Emerging treatments

Vaccines

Several preventive vaccine candidates have elicited anti-glycoprotein D (gD) neutralizing antibody responses, but unfortunately none have been shown to confer protection against HSV-1 or HSV-2 acquisition.[67][68]​ A number of candidate therapeutic vaccines are in clinical trials, but none have been approved.

Helicase-primase inhibitors

Viral helicase is an essential enzyme for viral replication. Helicase inhibitors have the potential to specifically prevent viral replication. Amenamevir had antiviral activity in a phase 2 clinical trial.[69] Pritelivir demonstrated reduction in genital shedding and lesions in two phase 2 trials, and a phase 3 amendment for acyclovir-resistant mucocutaneous HSV in immunocompromised subjects is underway.[70][71][72]

Tenofovir-based therapies

In the context of HIV-prevention studies, oral tenofovir, oral tenofovir/emtricitabine, and pericoital vaginal tenofovir gel have been shown to decrease the risk of HSV-2 acquisition by 30% to 50%.[73] However, when given to HSV-2-infected women, neither oral tenofovir nor vaginal tenofovir gel decreased genital HSV-2 shedding or recurrences.[74][75] Due to very low quality of evidence, a Cochrane review found the effects of tenofovir in the management of HSV to be uncertain.[76] [ Cochrane Clinical Answers logo ]

Monoclonal antibodies

MB66 is an investigational vaginal film that includes a combination of anti-HIV (VRC01-N) and anti-HSV (HSV8-N) monoclonal antibodies. The HSV8-N antibody has specificity for a HSV-1/2 envelope epitope.[77]

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