Stephen K. Tyring

Varicella zoster: an update on current treatment options and future perspectives

Introduction: Varicella zoster virus is a highly contagious virus that causes a primary infection known as varicella (chickenpox) that may reactivate years later to cause herpes zoster (HZ or shingles). After shingles heal, patients may develop post-herpetic neuralgia (PHN), neuropathic pain syndrome that can cause significant suffering for years and is often refractory to treatment. Areas covered: The wide range of treatment and management options for varicella, HZ and PHN are reviewed and discussed. PubMed was the database used for the literature search. Expert opinion: Antiviral therapy effectively treats acute varicella and HZ. However, PHN is still difficult to manage, especially with the numerous treatment measures that do not work consistently in all patients. The best approach is to prevent the complication from occurring in the first place by preventing HZ with the HZ vaccine, which have decreased the burden of illness caused by VZ and the incidence of HZ. Unlike the varicella vaccine, the uptake for the HZ vaccine is very low and thereby more patients over the age of 50 years should be encouraged to receive the vaccine to reduce the risk of developing HZ. Initiating treatment with gabapentin and antiviral concomitantly as soon as the rash develops may reduce the severity of complications but there is a lack of data showing these medications preventing the development of PHN.

Sexual Behavior and Psychological Aspects Associated with Sexually Transmitted Infections

While the incidence of sexually transmitted infections (STIs) is largely dependent on the distribution and prevalence of infection in the population, it is also important to consider the behavior of an individual and his or her partner(s), as well as their psychological state. The term “sexual behavior” encompasses many components including sexual experience and activity, age at sexual debut, current and lifetime number of sexual partners, frequency of sexual intercourse, consistency of sexual activity, mode of recruitment of sexual partners, duration of sexual relationships, and types of sexual practice. Some behaviors and practices that are associated with an increased risk of STIs include unprotected intercourse, receptive anal intercourse, having multiple and concurrent partners, and drug and alcohol use. Psychological factors, such as mood, mental health, and even personality types, may affect both risk of contracting STIs and presentation for and response to treatment.

Therapy-New Drugs

New medications for treatment of human immuxadnodeficiency virus (HIV) are under investixadgation in the existing classes of nucleoside/nucleotide reverse transcriptase inhibitors, nonxadnucleoside reverse transcriptase inhibitors, and protease inhibitors.

STDs and Travel Medicine

International travel contributes to the global spread of sexually transmitted diseases and resistant strains of infections.