Treatment of Genital Herpes Simplex

Introduction to Treatment

The Centers for Disease Control and Prevention recommends the first-line treatment for genital herpes simplex is oral antiviral therapy with valacyclovir, acyclovir, or famciclovir, with specific regimens depending on whether it is a first clinical episode or recurrent infection 1, 2

For the first clinical episode of genital herpes, the recommended regimens are valacyclovir 1 g orally twice daily, acyclovir 400 mg orally three times daily, acyclovir 200 mg orally five times daily, or famciclovir 250 mg orally three times daily, for 7-10 days 1
Treatment may be extended if healing is incomplete after 10 days of therapy 1

For recurrent episodes of genital herpes, the recommended regimens are valacyclovir 500 mg orally twice daily, acyclovir 400 mg orally three times daily, acyclovir 800 mg orally twice daily, acyclovir 200 mg orally five times daily, or famciclovir 125 mg orally twice daily, for 5 days 2
Episodic therapy is most effective when started during the prodrome or within 1 day after onset of lesions 2

For patients with frequent recurrences (≥6 episodes per year), suppressive therapy with valacyclovir 1 g orally once daily, valacyclovir 500 mg orally once daily, acyclovir 400 mg orally twice daily, or famciclovir 250 mg orally twice daily can reduce the frequency of recurrences by ≥75% and reduce asymptomatic viral shedding 2

Genital herpes is a recurrent, incurable viral disease; antiviral medications control symptoms but do not eradicate the virus 1, 2
Patients should abstain from sexual activity when lesions or prodromal symptoms are present 1, 2
Sexual transmission can occur during asymptomatic periods due to viral shedding 1, 2
Patients should inform sex partners about having genital herpes and use condoms during all sexual exposures with new or uninfected partners 1, 2

Topical acyclovir therapy is substantially less effective than systemic therapy and is not recommended 1
After 1 year of suppressive therapy, consider discontinuation to reassess recurrence frequency 2

Patients should be educated about the natural history of genital herpes, with emphasis on potential recurrences, asymptomatic viral shedding, and sexual transmission 1