What is the recommended treatment for a 27-year-old male with a recurrent herpetic outbreak on the glans penis, presenting with a tender, erythematous papule?

Treatment for Recurrent Genital Herpes Outbreak

For a 27-year-old male with a recurrent genital herpes outbreak presenting as a tender, erythematous papule on the glans penis, the recommended treatment is valacyclovir 500 mg twice daily for 3 days, initiated at the first sign or symptom of the episode. 1

First-Line Treatment Options

The FDA-approved dosing for recurrent genital herpes episodes includes:

• Valacyclovir: 500 mg twice daily for 3 days 1
• Famciclovir: 125 mg twice daily for 5 days 2
• Acyclovir: 400 mg three times daily for 5-10 days 2

Treatment should be initiated at the earliest sign or symptom of an outbreak to maximize effectiveness. Early intervention significantly reduces the duration of symptoms, viral shedding, and can sometimes abort the episode entirely 3.

Treatment Selection Considerations

Valacyclovir is often preferred due to:

• Better bioavailability than acyclovir
• More convenient dosing schedule (twice daily vs. three to five times daily)
• Shorter treatment duration (3 days) compared to other options 1

While a 2-day regimen of acyclovir (800 mg three times daily) has shown efficacy in reducing lesion duration and viral shedding 3, the FDA-approved regimens should be considered first-line therapy.

Prevention of Transmission

To prevent transmission to sexual partners:

• Avoid direct contact with active lesions
• Use latex condoms during sexual activity
• Consider daily suppressive therapy if recurrences are frequent 2

Suppressive Therapy Considerations

For patients with frequent recurrences (≥6 per year), suppressive therapy may be appropriate:

• Valacyclovir: 1 gram once daily, or 500 mg once daily for those with ≤9 recurrences per year 1
• Acyclovir: 400 mg twice daily 2
• Famciclovir: 250 mg twice daily 2

Follow-up Recommendations

• Re-examination within 3-7 days to assess treatment response
• Monitor for complete resolution of lesions
• Evaluate for any complications 2

Common Pitfalls to Avoid

1. Delayed treatment initiation: Treatment is most effective when started within the first 24 hours of symptoms
2. Inadequate patient education: Patients should understand that treatment reduces symptoms but does not cure the infection
3. Failure to consider suppressive therapy: For patients with frequent recurrences, suppressive therapy can significantly improve quality of life
4. Overlooking transmission risk: Patients should be counseled that transmission can occur even in the absence of visible lesions

Remember that while antiviral therapy effectively manages symptoms, it does not eradicate latent virus, and recurrences may continue to occur after treatment is discontinued 4, 5.