From the Guidelines
Treatment for HSV-2 (genital herpes) should involve antiviral medications, such as acyclovir, valacyclovir, or famciclovir, to manage symptoms and reduce outbreaks, as recommended by the 2021 Centers for Disease Control and Prevention (CDC) STI treatment guidelines 1. The primary goal of treatment is to reduce the frequency and severity of outbreaks, as well as to lower the risk of transmission to partners.
- For initial outbreaks, treatment typically involves:
- Acyclovir (400mg three times daily for 7-10 days)
- Valacyclovir (1000mg twice daily for 7-10 days)
- Famciclovir (250mg three times daily for 7-10 days)
- For recurrent episodes, treatment typically involves:
- Acyclovir (400mg twice daily)
- Valacyclovir (500mg daily)
- Famciclovir (125mg twice daily) For people with frequent outbreaks (more than 6 per year), daily suppressive therapy with these medications can reduce outbreak frequency and lower transmission risk to partners 1. During outbreaks, keeping the affected area clean and dry, wearing loose-fitting clothing, and taking over-the-counter pain relievers can help manage discomfort. These antiviral medications work by inhibiting viral DNA replication, which prevents the virus from multiplying. While there is no cure for HSV-2, these treatments effectively control symptoms and reduce the frequency of outbreaks. It's essential to discuss treatment options with a healthcare provider to determine the best approach based on outbreak frequency and severity, as recommended by the CDC guidelines 1.
From the FDA Drug Label
The median time to lesion healing was 4 days in the group receiving VALTREX 500 mg versus 6 days in the placebo group, and the median time to cessation of viral shedding in subjects with at least 1 positive culture (42% of the overall trial population) was 2 days in the group receiving VALTREX 500 mg versus 4 days in the placebo group The median time to cessation of pain was 3 days in the group receiving VALTREX 500 mg versus 4 days in the group receiving placebo. Results supporting efficacy were replicated in a second trial. In a third trial, subjects were randomized to receive VALTREX 500 mg twice daily for 5 days (n = 398) or VALTREX 500 mg twice daily for 3 days (and matching placebo twice daily for 2 additional days) (n = 402) The median time to lesion healing was about 4½ days in both treatment groups. The median time to cessation of pain was about 3 days in both treatment groups.
Treatment for HSV-2:
- Valacyclovir (PO) is effective in reducing the duration of symptoms and viral shedding in patients with HSV-2.
- The recommended dosage is 500 mg twice daily for 5 days, or 500 mg twice daily for 3 days followed by placebo for 2 days.
- Suppressive therapy with valacyclovir 1 gram once daily, or 500 mg twice daily, can reduce the frequency of recurrences in immunocompetent adults and HIV-1-infected adults.
- Patients should be advised to initiate treatment at the first sign or symptom of an episode, and to use safer sex practices in combination with suppressive therapy to reduce the risk of transmission to partners 2.
From the Research
Treatment Options for HSV2
- The standard treatment for HSV2 infection includes antiviral agents such as acyclovir (ACV) 3, 4, 5.
- In immunocompetent patients, HSV2 infection can be controlled rapidly with ACV therapy, and recurrent lesions are usually small and short-lived 3.
- For recurrent genital herpes, a 2-day regimen of ACV (800 mg three times a day) can be an effective treatment option 4.
- In cases of ACV-resistant HSV2 infection, alternative treatments such as foscarnet and cidofovir can be used 3, 5, 6, 7.
Management of ACV-Resistant HSV2 Infection
- Foscarnet is a potent inhibitor of HSV DNA polymerase and can be effective in treating ACV-resistant HSV2 infection 3, 6, 7.
- Cidofovir is a nucleotide analogue that can be used to treat ACV-resistant HSV2 infection 3, 7.
- The management of ACV-resistant HSV2 infection requires a combination of antiviral agents and careful monitoring of the patient's response to treatment 3, 6, 7.
Prevention of HSV2 Resistance
- The development of resistance to ACV and other nucleoside analogues is more common in immunocompromised patients 3, 5, 7.
- The use of antiviral agents with different mechanisms of action, such as foscarnet and cidofovir, can help prevent the development of resistance 7.
- The development of new antiherpetic compounds with different mechanisms of action is needed to address the issue of resistance 7.