What is the treatment and prevention of Herpes Simplex Virus (HSV) type 2 with Acyclovir (acyclovir)?

From the Guidelines

Acyclovir is an effective medication for both treatment and prevention of HSV-2 (genital herpes) outbreaks, with suppressive therapy reducing outbreak frequency by approximately 75% and reducing asymptomatic viral shedding, which decreases transmission risk to sexual partners 1.

Treatment and Prevention

For acute outbreaks, the standard treatment is 400 mg of oral acyclovir three times daily for 7-10 days for first episodes, or 5 days for recurrent episodes.

• For prevention (suppressive therapy), 400 mg twice daily is typically recommended for patients experiencing frequent outbreaks (more than 6 per year) 1.
• Suppressive therapy can reduce outbreak frequency and reduces asymptomatic viral shedding, which decreases transmission risk to sexual partners.
• Patients should take acyclovir with or without food and maintain adequate hydration while on the medication.
• Common side effects include headache, nausea, and diarrhea.
• For those with kidney problems, dose adjustments may be necessary.
• Acyclovir works by inhibiting viral DNA synthesis, preventing HSV replication.

Important Considerations

While suppressive therapy can significantly reduce outbreaks and transmission risk, it does not completely eliminate either, so barrier protection methods during sexual activity are still recommended 1.

• Patients should consult their healthcare provider before starting suppressive therapy to determine if it's appropriate for their specific situation.
• The use of suppressive antiviral therapy (valacyclovir 500 mg once daily) in persons with genital herpes reduced HSV-2 transmission to susceptible heterosexual partners by 50% 1.

From the FDA Drug Label

The duration of pain and new lesion formation was decreased in some patient groups Recurrent Genital Herpes: Double-blind, placebo-controlled studies in patients with frequent recurrences (6 or more episodes per year) have shown that orally administered acyclovir given daily for 4 months to 10 years prevented or reduced the frequency and/or severity of recurrences in greater than 95% of patients

• Acyclovir can be used for the treatment of HSV-2.
• The drug has been shown to reduce the frequency and severity of recurrences in patients with frequent recurrences of genital herpes.
• Daily administration of acyclovir for 4 months to 10 years can prevent or reduce the frequency and/or severity of recurrences in greater than 95% of patients 2.

From the Research

Hsv Type 2 Treatment with Acyclovir Prevention

• The use of acyclovir in the treatment and prevention of HSV-2 has been studied in various research papers 3, 4, 5, 6, 7.
• According to a study published in 2013, daily suppressive therapy with valacyclovir reduces the risk of sexual transmission of HSV-2 in HSV-2-serodiscordant heterosexual couples by 48% 3.
• However, the same study found that daily acyclovir 400 mg twice daily did not decrease the risk of HSV-2 transmission to susceptible partners in African HSV-2/HIV-1-serodiscordant couples 3.
• Another study published in 2003 found that valacyclovir is more effective than acyclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia (PHN) 4.
• A review of the treatment of herpes simplex infections published in 2008 found that acyclovir, valacyclovir, and famciclovir are effective in the treatment of genital and labial herpes simplex virus infections 5.
• A narrative review published in 2024 discussed the problem of resistance to acyclovir and its derivatives, and found that long-term treatment and prophylaxis with antiviral agents predisposes to drug resistance, especially in immunocompromised patients 6.
• A review published in 2020 found that acyclovir and its analogues are the only approved medicines for HSV infection therapies, and that acyclovir remains the gold standard in the treatment of herpes virus infections 7.

Key Findings

• Acyclovir is effective in the treatment of HSV-2, but its effectiveness in preventing transmission is still unclear 3, 4, 5, 6, 7.
• Valacyclovir is more effective than acyclovir in hastening the healing of zoster-associated pain and PHN 4.
• Long-term treatment and prophylaxis with antiviral agents predisposes to drug resistance, especially in immunocompromised patients 6.
• Acyclovir remains the gold standard in the treatment of herpes virus infections, mainly due to the emerging of new delivery systems improving its bioavailability 7.