Acyclovir Treatment for Genital Herpes

Introduction to Acyclovir Regimens

The Centers for Disease Control and Prevention recommends treating first-episode genital herpes with acyclovir 200 mg orally 5 times daily for 7-10 days until clinical resolution, with treatment initiated as soon as possible after symptom onset for maximum benefit 1, 2
For recurrent genital herpes, the American College of Obstetricians and Gynecologists suggests using acyclovir 800 mg orally twice daily for 5 days, initiated at the earliest sign of prodrome or within 2 days of lesion onset 1, 2

The CDC recommends that for herpes proctitis, a higher dose of 400 mg orally 5 times daily for 10 days should be used 1, 2
For patients with frequent recurrences (≥6 episodes per year), the CDC advises prescribing acyclovir 400 mg orally twice daily for continuous suppression, which reduces recurrence frequency by at least 75% 1, 2, 4

The CDC notes that for severe genital herpes with complications, acyclovir 5-10 mg/kg IV every 8 hours for 5-7 days or until clinical resolution should be administered 1, 2, 4
The Infectious Diseases Society of America recommends that HIV-infected patients may require more aggressive therapy than standard regimens 2, 4

The American College of Obstetricians and Gynecologists advises that patient counseling should include information that acyclovir does not eradicate latent virus or prevent future recurrences after discontinuation 3
The CDC warns that viral shedding and transmission can occur during asymptomatic periods despite therapy 1, 2

The CDC recommends monitoring for acyclovir-resistant strains, which may emerge in immunocompromised patients, and considering alternative treatments like foscarnet if lesions persist despite therapy 4
The National Kidney Foundation suggests that dose adjustment is mandatory in renal impairment, as acyclovir is primarily renally excreted 4