From the Guidelines
Genital herpes affects approximately 12.1% of the United States population aged 14–49 years, with HSV-2 causing most genital infections while HSV-1 increasingly causes new cases. Management involves both suppressive and episodic therapy approaches. For suppressive therapy, acyclovir 400mg twice daily, valacyclovir 500-1000mg once daily, or famciclovir 250mg twice daily can reduce outbreaks by 70-80% and decrease transmission risk, as noted in the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines 1.
Key Points
- The prevalence of genital herpes is significant, with 47.8% and 12.1% of the United States population aged 14–49 years seropositive for HSV-1 and HSV-2, respectively, in 2015–2016 1.
- For episodic treatment of outbreaks, options include acyclovir 400mg three times daily for 5 days, valacyclovir 1g twice daily for 3 days, or famciclovir 125mg twice daily for 5 days, ideally started within 24 hours of symptom onset.
- First episodes may require longer treatment (7-10 days) 1.
- Daily suppressive therapy is recommended for patients with frequent outbreaks (>6 per year) or those concerned about transmission to partners, as it can reduce the frequency of genital herpes recurrences by greater than or equal to 75% among patients who have frequent recurrences 1.
- These antiviral medications work by inhibiting viral DNA synthesis, preventing replication.
- Patients should also be counseled about transmission risk, which remains present even without symptoms due to asymptomatic viral shedding, and the importance of barrier protection during sexual activity.
- While herpes remains incurable, these medications effectively manage symptoms and reduce transmission risk, with the goal of improving quality of life and reducing morbidity and mortality associated with genital herpes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Prevalence of Genital Herpes
- Genital herpes is the most prevalent sexually transmitted infection in the USA 2.
- The prevalence of genital herpes is not explicitly stated in the provided studies, but it is mentioned that genital herpes is a common and distressing condition 2.
Management of Genital Herpes
- Antiviral therapy with acyclovir, valacyclovir, and famciclovir is safe and effective for the treatment of genital herpes 3, 2, 4, 5, 6.
- There are two options for the management of recurrent genital herpes: antiviral treatment of each outbreak as it arises, or suppression of outbreaks with daily oral therapy 4.
- Daily antiviral therapy with famciclovir and valacyclovir has been shown to be effective in reducing both symptomatic and asymptomatic reactivation of herpes simplex virus type 2 (HSV-2) 5.
- Valacyclovir appears to be somewhat better than famciclovir for suppression of genital herpes and associated shedding 5.
- Oral acyclovir, valacyclovir, and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes and are useful as suppressive therapy for individuals with frequent genital herpes recurrences 6.