Acyclovir Treatment for Herpes Simplex

Introduction to Acyclovir Therapy

The Centers for Disease Control and Prevention (CDC) recommends that acyclovir cream (5%) should be applied 5 times daily for 5 days, but oral acyclovir is strongly preferred over topical formulations because topical therapy is substantially less effective and its use is discouraged for treating herpes simplex infections 1
The CDC explicitly states that topical acyclovir therapy is substantially less effective than oral formulations and its use is discouraged for treating herpes simplex infections 1

The CDC recommends acyclovir 200 mg orally 5 times daily for 7-10 days until clinical resolution for first episode genital herpes 1, 2
The CDC recommends acyclovir 800 mg orally twice daily for 5 days for recurrent genital herpes 1
The CDC recommends acyclovir 400 mg orally 3 times daily for 5 days for recurrent genital herpes 1
The CDC recommends acyclovir 200 mg orally 5 times daily for 5 days for recurrent genital herpes 1

Treatment must be initiated during prodrome or within 2 days of lesion onset for maximum benefit 3, 2
Starting therapy after this window significantly reduces effectiveness, and most immunocompetent patients with recurrent disease experience limited benefit from delayed therapy 3

Immunocompromised patients require more aggressive therapy with acyclovir 400 mg orally 3-5 times daily or IV administration 4, 5
Immunocompromised patients may have prolonged episodes with extensive disease requiring IV acyclovir 5-10 mg/kg every 8 hours 4
Hospitalized patients with disseminated infection, pneumonitis, hepatitis, or CNS complications require IV acyclovir 5-10 mg/kg every 8 hours for 5-7 days 4

Acyclovir neither eradicates latent virus nor affects subsequent risk, frequency, or severity of recurrences after discontinuation 1, 3
Patients should abstain from activities that might spread the virus while lesions are present, though transmission can occur during asymptomatic periods 3, 2
Most immunocompetent patients with recurrent disease experience limited benefit from therapy overall 1, 3