A 25-year-old immunocompetent patient has recurrent genital herpes confirmed by PCR as HSV-2. He enquires about suppressive antiviral therapy. Which of the following is the correct rationale for valacyclovir suppressive therapy over episodic therapy in this patient?
- A Suppressive therapy eradicates latent HSV-2 from sacral dorsal root ganglia, preventing future recurrences permanently
- B Episodic therapy is superior for reducing viral transmission as it achieves higher peak plasma levels
- C Suppressive therapy reduces frequency of recurrences by ~70–80%, reduces subclinical shedding, and decreases transmission risk to sexual partners; it does not eradicate latent virus ✓
- D Suppressive therapy is only recommended for immunocompromised patients; immunocompetent patients benefit solely from episodic therapy
Explanation
Valacyclovir (a prodrug of acyclovir) used as daily suppressive therapy (500 mg OD) in HSV-2 genital herpes reduces clinical recurrence frequency by approximately 70–80% and significantly reduces asymptomatic viral shedding. Critically, it reduces sexual transmission risk to susceptible partners by approximately 48% (NEJM 2004). However, it does not eradicate the latent virus residing in sacral ganglia. Suppressive therapy is recommended for patients with frequent recurrences (≥6/year), significant psychological impact, or when partner protection is a priority. Episodic therapy works best for infrequent recurrences.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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