Herpes simplex genitalis antiviral treatment of first episode genital herpes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Principles of Management of Genital Herpes

• Antiviral chemotherapy offers clinical benefits to the majority of symptomatic patients and is the mainstay of management.

• Systemic antiviral drugs can partially control the signs and symptoms of herpes episodes when used to treat first clinical episodes and recurrent episodes or when used as daily suppressive therapy. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.

• Topical therapy with antiviral drugs offers minimal clinical benefit, and its use is discouraged.

First Clinical Episode of Genital Herpes

• Many patients with first-episode herpes have mild clinical manifestations but later develop severe or prolonged symptoms. Therefore, patients with initial genital herpes should receive antiviral therapy.

• CDC Recommended Regimens (treatment may be extended if healing is incomplete after 10 days of therapy):

• Acyclovir 400 mg orally three times a day for 7-10 days OR
• Acyclovir 200 mg orally five times a day for 7-10 days OR
• Famciclovir 250 mg orally three times a day for 7-10 days OR
• Valacyclovir 1 g orally twice a day for 7-10 days