From the Guidelines
The recommended treatment for herpes genitalis includes antiviral medications such as acyclovir, valacyclovir, or famciclovir, which can reduce symptoms, healing time, and viral shedding, but do not cure the infection. For first episodes, the treatment options are:
- Acyclovir (400mg three times daily for 7-10 days)
- Valacyclovir (1g twice daily for 7-10 days)
- Famciclovir (250mg three times daily for 7-10 days) 1. For recurrent outbreaks, the same medications can be used at similar or slightly lower doses for a shorter duration of 3-5 days, ideally started at the first sign of symptoms. For patients with frequent recurrences (more than 6 per year), suppressive therapy may be recommended with daily acyclovir (400mg twice daily), valacyclovir (500mg daily), or famciclovir (250mg twice daily) 1. It's also important to note that daily suppressive therapy reduces the frequency of genital herpes recurrences by greater than or equal to 75% among patients who have frequent recurrences, and has been documented to be safe and effective for up to 6 years with acyclovir, and 1 year with valacyclovir and famciclovir 1. Additionally, patients with HSV infections can be treated with episodic therapy when lesions occur or with daily therapy to prevent recurrences, and the management of genital HSV-2 in HIV-infected persons should include several factors, including frequency and severity of HSV recurrences, the risk for HSV-2 transmission to susceptible partners, and the potential for interactions between HIV and HSV-2 that might result in increased HIV in plasma and genital secretions 1. Patients should also be advised to avoid sexual contact during outbreaks, consider using condoms between outbreaks, and inform sexual partners about their infection status. Pain management with acetaminophen or ibuprofen and keeping the affected area clean and dry can help with symptom relief.
From the FDA Drug Label
The recommended dosage of VALTREX for treatment of initial genital herpes is 1 gram twice daily for 10 days. Therapy was most effective when administered within 48 hours of the onset of signs and symptoms. The recommended dosage of VALTREX for treatment of recurrent genital herpes is 500 mg twice daily for 3 days Initiate treatment at the first sign or symptom of an episode.
The recommended treatment for herpes genitalis is:
- For initial genital herpes: 1 gram of valacyclovir twice daily for 10 days, with therapy most effective when administered within 48 hours of the onset of signs and symptoms.
- For recurrent genital herpes: 500 mg of valacyclovir twice daily for 3 days, with treatment initiated at the first sign or symptom of an episode 2. Alternatively, famciclovir can be used for recurrent genital herpes at a dose of 1000 mg twice daily for 1 day, with therapy initiated at the first sign or symptom of a recurrent episode 3.
From the Research
Treatment Options for Herpes Genitalis
The treatment for herpes genitalis typically involves antiviral medications. Some of the key treatment options include:
- Valaciclovir: a prodrug of aciclovir, which has been shown to be effective in suppressing genital herpes recurrences in immunocompetent individuals 4, 5
- Aciclovir: an antiviral medication that can be used to treat initial genital HSV infection, as well as recurrent episodes 6, 7
- Famciclovir: an antiviral medication that can be used to suppress recurrent genital herpes, although it may not be as effective as valacyclovir in reducing viral shedding 8
Recommended Treatment Regimens
The recommended treatment regimens for herpes genitalis vary depending on the severity and frequency of symptoms. Some of the recommended regimens include:
- Valaciclovir 500-1000 mg daily for suppression of genital herpes recurrences in immunocompetent individuals 4
- Aciclovir 200 mg 5 times daily for 5 days for initial genital HSV infection 6
- Famciclovir 250 mg twice daily for suppression of recurrent genital herpes 8
Efficacy and Safety of Treatment Options
The efficacy and safety of treatment options for herpes genitalis have been evaluated in several studies. Some of the key findings include:
- Valaciclovir has been shown to be effective in suppressing genital herpes recurrences, with a similar efficacy to aciclovir 4, 5
- Valaciclovir has been shown to be well-tolerated, with headache being the most commonly reported adverse event 4
- Famciclovir has been shown to be effective in suppressing recurrent genital herpes, although it may not be as effective as valacyclovir in reducing viral shedding 8