? Recent studies demonstrate great differences between the outcomes of patients treated with episodic therapy compared with those receiving suppressive therapy. Episodic therapy describes temporary, immediate, treatment that can reduce the length of time that symptoms last, as well as the severity of symptoms, providing it commences within three days of the infection first appearing. Suppressive therapy is daily treatment for months or years that may reduce both the number of episodes and their severity. Most patients affected reported no relapses during suppressive therapy treatment. I Despite these significant findings, less than 20 per cent of people diagnosed with genital herpes are being treated with medication, either to reduce further outbreaks or the risk of infecting others.3 Women may also experience pain Raising awareness of the prevalence of genital herpes is important and pharmacies are well placed to provide advice and direct customers to relevant resources. Most people who are HSV-2 seropositive are unaware of its implications because they either do not recognise the symptoms or have no symptoms.4 I There are two helpful Australian Internet sites— www.thefacts.com.au and www.ahmf.com.au—which may be of interest to many of your customers. They contain information to help communicate with people who have genital herpes (for example www.ahmf.com.au/health_ professionals/guidelines/counselling) as well as fact sheets (for example, www.ahmf.com.au/ patients/default.htm) which can be downloaded and given to the patient. s there a role for pharmacy in the identification and treatment of genital herpes? ADVERTORTIAL