Clinical Response Difference between Acyclovir and Valacyclovir in Recurrent Intraoral Herpes: Adaptation Treatment in Pandemic Situation

Abstract

Recurrent intraoral herpes (RIH) is a reactivation of herpes simplex virus 1 (HSV 1) and is treated with an antiviral. In this pandemic situation, limited access to health care may lead to many consequences. This case report reports the difference in clinical response between acyclovir and valacyclovir in RIH and treatment in the pandemic situation. A 24 years old man complained of ulcers and pain in the mouth in the last two weeks. The patient had a history of recurrent ulcers since a year ago. Intraoral examination showed multiple ulcers, with erythema halo, 0.2-0.3 cm in diameters on the tongue, uvula, and pharynx. The patient had difficulty in eating. The IgG anti-HSV 1 test showed a positive result, and the lesions were diagnosed as RIH. The patient was treated with acyclovir, benzylamine HCl, and vitamin B12. One month after treatment, the lesions improved, but new lesions still emerged. Therefore, valacyclovir was substituted for acyclovir. Since the patient had difficulty in going to the hospital due to the lockdown policy, medication for two weeks was prescribed for him. One month after treatment with valacyclovir, there was no more new lesion emerging. In conclusion, there was a difference in clinical response between acyclovir and valacyclovir. It is assumed that the patient has resistancy to acyclovir which resulting in poor improvement. The pandemic condition forces us to be flexible in handling patients and adapting to government conditions and rules.Keywords: recurrent intraoral herpes; acyclovir; valacyclovir