From the Guidelines
Antiviral medications, specifically valacyclovir, acyclovir, and famciclovir, are the primary treatment for genital herpes, and should be prioritized for their ability to control symptoms and reduce transmission risk. For first episodes of genital herpes, recommended treatments include valacyclovir 1g twice daily for 7-10 days, acyclovir 400mg three times daily for 7-10 days, or famciclovir 250mg three times daily for 7-10 days, as supported by the 2022 review of evidence for the Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines 1.
Key Considerations
- For recurrent outbreaks, shorter courses are effective: valacyclovir 500mg twice daily for 3 days, acyclovir 800mg three times daily for 2 days, or famciclovir 1g twice daily for 1 day.
- Patients with frequent recurrences (6 or more per year) may benefit from daily suppressive therapy with valacyclovir 500-1000mg once daily, acyclovir 400mg twice daily, or famciclovir 250mg twice daily, which can reduce outbreaks by up to 80% and lower transmission risk to partners, as indicated by the 1998 guidelines for treatment of sexually transmitted diseases 1.
- These medications work by inhibiting viral DNA replication, preventing the herpes simplex virus from multiplying.
- While antivirals can control symptoms and reduce transmission, they cannot cure the infection.
Additional Recommendations
- Patients should start treatment as soon as prodromal symptoms (tingling, burning) appear for maximum effectiveness.
- Patients should avoid sexual contact during outbreaks to prevent transmission.
- Adequate hydration and pain management with acetaminophen or ibuprofen can help manage symptoms during outbreaks.
From the FDA Drug Label
Acyclovir is a synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and varicella-zoster virus (VZV) The inhibitory activity of acyclovir is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded by HSV and VZV. Famciclovir is a prescription antiviral medicine used: • in adults with a normal immune system to: o treat outbreaks of cold sores o treat outbreaks of genital herpes o decrease the number of outbreaks of genital herpes o treat shingles (herpes zoster)
Antivirals for Genital Herpes:
- Acyclovir 2 and Famciclovir 3 are two antiviral medications used to treat genital herpes.
- Key Uses:
- Acyclovir: treats outbreaks of genital herpes
- Famciclovir: treats outbreaks of genital herpes, decreases the number of outbreaks of genital herpes
- Important Considerations:
- Neither medication is a cure for genital herpes
- Patients should practice safer sex to lower the chances of spreading genital herpes to others
- It is not known if these medications can stop the spread of herpes to others
From the Research
Antiviral Medications for Genital Herpes
- Acyclovir, valacyclovir, and famciclovir are commonly used antiviral medications for the treatment of genital herpes 4, 5, 6.
- These medications have been shown to be effective in reducing the severity and frequency of genital herpes outbreaks 4, 5, 7.
- Oral acyclovir, valacyclovir, and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes, and are useful as suppressive therapy for individuals with frequent genital herpes recurrences 4, 5.
Treatment Regimens
- A study found that oral acyclovir 1 g twice a day for 3 days is an effective treatment for genital herpes, with advantages of comparable healing time and convenient dosage schedule 7.
- Daily antiviral therapy with famciclovir and valacyclovir has been shown to be effective in reducing both symptomatic and asymptomatic reactivation of herpes simplex virus type 2 (HSV-2) 8.
- Valacyclovir appears to be somewhat better than famciclovir for suppression of genital herpes and associated shedding 8.
Safety and Efficacy
- The safety and efficacy of antiviral medications for genital herpes have been established in several studies 4, 5, 6, 7, 8.
- However, further research is required to clarify the safety of these agents in pregnant women with genital herpes, and the efficacy and cost-effectiveness of these agents in treating herpes zoster in people below the age of 50 years 4.