Treatment of Genital Herpes in Males

First Clinical Episode Treatment

The Centers for Disease Control and Prevention recommends acyclovir 200 mg orally 5 times a day for 7-10 days or until clinical resolution is attained for the first clinical episode of genital herpes 2, 3
For herpes proctitis, the recommended treatment is acyclovir 400 mg orally 5 times a day for 10 days or until clinical resolution 2

The Centers for Disease Control and Prevention recommends starting episodic treatment at the first sign of symptoms, with options including valacyclovir 500 mg orally twice daily for 5 days 1, 4
Alternative episodic treatment options include acyclovir 400 mg orally three times daily for 5 days, acyclovir 200 mg orally five times daily for 5 days, acyclovir 800 mg orally twice daily for 5 days, and famciclovir 125 mg orally twice daily for 5 days 1, 4

The Centers for Disease Control and Prevention recommends daily suppressive therapy for patients with frequent recurrences (≥6 episodes per year), with options including valacyclovir 1,000 mg orally once daily and valacyclovir 500 mg orally once daily 1, 4
Alternative suppressive therapy options include acyclovir 400 mg orally twice daily and famciclovir 250 mg orally twice daily 1, 3, 4

The Centers for Disease Control and Prevention recommends acyclovir 5-10 mg/kg body weight IV every 8 hours for 5-7 days or until clinical resolution for severe disease requiring hospitalization 3

Suppressive therapy reduces recurrence frequency by ≥75% in patients with frequent episodes, according to the Centers for Disease Control and Prevention 1, 4, 5
The Centers for Disease Control and Prevention advises patients to abstain from sexual activity when lesions or prodromal symptoms are present, and to use condoms during all sexual exposures with new or uninfected partners 1, 4
Patients should be informed that asymptomatic viral shedding can occur, potentially leading to transmission, and that antiviral medications control symptoms but do not eradicate the virus or prevent all recurrences 1, 4

Antiviral resistance is rare in immunocompetent patients but more common in immunocompromised individuals, according to the Centers for Disease Control and Prevention 4
Topical acyclovir is substantially less effective than oral therapy and is not recommended by the Centers for Disease Control and Prevention 1, 3