From the Guidelines
For prevention of HSV-2 outbreaks, suppressive therapy with acyclovir should be taken continuously for at least 1 year, after which the treatment can be discontinued to assess the patient's rate of recurrent episodes, as recommended by the 1998 guidelines 1. The duration of suppressive therapy can vary depending on the frequency of recurrences, with patients having six or more recurrences per year potentially benefiting from indefinite treatment.
- The efficacy of suppressive therapy in reducing the frequency of genital herpes recurrences is well-documented, with a reduction of greater than or equal to 75% among patients with frequent recurrences 1.
- The safety and efficacy of daily therapy with acyclovir have been documented for up to 6 years, making it a viable long-term treatment option 1.
- It is essential to note that while suppressive therapy significantly reduces outbreak frequency and transmission risk, it does not completely eliminate either, and patients should be aware of this when making informed decisions about their treatment.
- Regular follow-up with a healthcare provider is crucial to monitor the effectiveness of the treatment and adjust it as needed, taking into account the patient's psychological adjustment to genital herpes and rate of recurrent episodes 1.
From the FDA Drug Label
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
The recommended duration of acyclovir treatment for prevention of HSV type 2 recurrence is at least 4 months to 10 years 2.
- The treatment should be given daily.
- The exact duration of treatment may vary depending on the individual patient's response and the frequency of recurrences.
From the Research
Hsv Type 2 Treatment with Acyclovir Prevention
- The use of acyclovir for the prevention of HSV-2 transmission has been studied in various clinical trials 3, 4, 5.
- A study published in 2010 found that acyclovir suppressive therapy (400 mg twice daily) reduces HSV-2-associated genital ulcer disease and lesional HSV shedding 3.
- However, another study published in 2013 found that daily suppressive therapy with acyclovir did not decrease the risk of HSV-2 transmission from HSV-2/HIV-1 coinfected persons to susceptible partners 4.
- A study published in 1996 found that daily therapy with oral acyclovir suppresses subclinical shedding of HSV-2 in the genital tract, suggesting that studies to evaluate the use of acyclovir in preventing HSV-2 transmission are warranted 5.
Duration of Acyclovir Treatment for Prevention
- The optimal duration of acyclovir treatment for the prevention of HSV-2 transmission is not clearly established.
- A study published in 2002 found that a 2-day regimen of acyclovir (800 mg given by mouth 3 times per day) was effective in treating recurrent genital herpes simplex virus type 2 infection 6.
- However, this study did not specifically address the use of acyclovir for prevention of HSV-2 transmission.
- Other studies have used longer durations of acyclovir treatment, such as 70 days 5 or ongoing daily suppressive therapy 4.