From the Guidelines
The first-line treatment for genital herpes type 1 is oral antiviral medication, specifically acyclovir, valacyclovir, or famciclovir. For a first episode, typical regimens include acyclovir 400 mg three times daily for 7-10 days, valacyclovir 1 gram twice daily for 7-10 days, or famciclovir 250 mg three times daily for 7-10 days, as recommended by the most recent guidelines 1. These medications work by inhibiting viral DNA replication, which helps reduce the severity and duration of symptoms, promotes faster healing of lesions, and decreases viral shedding.
Key Considerations
- Treatment should begin as soon as symptoms appear for maximum effectiveness.
- For recurrent episodes, the same medications can be used but for shorter durations (typically 3-5 days) or as suppressive therapy if outbreaks occur frequently (more than 6 times per year).
- Suppressive therapy involves taking lower daily doses continuously (e.g., acyclovir 400 mg twice daily or valacyclovir 500 mg daily) to prevent recurrences, as supported by earlier studies 1.
- Pain management with acetaminophen or ibuprofen and keeping the affected area clean and dry can help with symptom relief.
- While these medications can control symptoms, they do not cure the infection, as the virus remains dormant in nerve cells between outbreaks.
Additional Recommendations
- The use of suppressive antiviral therapy can reduce the transmission of HSV-2 to susceptible partners 1.
- Consistent use of latex condoms can also reduce the transmission of HSV-2 and other sexually transmitted pathogens.
- HIV-infected persons should specifically avoid sexual contact when their partners have overt (genital or orolabial) herpetic lesions.
From the FDA Drug Label
The median time to lesion healing was 9 days, the median time to cessation of pain was 5 days, and the median time to cessation of viral shedding was 3 days. For both treatment groups the median time to lesion healing was 9 days, the median time to cessation of pain was 5 days, and the median time to cessation of viral shedding was 3 days. The first-line treatment for genital herpes type 1 is valacyclovir (PO) 1 gram twice daily for 10 days for initial episodes, and 500 mg twice daily for 5 days for recurrent episodes 2.
- Key points:
- Initial episode: valacyclovir 1 gram twice daily for 10 days
- Recurrent episode: valacyclovir 500 mg twice daily for 5 days
- Valacyclovir can reduce the median time to lesion healing, cessation of pain, and cessation of viral shedding.
From the Research
Genital Herpes Type 1 Treatment
The first-line treatment for genital herpes type 1 includes antiviral medications. Some key points about the treatment are:
- Valacyclovir is an effective treatment for genital herpes type 1, with similar efficacy to acyclovir in episodic and suppressive treatment 3, 4.
- Famciclovir is also a well-tolerated first-line option for the treatment of genital herpes, with efficacy similar to acyclovir and valacyclovir 5.
- Antiviral therapy, including acyclovir, valacyclovir, and famciclovir, is safe and effective for symptom relief and prevention of transmission of genital herpes 6, 7.
- The choice of therapy may depend on factors such as cost, ease of dosing, and acyclovir resistance 6.
Treatment Options
Some treatment options for genital herpes type 1 include:
- Valacyclovir: 1 g twice a day for 10 days for the treatment of a first episode, and 1 g once a day for suppressive therapy 3, 4.
- Famciclovir: single-day dosage regimens for recurrent genital herpes, and single-dose regimens for orolabial herpes 5.
- Acyclovir: 200 mg five times a day for 10 days for the treatment of a first episode, and 200 mg five times a day for 5 days for recurrent episodes 4.