Acyclovir Dosing for Herpes Simplex in Females

First Clinical Episode (Primary Infection)

The Centers for Disease Control and Prevention recommends treating a first episode of genital herpes simplex with acyclovir 200 mg orally 5 times daily for 7-10 days until clinical resolution 1
For severe disease requiring hospitalization, the Centers for Disease Control and Prevention recommends acyclovir 5-10 mg/kg IV every 8 hours for 5-7 days or until clinical resolution 1

The Centers for Disease Control and Prevention recommends three equally effective dosing options for recurrent genital herpes: acyclovir 200 mg orally 5 times daily, acyclovir 400 mg orally 3 times daily, or acyclovir 800 mg orally twice daily, all for 5 days duration 1
Treatment must be initiated during prodrome or within 2 days of lesion onset for maximum benefit, according to the Centers for Disease Control and Prevention and other guidelines 1, 2

For patients with frequent recurrences, the Centers for Disease Control and Prevention recommends acyclovir 400 mg orally twice daily as the suppressive regimen, which reduces recurrence frequency by at least 75% 1
The Centers for Disease Control and Prevention also recommends alternative regimens, such as 200 mg orally 3-5 times daily, with the goal of finding the lowest effective dose 1

Immunocompromised patients, including HIV-infected individuals, may require more aggressive therapy with prolonged treatment courses, according to the Centers for Disease Control and Prevention and other guidelines 1, 3
Women of childbearing age should inform obstetric providers about HSV infection due to neonatal transmission risk, as recommended by the Centers for Disease Control and Prevention 1

The Centers for Disease Control and Prevention and other guidelines recommend against using topical acyclovir as primary therapy, as it provides no improvement in systemic symptoms and is significantly less effective than oral formulations 2
Patients should be counseled to abstain from sexual activity while lesions are present, though transmission can occur during asymptomatic periods, as recommended by the Centers for Disease Control and Prevention 1