What is the recommended treatment for herpes, a sexually transmitted disease?

Treatment for Herpes Sexually Transmitted Disease

The recommended first-line treatment for genital herpes is valacyclovir 1000 mg three times daily for initial episodes, or 500 mg twice daily for recurrent episodes, with suppressive therapy of 500-1000 mg once daily for frequent recurrences. 1

Antiviral Treatment Options

Initial Episode of Genital Herpes

• First-line treatment options:
  • Valacyclovir 1000 mg orally three times daily for 7-10 days 1
  • Acyclovir 800 mg orally five times daily for 7-10 days 2
  • Famciclovir (alternative option) 3

Recurrent Episodes of Genital Herpes

• Treatment options:
  • Valacyclovir 500 mg twice daily for 3 days 1, 4
  • Acyclovir 800 mg orally three times daily for 2 days 5
  • Treatment should be initiated within 24 hours of symptom onset for maximum effectiveness 1

Suppressive Therapy

• For patients with frequent recurrences (≥6 episodes per year):
  • Valacyclovir 500-1000 mg once daily 1, 6
  • For patients with <10 recurrences per year: 500 mg once daily is effective 6
  • For patients with ≥10 recurrences per year: 1000 mg once daily is recommended 6
• Suppressive therapy reduces:
  • Frequency of outbreaks by 70-80%
  • Severity and duration of breakthrough episodes
  • Asymptomatic viral shedding 2
  • Risk of transmission to sexual partners 1

Special Considerations

Pregnant Women

• Acyclovir is the first-line treatment during pregnancy due to its established safety profile 2
• Dosage: 800 mg orally 5 times daily 2
• Treatment should be initiated within 72 hours of symptom onset 2
• Acyclovir has not been associated with increased risk of major birth defects 2, 7

Immunocompromised Patients

• May require higher doses and longer treatment duration 2
• For HIV-infected patients with CD4+ counts <200 cells/μL, higher oral doses are recommended 2
• Close monitoring for treatment response is essential 2

Severe Cases

• Intravenous acyclovir 10 mg/kg every 8 hours may be required 2
• For acyclovir-resistant infections, foscarnet 40 mg/kg IV 3 times daily is recommended 2

Treatment Timing and Follow-up

• Antiviral therapy should be initiated as soon as possible after symptom onset:
  • Within 72 hours for initial episodes 2
  • Within 24 hours for recurrent episodes 1
• Early treatment significantly reduces:
  • Duration of viral shedding
  • Time to lesion healing
  • Severity of symptoms 8
• Follow-up within 7 days is recommended to assess:
  • Treatment response
  • Complete resolution of lesions
  • Signs of complications 2

Pain Management

• For mild pain: acetaminophen or NSAIDs 2
• For moderate to severe pain: consider gabapentin, pregabalin, or tricyclic antidepressants 2
• Topical options for localized pain: lidocaine patches or 2% viscous lidocaine 2

Prevention and Patient Education

• Safer sex practices should be used even with suppressive therapy 1
• Patients should be counseled about:
  • The chronic nature of the infection
  • Potential for asymptomatic viral shedding
  • Risk of transmission to sexual partners
  • Importance of adherence to treatment regimens 4, 7

The once-daily dosing regimen of valacyclovir for suppressive therapy offers a convenient option that may improve patient adherence compared to multiple daily doses required with acyclovir 4, 6.