From the Guidelines
Herpes simplex virus (HSV) suppression therapy is recommended for individuals with frequent or severe outbreaks, typically using daily antiviral medications, with valacyclovir 500-1000mg once daily being a common first-line treatment. The goal of suppressive therapy is to reduce the frequency and severity of outbreaks, as well as decrease asymptomatic viral shedding, which can help reduce transmission risk to partners 1.
When considering treatment options, it's essential to prioritize regimens that are most feasible for patient adherence, taking into account the frequency of dosing and potential side effects 1. The same medication dosages and frequencies are recommended for both genital HSV-1 and HSV-2 infections.
Some key points to consider when implementing HSV suppression therapy include:
- Consistent daily medication use, taken at the same time each day, to optimize suppression
- Regular reassessment of treatment duration, typically after 12 months, to determine the need for ongoing therapy
- Patient education on the importance of barrier protection during sexual activity and informing partners about their HSV status, as transmission can still occur even while on suppression therapy
- Monitoring for potential side effects, such as headache, nausea, or diarrhea, which are generally minimal but can occur
According to the most recent evidence, daily suppressive therapy can reduce outbreaks by approximately 70-80% and decrease asymptomatic viral shedding by about 50% 1. This reduction in outbreaks and viral shedding can significantly improve the quality of life for individuals with frequent or severe HSV outbreaks.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Patients Suppressive Therapy: VALTREX is indicated for chronic suppressive therapy of recurrent episodes of genital herpes in immunocompetent and in HIV-1−infected adults.
The answer to HSV suppression is that valacyclovir (PO) is indicated for chronic suppressive therapy of recurrent episodes of genital herpes in immunocompetent and in HIV-1−infected adults 2.
- Key points:
- Indicated for suppressive therapy of genital herpes.
- Approved for use in immunocompetent and HIV-1−infected adults.
- The efficacy and safety of valacyclovir for the suppression of genital herpes beyond 1 year in immunocompetent patients and beyond 6 months in HIV-1−infected patients have not been established.
From the Research
Hsv Suppression
- Hsv suppression can be achieved through antiviral medications such as acyclovir, valacyclovir, and famciclovir 3, 4, 5, 6
- Daily suppressive therapy with valacyclovir has been shown to reduce the risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48% 3
- However, a study found that daily suppressive acyclovir did not decrease the risk of HSV-2 transmission to susceptible partners in African HSV-2/HIV-1-serodiscordant couples 3
- Valacyclovir has been shown to be effective in suppressing recurrent genital herpes, with a dose-response relationship observed across once-daily regimens 4
- The treatment of herpes simplex infections typically involves the use of antiviral medications, with the choice of medication and dosing regimen depending on the severity and frequency of outbreaks, as well as patient preference 5
- A review of oral antiviral therapy for prevention of genital herpes outbreaks found that acyclovir, valacyclovir, and famciclovir were all effective in reducing the risk of recurrence, but the quality of evidence was generally low due to risk of bias and inconsistency 6
- Newer treatments, such as helicase primase inhibitors (HPIs), are emerging as a promising alternative for the management of HSV infections, with high efficacy and a novel mode of action that may provide better viral suppression with a lower risk of resistance 7
Treatment Options
- Acyclovir: effective in reducing the risk of recurrence, but may have limited efficacy and be susceptible to resistance, especially in immunosuppressed populations 3, 5, 6
- Valacyclovir: effective in suppressing recurrent genital herpes, with a dose-response relationship observed across once-daily regimens 4, 6
- Famciclovir: effective in reducing the risk of recurrence, but may have a higher risk of adverse events compared to other treatments 6
- Helicase primase inhibitors (HPIs): emerging as a promising alternative for the management of HSV infections, with high efficacy and a novel mode of action that may provide better viral suppression with a lower risk of resistance 7