Valacyclovir Treatment for Genital Herpes

Treatment Regimens and Efficacy

The Centers for Disease Control and Prevention recommends that HIV-infected patients with genital herpes should not use 1-3 day short-course regimens, instead requiring 5-14 days of treatment 1, 2
For patients with 10 or more recurrences per year, valacyclovir 1 gram once daily is necessary for adequate suppression, as the 500 mg daily dose is less effective in this population 3
Suppressive therapy with valacyclovir reduces recurrence frequency by ≥75% in patients with frequent episodes 3
Valacyclovir 500 mg once daily reduces HSV-2 transmission to susceptible heterosexual partners by 50% 1, 2

For HIV-infected patients with CD4+ count ≥100 cells/mm³, valacyclovir 500 mg twice daily is recommended for suppressive therapy, and acute treatment should last 5-14 days 1, 2
Suppressive therapy in HIV-infected persons decreases HIV concentration in plasma and genital secretions 1, 2

No laboratory monitoring is required for patients on episodic or suppressive therapy unless substantial renal impairment exists 1, 2
Common adverse effects of valacyclovir include headache and nausea, which are generally mild 1, 2
Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome has been reported in HIV-infected patients receiving high-dose valacyclovir, but not at standard doses used for HSV treatment 1, 2, 3

Suspect acyclovir resistance if lesions do not begin to resolve within 7-10 days of initiating therapy, and obtain viral culture with susceptibility testing to confirm resistance 1, 2
For confirmed acyclovir-resistant HSV, IV foscarnet is the treatment of choice 1, 2
All acyclovir-resistant strains are also resistant to valacyclovir 3