eMedicine Specialties > Infectious Diseases > Viral Infections

Herpes B: Treatment & Medication

Author: Brian Hogan, MD, MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium
Coauthor(s): Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center; Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus; Robert O Deaner, PhD, Assistant Professor, Department of Psychology, Grand Valley State University
Contributor Information and Disclosures

Updated: Mar 24, 2009

Treatment

Medical Care

The guidelines for medical treatment of individuals exposed to herpes B virus are complex. Refer to the most recently published guidelines for a detailed discussion.¹ The substance of these guidelines is delineated below. Prompt attention to a potential exposure is vital to minimize the risk of this disease, which carries high morbidity and mortality rates.

• Wound decontamination
  • Cleansing of the exposed area within minutes of the episode is the only means of preventing a contaminated wound from progressing to actual infection. The herpes B virus is likely to enter host cells within 5 minutes.
  • At least 15 minutes of scrubbing and/or irrigating the exposed area is recommended. Sterile saline or rapidly flowing water is used for the eye, and decontaminants (eg, soap solution, povidone-iodine, chlorhexidine) can be used at other sites.
  • Dakin solution (0.25% hypochlorite) has been suggested for high-risk deep lacerations or needle sticks. The solution must be fresh, and standard decontaminants should be used after a 5-minute treatment. Dakin solution should never be used to wash the eyes or mucous membranes.
• Antiviral therapy
  • Antiviral therapy is clearly indicated for suspected clinical cases of human herpes B virus infection; use of prophylactic antiviral therapy is problematic.
  • The decision regarding postexposure prophylaxis should be individualized and made by a health care provider experienced with the evaluation, treatment, and prevention of herpes B virus infection. Early prophylaxis may prevent either overall or symptomatic infection; on the other hand, infection is quite rare compared with the number of exposures.
  • The ability of therapy to prevent herpes B virus infection is not documented, and therapy can suppress shedding and seroconversion, further complicating diagnosis. In addition, the length of therapy is undefined.¹

Surgical Care

Incision of wounds directed at diagnosis or treatment is usually of little benefit and can increase the risk of secondary bacterial infection. Therefore, it is not generally recommended.¹

Consultations

For prevention protocol and specimen testing, obtain appropriate consultation from occupational health personnel of primate centers. In addition, the National Institute of Health’s National Center for Research Resources funds the National B Virus Resource Center, which is an excellent resource for numerous topics related to herpes B virus, including both diagnostic testing and education. Other resources include the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health.

Medication

Specific antiviral agents are recommended as soon as possible to attempt prevention of herpes B virus disease progression in humans or when prophylaxis is indicated. No treatment is currently approved for herpes B virus infection by the US Food and Drug Administration. Early treatment has been successful in modifying infection in some animal models, but human data, albeit anecdotal, have been mixed. The progression of complications seems to be limited in some human reports. The dosing, especially for prophylaxis, is not clearly delineated. Because of its bioavailability profile, valacyclovir seems preferable to acyclovir for oral use in either treatment or prophylaxis.

Topical antiseptic compounds or preparations are used topically on potentially contaminated or infected body surfaces or on inanimate objects. In these cases, the topical antiseptics are used to inactivate any herpes B virus remaining in the wound after irrigation.

Antivirals

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase. Herpes B virus thymidine kinase has only recently been characterized. Initial in vitro study has suggested that, under experimental conditions, B virus thymidine kinase is less susceptible to several commonly used antiherpes drugs, including acyclovir and ganciclovir. This may lead to further research aimed at developing more effective alternatives than the currently accepted drugs for this infection.⁴

Acyclovir (Zovirax)

Synthetic purine nucleoside analogue with activity against a number of herpesviruses, including herpes B. Primarily available in preparations for PO and IV use. Highly selective for virus-infected cells because of high affinity for viral thymidine-kinase enzyme. This effect serves to concentrate acyclovir monophosphate into virus-infected cells. The monophosphate is then metabolized into triphosphate active form by cellular kinases.

Valacyclovir (Valtrex)

Hydrochloride salt of the L-valyl ester of acyclovir. Rapidly converted into acyclovir after prompt absorption from the gut via first-pass intestinal or hepatic metabolism. An alternative to acyclovir for prophylaxis (or possibly treatment).

Topical antiseptics

These agents are to be used for decontamination of affected areas. Scrubbing should persist for at least 15 min.

Povidone-iodine (Betadine)

Broad-spectrum germicidal agent used topically on skin or mucous membranes. Used as a surgical scrub or topical cleanser. Elemental iodine is the active form.

Chlorhexidine (Hibiclens, Peridex, PerioChip)

Effective, safe, and reliable topical wash or PO mouthwash antiseptic. A polybiguanide with bactericidal activity; usually is supplied as a gluconate salt. At physiologic pH, the salt dissociates to a cation that binds to bacterial cell walls. Commercially available central venous catheters impregnated with chlorhexidine and silver sulfadiazine are available.

Dakin solution

Originally described by Dakin in 1915. Made from sodium carbonate, salt, bleaching powder, and boric acid. Today, commonly referred to 0.5% sodium hypochlorite (a 1:10 dilution of household bleach). Solution deteriorates with time and should be made fresh. Further dilutions also can be made. Some physicians use it as part of pressure ulcer management. Because of potential injury, other topical antiseptics usually are used.

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