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1 July 2005

Volume 192, Number 1
The Journal of Infectious Diseases 2005;192:156–161
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19201-0021$15.00
DOI: 10.1086/430612
MAJOR ARTICLE

Recurrent Antiviral‐Resistant Genital Herpes in an Immunocompetent Patient

John D. Kriesel,1

Spotswood L. Spruance,1

Mark Prichard,2

Jacqueline N. Parker,2 and

Earl R. Kern2

1Department of Medicine, University of Utah, Salt Lake City; 2Department of Pediatrics, University of Alabama, Birmingham

Herpes simplex virus type 2 (HSV‐2) resistance to antiviral drugs has been described primarily in immunocompromised patients. We report an apparently immunocompetent, human immunodeficiency virus–negative male patient who has experienced repeated HSV‐2 genital outbreaks despite receiving antiviral prophylaxis with several different drugs. Several of the HSV‐2 genital isolates from this patient have been confirmed as resistant to acyclovir and penciclovir. Antiviral resistance occurred in the setting of long‐term prednisone treatment and intermittent acyclovir prophylaxis at suboptimal doses and persisted despite the cessation of oral steroid treatment. The patient’s genital herpes outbreaks were not controlled by high‐dose prophylaxis with acyclovir, valacyclovir, and famciclovir. Cessation of antiviral prophylaxis resulted in reversion of this patient’s HSV‐2 isolates to acyclovir and penciclovir sensitivity, although resistant virus reappeared when antiviral prophylaxis was resumed. Transmission of a sensitive HSV‐2 strain from this patient to a female sex partner was observed. These observations confirm previous reports that resistance to acyclovir may develop during prophylactic therapy in an otherwise well, immunocompetent patient. These findings support the conclusion that both drug‐sensitive and drug‐resistant HSV‐2 strains established latency in this patient and that both strains are capable of frequent reactivation.

Received 27 August 2004; accepted 31 January 2005; electronically published 27 May 2005.

Reprints or correspondence: Dr. John D. Kriesel, University of Utah School of Medicine, 30 N. 1900 East, Rm. 4B‐322, Salt Lake City, UT 84132 ().

Cited by

Julie S Brantley, Lindsey Hicks, Karan Sra, Stephen K Tyring. (2006) Valacyclovir for the treatment of genital herpes. Expert Review of Anti-infective Therapy 4:3, 367
CrossRef
Stephen L Sacks, Fred Y Aoki. (2005) Famciclovir for the Management of??Genital Herpes Simplex in Patients??with Inadequate Response to??Aciclovir or Valaciclovir. Clinical Drug Investigation 25:12, 803-809
Online publication date: 1-Feb-2005.
CrossRef

  • Potential conflicts of interest: J.D.K. has a current research contract with Novartis and has served on the GlaxoSmithKline speakers’ bureau. S.L.S. is a consultant for and receives research support from both Novartis and GlaxoSmithKline and is also on the GlaxoSmithKline speaker’s bureau.

    Financial support: National Institute of Allergy and Infectious Diseases, National Institutes of Health (contract NO1‐AI‐85347 to the University of Alabama at Birmingham).

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