From the Guidelines
Herpes infections can be effectively managed with antiviral medications, with the most practical treatment regimens prioritizing patient adherence and feasibility, as recommended in the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines 1. For genital herpes, the treatment options include:
- First clinical episode: oral acyclovir, famciclovir, or valacyclovir, with dosing strategies that prioritize patient adherence, such as acyclovir 400mg three times daily for 7-10 days, valacyclovir 1000mg twice daily for 7-10 days, or famciclovir 250mg three times daily for 7-10 days 1
- Episodic therapy: a shorter course of oral acyclovir, famciclovir, or valacyclovir, such as acyclovir 400mg three times daily for 5 days, valacyclovir 500mg twice daily for 5 days, or famciclovir 250mg three times daily for 5 days 1
- Suppressive therapy: daily oral acyclovir, valacyclovir, or famciclovir, such as acyclovir 400mg twice daily, valacyclovir 500mg daily, or famciclovir 250mg twice daily, which can reduce recurrences by up to 80% 1 It is essential to note that these medications work by inhibiting viral DNA replication, preventing the virus from multiplying, but they cannot cure herpes, as the virus remains dormant in nerve cells. During outbreaks, keeping the affected area clean and dry, wearing loose clothing, and avoiding sexual contact until lesions heal completely are important self-care measures. The same medication dosages and frequencies are recommended for genital HSV-1 infection as for genital HSV-2 infection, although episodic and suppressive therapy for genital HSV-1 infection have not been studied as comprehensively 1.
From the FDA Drug Label
FAMCICLOVIR tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: Immunocompetent Adult Patients • Herpes labialis (cold sores) o Treatment of recurrent episodes • Genital herpes o Treatment of recurrent episodes o Suppressive therapy of recurrent episodes • Herpes zoster (shingles) Human Immunodeficiency Virus (HIV)-Infected Adult Patients • Treatment of recurrent episodes of orolabial or genital herpes
The treatment options for Herpes (Herpes Simplex Virus) infection include:
- Famciclovir (PO): for the treatment of recurrent episodes of herpes labialis (cold sores), genital herpes, and herpes zoster (shingles) in immunocompetent adult patients, as well as for the treatment of recurrent episodes of orolabial or genital herpes in HIV-infected adult patients 2.
- Acyclovir (PO): for the treatment of genital herpes, herpes zoster (shingles), and chickenpox, although the specific dosing regimens are not directly stated in the provided text for herpes simplex virus infection 3.
From the Research
Treatment Options for Herpes Simplex Virus Infection
The treatment options for Herpes Simplex Virus (HSV) infection include:
- Antiviral therapy for symptom relief and prevention of transmission 4, 5, 6, 7, 8
- Episodic treatment of recurrent episodes 4, 5, 6, 7
- Daily suppressive therapy 4, 5, 6, 7, 8
- Treatment with acyclovir, valacyclovir, or famciclovir 4, 5, 6, 7, 8
Antiviral Medications
The following antiviral medications are used to treat HSV infection:
- Acyclovir: effective and often less expensive option 6, 8
- Valacyclovir: highly bioavailable prodrug of acyclovir, effective in suppressing recurrences and reducing transmission 4, 5
- Famciclovir: highly bioavailable prodrug of penciclovir, effective in treating genital herpes and herpes zoster 4, 5, 6
Treatment Regimens
The following treatment regimens are recommended:
- Acyclovir, 400 mg twice daily, for patients with six or more recurrences of genital herpes per year 6
- Valacyclovir, 1 g daily, for patients with six or more recurrences of genital herpes per year 6
- Famciclovir, 250 mg twice daily, for patients with six or more recurrences of genital herpes per year 6
- Daily suppressive therapy with acyclovir, valacyclovir, or famciclovir to decrease the number and severity of outbreaks 7